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1.
BMJ ; 367: l6326, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31776110

RESUMO

OBJECTIVE: To determine how the UK National Health Service (NHS) is performing relative to health systems of other high income countries, given that it is facing sustained financial pressure, increasing levels of demand, and cuts to social care. DESIGN: Observational study using secondary data from key international organisations such as Eurostat and the Organization for Economic Cooperation and Development. SETTING: Healthcare systems of the UK and nine high income comparator countries: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the US. MAIN OUTCOME MEASURES: 79 indicators across seven domains: population and healthcare coverage, healthcare and social spending, structural capacity, utilisation, access to care, quality of care, and population health. RESULTS: The UK spent the least per capita on healthcare in 2017 compared with all other countries studied (UK $3825 (£2972; €3392); mean $5700), and spending was growing at slightly lower levels (0.02% of gross domestic product in the previous four years, compared with a mean of 0.07%). The UK had the lowest rates of unmet need and among the lowest numbers of doctors and nurses per capita, despite having average levels of utilisation (number of hospital admissions). The UK had slightly below average life expectancy (81.3 years compared with a mean of 81.7) and cancer survival, including breast, cervical, colon, and rectal cancer. Although several health service outcomes were poor, such as postoperative sepsis after abdominal surgery (UK 2454 per 100 000 discharges; mean 2058 per 100 000 discharges), 30 day mortality for acute myocardial infarction (UK 7.1%; mean 5.5%), and ischaemic stroke (UK 9.6%; mean 6.6%), the UK achieved lower than average rates of postoperative deep venous thrombosis after joint surgery and fewer healthcare associated infections. CONCLUSIONS: The NHS showed pockets of good performance, including in health service outcomes, but spending, patient safety, and population health were all below average to average at best. Taken together, these results suggest that if the NHS wants to achieve comparable health outcomes at a time of growing demographic pressure, it may need to spend more to increase the supply of labour and long term care and reduce the declining trend in social spending to match levels of comparator countries.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Países Desenvolvidos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde da População/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Produto Interno Bruto , Gastos em Saúde/estatística & dados numéricos , Humanos , Renda , Reino Unido
2.
Asian Pac J Cancer Prev ; 20(7): 2015-2020, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31350959

RESUMO

Background: breast cancer is the most common cause of cancer death for women worldwide. In the past two decades, published epidemiological reports in different parts of the world show significant increase in breast cancer mortality rate. The aim of this study was to determine the 25-year trend of breast cancer mortality rate in 7 super regions defined by the Health Metrics and Evaluation (IHME), i.e. Sub-Saharan Africa, North Africa and Middle East, South Asia, Southeast Asia and East Asia and Oceania, Latin America and Caribbean, Central Europe and Eastern Europe and Central Asia, High-income. Methods: Our study population consisted of 195 world countries in the IHME pre-defined seven super regions. The age-standardized mortality rates from 1990 to 2015 were extracted from the IHME site. The reference life table for calculating mortality rates was constructed based on the lowest estimated age-specific mortality rates from all locations with populations over 5 million in the 2015 iteration of GBD. To determine the trend of breast cancer mortality rate, a generalized linear mixed model was fitted separately for each IHME region and super region. Results: Statistical analysis showed a significant increase for breast cancer mortality rate in all super regions, except for High-income super region. For total world countries, the mean breast cancer mortality rate was 13.77 per 100,000 in 1990 and the overall slope of mortality rate was 0.7 per 100,000 from 1990 to 2015. The results showed that Latin America and Caribbean the highest increasing trend of breast cancer mortality rate during the years 1990 to 2015 (1.48 per 100,000). Conclusion: In general, our finding showed a significant increase in breast cancer mortality rate in the world during the past 25 years, which could be due to increase in incidence and prevalence of this cancer. Low this increasing trend is an alarm for health policy makers in all countries, especially in developing countries and low-income regions which experienced sharp slopes of breast cancer mortality rate.


