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2.
Medicine (Baltimore) ; 98(39): e17330, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574869

RESUMO

The aim of this study was to investigate the experiences of medical transportation of Korean travelers who suffered accidents abroad and then transferred home by our aeromedical team.We collected demographic and clinical data on patients injured while traveling abroad from January 2013 to July 2017. Descriptive analyses based on 4 different transportation methods and transport time since hospitalization were performed.A total of 33 patients were repatriated during the study period. Of these, 28 (84.8%) were trauma cases with pedestrian injuries being the most common (11 cases; 39.3%). Twenty patients were repatriated by flight-stretchers, 6 by flight-prestige, 2 by ship, and 5 by air ambulance. The air ambulance was the most expensive (average 61,124 US Dollars) mode of transportation (P = .001) and the ship took the longest time (14 hours) to transport patients back to Korea from regions with similar distance (P = .0023).We experienced medical repatriation of 33 seriously injured Korean travelers back to South Korea. Transfer time should be an important considering factor and directly contacting and communicating with the specialized staff of foreign hospitals could also be very important to reduce unnecessary overseas hospital stay and cost incidence.


Assuntos
Transporte de Pacientes , Viagem/estatística & dados numéricos , Ferimentos e Lesões , Acidentes/economia , Acidentes/estatística & dados numéricos , Adulto , Resgate Aéreo , Feminino , Humanos , Incidência , Seguro Saúde , Internacionalidade , Masculino , República da Coreia , Macas (Leitos) , Transporte de Pacientes/economia , Transporte de Pacientes/métodos , Transporte de Pacientes/estatística & dados numéricos , Ferimentos e Lesões/economia , Ferimentos e Lesões/epidemiologia
3.
Soins Pediatr Pueric ; 40(310): 34-38, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31543233

RESUMO

Most children adopted in a foreign country present somatic disorders, which can have an impact on the construction of the bond with the adoptive parents. This potential complication must be taken into account in the adoption procedure and during the post-adoption follow-up, taking on board the trauma of everyone involved.


Assuntos
Adoção , Internacionalidade , Pais/psicologia , Transtornos Somatoformes/psicologia , Criança , Humanos , Relações Pais-Filho
5.
Isr Med Assoc J ; 21(8): 565-567, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474024

RESUMO

BACKGROUND: Global trends, such as the population aging, the increase of chronic morbidity, soaring costs of healthcare services, and work overload in hospitals raise the need to find innovative solutions for providing quality medical services. One solution adopted by healthcare systems around the world is "home hospitalization," that is, providing an array of necessary health services in the patient's home, instead of in the hospital department. The aim of this focus article is to explore the spread of home hospitalization worldwide and examine the challenges and pathways for its adoption and implementation. Many countries, including the United States, Canada, the United Kingdom, and Australia, operate home-based hospitalization programs. In Israel, the service is in its infancy, but in view of the extreme workload and the high mortality rate from infections in acute care hospitals, home hospitalization has recently gained public interest and political support, which may encourage its further development.


Assuntos
Serviços de Assistência Domiciliar , Hospitais , Austrália , Canadá , Humanos , Internacionalidade , Israel , Reino Unido , Estados Unidos
7.
Am J Bioeth ; 19(9): 60-62, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31419196
8.
An Acad Bras Cienc ; 91(supp 3): e20190236, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365610

RESUMO

To understand the increasingly tenuous relationship between ourselves and the finite resource base upon which we depend for all sustenance, an exploration of recent history and basic human behavior is warranted. An attempt is made to shed light on how short-term economic demands have come to take priority over nearly all other long-term aspects of our existence. Without full recognition of our historical and cultural trajectories in relation to the modern mass mentality of materialism, consumerism and wealth, there is little possibility to develop or implement truly functional strategies that can be utilized indefinitely.


Assuntos
Saúde Ambiental , Internacionalidade , Recursos Naturais , Valores Sociais , Humanos
9.
World J Microbiol Biotechnol ; 35(9): 139, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451943

RESUMO

Exploitation of microbes, especially fungi, has the potential to help humankind meet the UN's sustainable development goals, help feed the worlds growing population and improve bioeconomies of poorer nations. The majority of the world's fungal genetic resources are held in collections in developed countries, primarily within the USA, Europe and Japan. Very little capacity exists in low to middle income countries, which are often rich in biodiversity but lack resources to be able to conserve and exploit their own microbial resources. In this paper we review the current challenges facing culture collections and the challenges of integrating new approaches, the worth of collaborative networks, and the importance of technology, taxonomy and data handling. We address the need to underpin research and development in developing countries through the need to build 'in country' infrastructure to address these challenges, whilst tackling the global challenges to meet the requirements of the research community through the impacts of legislation and the Nagoya protocol on access to biological resources.