Assuntos
Neoplasias da Mama/mortalidade , Bases de Dados Factuais , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Saúde Global , Mortalidade/tendências , Fatores Etários , Neoplasias da Mama/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Prognóstico , Taxa de Sobrevida , Fatores de Tempo
3.
Artigo em Inglês | MEDLINE | ID: mdl-31248074

RESUMO

China is facing challenges in caring for older adults. This paper aimed to understand knowledge, attitude, and practice (KAP) regarding the quality of caregivers for the elderly in long-term care institutions in Zhejiang Province, and also to find related factors to improve the quality of caregivers. A cross-sectional survey was conducted from April to June 2016 in Zhejiang Province. In total, 84 caregivers were interviewed face-to-face with questionnaires on KAP towards elderly care. Multiple linear regression was used to find the related factors to KAP. A conceptual model was made to process path analysis among KAP and influencing factors using structural equation modeling. The study found that most caregivers in Zhejiang Province were middle-aged, female, and with a diploma below middle school. Many caregivers had not received any pre-employment training. Their salary was low although they undertook high-intensity work. Education and working years had a positive effect on knowledge and practice scores, and pre-employment training had a positive effect on knowledge and attitude scores. Knowledge and attitude regarding elderly care could positively affect elderly care practices. The quality of caregivers in Zhejiang Province was at a low level compared to developed countries. Continuous and regular elderly care training should be provided for caregivers to improve their elderly care knowledge and hence the quality of elderly care.


Assuntos
Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Assistência de Longa Duração/psicologia , Assistência de Longa Duração/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Estudos Transversais , Países Desenvolvidos/estatística & dados numéricos , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
4.
BMC Med Educ ; 19(1): 189, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170974

RESUMO

BACKGROUND: Whether medical education research (MER) is primarily conducted in wealthy countries (in the "Realm of the Rich") is the subject of an ongoing debate. Previous studies of the geography of MER publication output have relied upon proprietary databases, have not compared MER with other fields of study, and have not studied the relationship between authorship geography and topics of study. This study was designed to evaluate the geographic distribution of MER authorship and to relate this to the topics studied in MER. METHODS: Authors' countries of affiliation were identified from PubMed records by parsing and cleaning the text of affiliations and submitting them to the google maps geocoding API. The geography of publication output in MER was compared to other fields using the chi-square goodness-of-fit test. Country income classifications and medical subject heading (MeSH) terms were used to evaluate the topical contributions of countries at different income levels, and simulation was used to compute significance of MeSH term enrichment in MER papers from low income and lower middle income countries. RESULTS: The vast majority of MER papers were contributed by authors based in high income countries. The top four countries were the United States, the United Kingdom, Canada, and Australia, with listed author affiliations in 80% of all MER papers. This percentage was greater in MER than in several other categories, including Biological Science Disciplines (48%), Medicine (69%) and Education (74%), which is a parent category of MER. Authors from low income countries contributed significantly to the topical diversity of MER. MeSH terms associated with government, community health, and health delivery were enriched in papers from low income countries, while terms associated with specialty and clinical training, technology in teaching, and professional obligations (such as workload, burnout, and empathy) were enriched in papers from high income countries. CONCLUSIONS: Geographic disparities in publication output are greater in MER than in any other field examined. The historical origins of MER in North America might explain disproportionate publication output by authors from this region. This study suggests that the MER field benefits from research contributed by authors from low income countries, and also points to potential gaps in MER (and medical education as a whole) in the developing world.


Assuntos
Educação Médica , Pesquisa , Bibliometria , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Educação Médica/métodos , Geografia , Humanos , Pesquisa/estatística & dados numéricos
5.
Public Health ; 172: 125-134, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31227270