Assuntos
Fungos , Desenvolvimento Sustentável/tendências , Biodiversidade , Bases de Dados Genéticas , Fungos/classificação , Fungos/genética , Fungos/isolamento & purificação , Fungos/fisiologia , Disseminação de Informação , Internacionalidade
10.
Artigo em Alemão | MEDLINE | ID: mdl-31420718

RESUMO

In 2014/2015 West Africa suffered an Ebola virus disease (EVD) outbreak of unprecedented unknown severity. The outbreak affected mostly Liberia, Sierra Leone and Guinea, and for the first time spread to major cities, some of which have international airports. Worldwide, 28,652 cases were registered, 11,325 of which were fatal. A few cases were confirmed outside the main outbreak countries. Three EVD patients and one person with a needle-stick injury were evacuated to Germany and treated or kept under observation there. One of the patients died.In this article, the course of the outbreak and the international response are addressed. Epidemiological data and important political developments in connection with the EVD outbreak are summarized.The outbreak started in December 2013 in Guinea. It reached its peak from September to December 2014. On 8 August 2014, the World Health Organization (WHO) declared a public health emergency of international concern (PHEIC). The General Assembly of the United Nations (UN) established on 19 September 2014 the UN Mission for Ebola Emergency Response (UNMEER). On the same day, the German government pledged more financial aid and other support, such as the establishment of an air bridge, the construction of treatment centres and training.Up until April 2016, there were repeated local outbreaks. On 29 March 2016 WHO declared that the PHEIC had ended. On 28 April 2016 the outbreak was finally over.


Assuntos
Surtos de Doenças , Doença pelo Vírus Ebola/terapia , África Ocidental/epidemiologia , Surtos de Doenças/prevenção & controle , Alemanha , Guiné/epidemiologia , Doença pelo Vírus Ebola/epidemiologia , Humanos , Internacionalidade , Serra Leoa/epidemiologia
11.
Implement Sci ; 14(1): 71, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288828

RESUMO

BACKGROUND: Evidence-based clinical practice guidelines (CPGs) are relevant sources for generating quality indicators (QIs). The objective of this study was to compare guideline-based QIs of German and international CPGs and their underlying methodological approaches. METHODS: We conducted systematic searches in the guideline databases of G-I-N (Guidelines International Network) and NGC (National Guideline Clearinghouse) between February and June 2017 to identify international CPGs matching the topics of German evidence-based CPGs (n = 35) that report QIs, which were identified in a preceding study. Additionally, we searched the websites of the particular CPG providers for separate documents with regard to QIs. We included evidence-based CPGs which report QIs. Reported QIs, the underlying guideline recommendations, and information on methods of development were extracted. The selection and extraction of CPGs were conducted by one reviewer and checked by another. For each matched pair of CPGs, we assessed whether the suggested QIs matched or were not directly comparable. RESULTS: Twenty-five international CPGs, originating from seven CPG providers in total, met the criteria for inclusion. They matched the topics of 18 German CPGs. This resulted in 30 CPG pairs for the comparison of QIs (some of the international CPGs matched the topic of more than one German CPG). We found 27 QI pairs with QIs "not different or slightly different", corresponding to 13% (27 of 212) of the QIs in German CPGs and 16% (27 of 166) in international CPGs. Only two QI pairs were judged to be "different/inconsistent". For 183 of 212 (86%) QIs from German CPGs and 137 of 166 (83%) QIs from international CPGs, no direct comparison could be made. An explicit link to one or more guideline recommendations was found for 136 of 152 (89%) QIs from German CPGs and 82 of 166 (49%) QIs from international CPGs. Some information on methods for the development of QIs existed for 12 of 18 (67%) German CPGs and 8 of 25 (32%) international CPGs. CONCLUSIONS: The majority of QIs in German and international CPGs were not comparable. Various reasons for this are conceivable. More transparent reporting of the underlying methods for generating guideline-based QIs is needed.


Assuntos
Assistência à Saúde/normas , Guias de Prática Clínica como Assunto/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Bases de Dados Factuais , Alemanha , Humanos , Internacionalidade
12.
Global Health ; 15(1): 43, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262312

RESUMO

BACKGROUND: Non-communicable diseases (NCDs)-chronic human health problems such as cardiovascular diseases linked to poor diets-are significant challenges for sustainable development and human health. The international livestock trade increases accessibility to cheap animal products that may expand diet-related NCDs worldwide. However, it is not well understood how the complex interconnections among livestock production, trade, and consumption affect NCD risks around the world. METHOD: Our global dataset included 33 livestock products (meat, offal, and animal fats) in 156 countries from 1992 to 2011. We employed path analysis to uncover how livestock trade contributes to diet-related NCDs and identify underlying environmental and socioeconomic factors of livestock trade. Then we performed trend analyses to investigate long-term changes in livestock production and trade at a country level. RESULTS: We found that livestock consumption through livestock import increased diet-related NCD risks. This was especially true in developing countries, which in general were not well prepared in terms of policies for NCD risk reduction, and where there was a lack of funding to implement the policies. Population size and income level were the main factors affecting global livestock import activities. CONCLUSIONS: Our results suggest that new governance structures to incorporate separate international efforts, improved national policies, and bolstering individual efforts are needed to decrease NCD risks, particularly in developing countries.


Assuntos
Comércio , Internacionalidade , Gado , Doenças não Transmissíveis/epidemiologia , Animais , Doenças Cardiovasculares/epidemiologia , Países em Desenvolvimento , Dieta/efeitos adversos , Humanos , Fatores Socioeconômicos
13.
BMJ ; 366: l4416, 2019 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-31358508

RESUMO

OBJECTIVES: To evaluate the association between experience in the management of acute pulmonary embolism, reflected by hospital case volume, and mortality. DESIGN: Multinational population based cohort study using data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry between 1 January 2001 and 31 August 2018. SETTING: 353 hospitals in 16 countries. PARTICIPANTS: 39 257 consecutive patients with confirmed diagnosis of acute symptomatic pulmonary embolism. MAIN OUTCOME MEASURE: Pulmonary embolism related mortality within 30 days after diagnosis of the condition. RESULTS: Patients with acute symptomatic pulmonary embolism admitted to high volume hospitals (>40 pulmonary embolisms per year) had a higher burden of comorbidities. A significant inverse association was seen between annual hospital volume and pulmonary embolism related mortality. Admission to hospitals in the highest quarter (that is, >40 pulmonary embolisms per year) was associated with a 44% reduction in the adjusted odds of pulmonary embolism related mortality at 30 days compared with admission to hospitals in the lowest quarter (<15 pulmonary embolisms per year; adjusted risk 1.3% v 2.3%; adjusted odds ratio 0.56 (95% confidence interval 0.33 to 0.95); P=0.03). Results were consistent in all sensitivity analyses. All cause mortality at 30 days was not significantly reduced between the two quarters (adjusted odds ratio 0.78 (0.50 to 1.22); P=0.28). Survivors showed little change in the odds of recurrent venous thromboembolism (odds ratio 0.76 (0.49 to 1.19)) or major bleeding (1.07 (0.77 to 1.47)) between the low and high volume hospitals. CONCLUSIONS: In patients with acute symptomatic pulmonary embolism, admission to high volume hospitals was associated with significant reductions in adjusted pulmonary embolism related mortality at 30 days. These findings could have implications for management strategies.


Assuntos
Hemorragia/epidemiologia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Embolia Pulmonar/mortalidade , Tromboembolia Venosa/epidemiologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/terapia , Recidiva , Sistema de Registros , Resultado do Tratamento
14.
Am Surg ; 85(6): 563-566, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267894

RESUMO

Since their development in 1908, surgical staplers have been used as a method of "mechanical suturing" in efforts to divide hollow viscera and create anastomoses in an efficient and sterile manner. The concept for the surgical stapler was first developed by Humér Hultl, a Hungarian professor and surgeon, and designed by Victor Fischer, a Hungarian businessman and designer of surgical instruments. The design was highly acclaimed; however, it was bulky, cumbersome, and expensive to manufacture. In 1920, Aladár Petz, a student of Hultl, incorporated two innovations to the Fischer-Hultl stapler to create a more lightweight model, which was named the Petz clamp. In 1934, Friedrich of Ulm designed what would be the predecessor to the modern-day linear stapler. In the 1950s, Russian and American staplers began to emerge. Throughout the 1960s, a variety of stapling instruments were developed in the United States, manufactured by the United States Surgical Corporation. In the 1970s, Johnson & Johnson Ethicon brand joined the market. The United States Surgical Corporation was later bought by Tyco Healthcare and became Covidien in 2007. Through the collaboration of Felicien Steichen, Mark Ravitch, and Leon Hirsch, surgical staplers were further modified to incorporate interchangeable cartridges with various designs. With the advent of minimally invasive surgery began production of laparoscopic surgical staplers. Since its inception, the surgical stapler has provided a means to efficiently create safe and effective visceral and vascular anastomoses. The surgical stapler design continues to evolve while still maintaining the basic principles that were implemented in the original design.