RESUMO

BACKGROUND: Epidemic obesity poses a major threat to global health. This phenomenon reflects the inability of the average person to cope, biologically and behaviorally, with environmental contexts that promote caloric overconsumption and inadequate caloric expenditure. There is still much to be learned about how to improve these contexts nationally and within-countries for sociodemographic groups with above-average obesity risks. METHODS: Higher obesity risks relative to respective white majority populations were identified among diverse indigenous, other native-born, or migrant 'racial' or ethnic minority (hereafter, ethnic minority) populations in the United States, Canada, Australia, New Zealand, and the Netherlands, using publicly available national survey data or other sources. Cross-national comparisons were of interest for identifying common risk pathways associated with social and economic inequities. Potential explanations were explored through a narrative review of peer-reviewed literature, informed by the World Health Organization's Conceptual Framework for Action on The Social Determinants of Health. MAIN FINDINGS: Identifying viable solutions to the high risk of obesity in ethnic minority populations in these high-income countries requires examination of national-level social, economic, and health system contexts, food systems, and built environments for physical activity, as well as patterns of social stratification and cultural biases related to ethnicity, migration, and other determinants of social disadvantage. These factors can be linked to mediators of exposure or vulnerability to obesity-related risks, such as poverty, being an 'outsider', stress and trauma resulting from historical and current oppression, exposure to bias and discrimination, related biological or behavioral consequences, and inadequate health and social care. CONCLUSIONS: Focusing on ethnic minority populations in high-income countries is critical for public health efforts to address epidemic obesity. Mitigating intersecting risk pathways arising from stratification and bias based on ethnicity and migrant status should be prominent in these efforts.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Países Desenvolvidos/estatística & dados numéricos , Epidemias/prevenção & controle , Grupos Étnicos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Obesidade/etnologia , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Austrália/epidemiologia , Canadá/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Nova Zelândia/epidemiologia , Obesidade/prevenção & controle , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
6.
Nature ; 569(7755): 260-264, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31068725

RESUMO

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3-6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.


Assuntos
Índice de Massa Corporal , Estado Nutricional , Obesidade/epidemiologia , Saúde da População Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Mapeamento Geográfico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Saúde da População Urbana/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto Jovem
7.
Eur J Health Econ ; 20(Suppl 1): 79-90, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31098884

RESUMO

BACKGROUND: Health systems are undertaking efforts to make health care more patient centered and value based. To achieve this goal, the use of patient-reported experience measures (PREMs) is increasing, especially across OECD countries. However, in Hungary, data on patients' experiences are still lacking. Thus, our aim was twofold: first, to collect data on outpatient experience in Hungary on patient-doctor communication and patient involvement in decision making and compare it with that of other OECD countries; second, to assess associations of outpatient experience with patients' socioeconomic characteristics. METHODS: In early 2019, we conducted a cross-sectional, online, self-administered survey in a national representative sample of Hungary's population (n = 1000). The sample was weighted considering gender, age, highest education level attained, type of settlement, and region of residence. The survey questions were based on a set of recommended questions by the OECD. RESULTS: Our findings show that the proportion of reported positive experiences is as follows: doctors providing easy-to-understand explanations (93.1%) followed by time spent on the consultation (87.5%), opportunities to raise questions (85.8%), and doctors involving patients in decision making about care and treatment (80.1%). The share of positive experiences falls behind OECD's average regarding patient-doctor communication and patient involvement in decision making, which signals room for improvement in these areas. CONCLUSIONS: Women, younger people, people with a paid job, and patients with consultations with allied health professionals reported significant lesser positive care experiences and, hence, more targeted policies can be initiated based on our findings.


Assuntos
Assistência Ambulatorial/normas , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente/estatística & dados numéricos , Relações Médico-Paciente , Adolescente , Adulto , Fatores Etários , Idoso , Comunicação , Estudos Transversais , Países Desenvolvidos/estatística & dados numéricos , Feminino , Humanos , Hungria , Internet , Masculino , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricos , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
8.
Environ Sci Pollut Res Int ; 26(19): 19915-19929, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31093911