Assuntos
Desenho de Equipamento/história , Grampeadores Cirúrgicos/história , Grampeamento Cirúrgico/história , Segurança de Equipamentos , História do Século XX , Humanos , Hungria , Internacionalidade , Procedimentos Cirúrgicos Minimamente Invasivos/história , Federação Russa , Estados Unidos
15.
J Environ Manage ; 248: 109290, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31357152

RESUMO

This paper addresses the claim that environmental policies stimulate domestic economies. The claim is parsed into two sequential parts: the effect of policies on innovation and the effect of that innovation on resulting manufacturing production. Each of these activities -- innovation and manufacturing -- can either take place at home or abroad, and where they take place determines the consequences for the domestic economy. The empirical evidence is based on measures of policy, patent activity, and trade in the renewable energy sector of 31 OECD countries between 1988 and 2003. The results from regression analysis suggest that renewable energy policies have had some success in stimulating domestic economies. While renewable energy policies are associated with little domestic innovation outside of Germany, Japan, and the United States, they do boost the adoption of foreign technologies overall. In turn, when patenting occurs the results detect an increase in manufacturing production of renewable energy technologies as well as a rise of the country's international competitiveness through exports.


Assuntos
Política Ambiental , Energia Renovável , Alemanha , Internacionalidade , Japão
17.
Khirurgiia (Mosk) ; (5): 120-127, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169829

RESUMO

During 2012-2018 in the Russian Federation, pursuant to Presidential Decree No. 599 of 05.07.2012, a set of state support measures was implemented aimed at increasing the specific gravity of Russian publications indexed in international databases. The national project 'Science' (NPS) designed to realize the goals set by Presidential Decree No.204 of 05.07.2018 'On the National Goals and Strategic Tasks for Development of the Russian Federation until 2024' continues and develops the theme of increasing the publication activity of the Russian Federation in the internationalized space. One of the six NPS targets is 'The place of the Russian Federation in terms of specific gravity in the total number of articles in areas defined by the priorities of scientific and technological development in publications indexed in international databases'. The purpose of this study was to evaluate the basic value of this indicator for biomedical disciplines related to the priority direction (paragraph 20c) of the Strategy for Scientific and Technological Development of the Russian Federation. We compared volumes of publication flows of the Russian Federation in 20 biomedical disciplines with a similar indicator of countries ranked fifth in the number of publications on the subject area under consideration, indexed in the Web of Science Core Collection (WoS CC). A 5-10 fold lag of the Russian Federation was recorded for the most part of the priority areas in the field of biomedicine identified by the NTS passport. The impact of public policy measures aimed at increasing the national biomedical publication stream for the period of 2012-2018 was estimated as insufficient to meet the considered NTS target.


Assuntos
Pesquisa Biomédica/estatística & dados numéricos , Tecnologia Biomédica/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Política Pública , Editoração/estatística & dados numéricos , Pesquisa Biomédica/normas , Tecnologia Biomédica/normas , Internacionalidade , Política Pública/legislação & jurisprudência , Política Pública/tendências , Editoração/normas , Federação Russa
18.
Dis Colon Rectum ; 62(7): 794-801, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31188179

RESUMO

BACKGROUND: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision. OBJECTIVE: This study aimed to obtain data from the transanal total mesorectal excision registries to identify trends and potential risk factors for carbon dioxide embolus specific to this surgical technique. DESIGN: Contributors to both the LOREC and OSTRiCh transanal total mesorectal excision registries were invited to report their incidence of carbon dioxide embolus. Case report forms were collected detailing the patient-specific and technical factors of each event. SETTINGS: The study was conducted at the collaborating centers from the international transanal total mesorectal excision registries. MAIN OUTCOME MEASURES: Characteristics and outcomes of patients with carbon dioxide embolus associated with transanal mesorectal excision were measured. RESULTS: Twenty-five cases were reported. The incidence of carbon dioxide embolus during transanal total mesorectal excision is estimated to be ≈0.4% (25/6375 cases). A fall in end tidal carbon dioxide was noted as the initial feature in 22 cases, with 13 (52%) developing signs of hemodynamic compromise. All of the events occurred in the transanal component of dissection, with mean (range) insufflation pressures of 15 mm Hg (12-20 mm Hg). Patients were predominantly (68%) in a Trendelenburg position, between 30° and 45°. Venous bleeding was reported in 20 cases at the time of carbon dioxide embolus, with periprostatic veins documented as the most common site (40%). After carbon dioxide embolus, 84% of cases were completed after hemodynamic stabilization. Two patients required cardiopulmonary resuscitation because of cardiovascular collapse. There were no deaths. LIMITATIONS: This is a retrospective study surveying reported outcomes by surgeons and anesthetists. CONCLUSIONS: Surgeons undertaking transanal total mesorectal excision must be aware of the possibility of carbon dioxide embolus and its potential risk factors, including venous bleeding (wrong plane surgery), high insufflation pressures, and patient positioning. Prompt recognition and management can limit the clinical impact of such events. See Video Abstract at http://links.lww.com/DCR/A961.


Assuntos
Embolia Aérea/etiologia , Hemorragia/complicações , Insuflação/efeitos adversos , Complicações Intraoperatórias/etiologia , Reto/cirurgia , Cirurgia Endoscópica Transanal/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Dióxido de Carbono , Embolia Aérea/diagnóstico , Embolia Aérea/terapia , Feminino , Humanos , Insuflação/métodos , Internacionalidade , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Cuidados Pós-Operatórios , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Veias
19.
Environ Sci Pollut Res Int ; 26(23): 23689-23695, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31203539

RESUMO

This study aims to investigate the validity of pollution haven hypothesis for the period from 1982 to 2013 in ten newly industrialized countries. For this purpose, we examine the relationship between real income, foreign direct investment, energy consumption, and ecological footprint using second-generation panel data methodology to take into account the cross-sectional dependence among newly industrialized countries. In doing so, the possible nonlinear relationship between foreign direct investment and environmental degradation is also searched. The results show that increased energy consumption and economic growth lead to increase in ecological footprint. Moreover, the U-shaped relationship between foreign direct investment and ecological footprint is confirmed in newly industrialized countries.


Assuntos
Países Desenvolvidos , Poluição Ambiental/economia , Conservação dos Recursos Naturais/economia , Estudos Transversais , Ecologia , Desenvolvimento Econômico , Poluição Ambiental/estatística & dados numéricos , Renda , Internacionalidade , Investimentos em Saúde
20.
MMWR Morb Mortal Wkly Rep ; 68(23): 524-528, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31194721

RESUMO

INTRODUCTION: Each year, rabies causes approximately 59,000 deaths worldwide, including approximately two deaths in the United States. Before 1960, dogs were a common reservoir of rabies in the United States; however, increasingly, species of wildlife (e.g., bats, raccoons) are the main reservoirs. This report characterizes human rabies deaths, summarizes trends in rabies mortality, and highlights current rabies risks in the United States. METHODS: Rabies trends in the United States during 1938-2018 were analyzed using national rabies surveillance data. Data from the Healthcare Cost and Utilization Project for 2006-2014 were used to estimate the number of postexposure prophylaxis (PEP) visits per 100,000 persons during 2017-2018. The Centers for Medicare & Medicaid Services' average sales price data were used to estimate PEP costs. RESULTS: From 1960 to 2018, a total of 125 human rabies cases were reported in the United States; 36 (28%) were attributed to dog bites during international travel. Among the 89 infections acquired in the United States, 62 (70%) were attributed to bats. In 2018, approximately 55,000 persons sought PEP after contact with a potentially rabid animal. CONCLUSIONS AND COMMENTS: In the United States, wildlife rabies, especially in bats, continues to pose a risk to humans. Travelers also might be exposed to canine rabies in countries where the disease is still present; increased awareness of rabies while traveling abroad is needed. Vaccinating pets, avoiding contact with wildlife, and seeking medical care if one is bitten or scratched by an animal are the most effective ways to prevent rabies. Understanding the need for timely administration of PEP to prevent death is critical.


Assuntos
Exposição Ambiental/estatística & dados numéricos , Vigilância da População , Raiva/mortalidade , Animais , Mordeduras e Picadas , Quirópteros/virologia , Doenças do Cão/virologia , Cães , Humanos , Internacionalidade , Mortalidade/tendências , Profilaxia Pós-Exposição , Raiva/prevenção & controle , Raiva/transmissão , Raiva/veterinária , Fatores de Risco , Doença Relacionada a Viagens , Estados Unidos/epidemiologia
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