RESUMO

Road traffic accidents (RTAs) are accountable for 1.2 million deaths and road safety is the part of sustainable development goals, which aims to provide a safe, accessible, affordable, and sustainable transport system by 2030. This study discovered the nexus of road traffic fatalities (RTFs) with its determinants in Asia, Europe, and America. Vector error correction model established the causality of RTFs (Asia, Europe), urbanization (Asia), physicians (Asia, Europe), traffic law enforcement index (Europe, America), vehicles (America), and paved roads (America). Short-run bidirectional causality of RTFs was established with educational expenditures (Asia, Europe), GNI (Europe), and urbanization (Europe). The fall in RTFs was 0.359% (Europe) and 0.957% (America) for 1% rise in GNI. The RTFs were decreased by 0.498% (Europe) and 0.390% (America) due to 1% rise in urbanization. Education shows 0.952% reduction in RTFs in Europe. The 1% increase in the number of physicians causes 0.793% reduction in RTFs in America. The RTFs were increased by 0.617% and 1.705% for 1% rise in the number of vehicles in Asia and America. The fall in RTFs was 3.604%, 0.134%, and 0.950% for 1% rise in paved roads in Asia, Europe, and America, respectively. Results show a reduction of 0.744% (Asia), 0.712% (Europe), and 0.312% (America) in RTFs due to 1% increase in traffic law enforcement index. The governments of all countries should expand and improve their paved road network and increase the enforcement of traffic laws. The government should make strict traffic laws like regular inspection of vehicles, strict inspection for the driving license, electronic challan, and medical fitness of drivers. The government should ensure the medical checkup of drivers at subsidized rates. It is useful to include the traffic rules in the educational syllabus due to the significant role of law enforcement in road safety. The government should use different media channels for the awareness of the public about loss due to road accidents.


Assuntos
Acidentes de Trânsito/mortalidade , Países Desenvolvidos/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Europa (Continente)
9.
Econ Hum Biol ; 34: 58-73, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30975614

RESUMO

The WHO views obesity as a significant risk to population health. Evidence suggests that obesity reduces labor-market attachment, worker productivity, and earnings. This link at the micro level may translate into adverse effects on economic growth at the macro level. Few studies have evaluated how body mass index impacts economic growth across and within countries. This sparse evidence base reflects the lack of consistent data across a broad spectrum of countries and timespan, as well as the empirical difficulties in bypassing endogeneity bias relating to unobserved selection and potential reverse causality between bodyweight and GDP. We address both of these challenges by first assembling a comprehensive panel of data spanning 116 countries over 25 years (1984-2008), and then presenting, to the best of our knowledge, the first empirical study of economic growth and obesiy correcting for endogeneity. Our GMM estimates indicate that, in developed countries, a higher level of BMI has direct negative effects on economic growth in a fully saturated model that controls for levels of human capital. In particular, we predict that the increase in BMI over the time period of analysis may have reduced potential economic growth over this period by between 3.5-5.8 percentage points.


Assuntos
Índice de Massa Corporal , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Desenvolvimento Econômico/estatística & dados numéricos , Produto Interno Bruto/estatística & dados numéricos , Obesidade/epidemiologia , Adulto , Idoso , Feminino , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Política , Fatores Socioeconômicos , Adulto Jovem
10.
J Obstet Gynaecol Res ; 45(6): 1091-1095, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30977214

RESUMO

AIM: To clarify the status of minimally invasive gynecologic surgery (MIGS) in the Asia/Oceania region. METHODS: Survey questionnaires were sent out to the representative of AOFOG countries. They consisted of questions on the general status of MIGS, the clinical indication of MIGS, cost coverage, company support, training and certification for MIGS, patient preference for MIGS and requirements for the AOFOG. RESULTS: Developmental stage of MIGS in this region was roughly divided into three categories: fully developed countries, countries in the developmental stage and countries in the rudimentary stage. Clinical indication of MIGS and training opportunity of young doctors were correlated with the developmental stage. CONCLUSION: Support by AOFOG should be considered according to the developmental stage of each country. Collecting updated information on MIGS in each member country is important to provide adequate support.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Procedimentos Cirúrgicos Minimamente Invasivos , Sociedades Médicas , Ásia , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Procedimentos Cirúrgicos em Ginecologia/economia , Procedimentos Cirúrgicos em Ginecologia/educação , Procedimentos Cirúrgicos em Ginecologia/normas , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/economia , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Oceania , Sociedades Médicas/normas , Sociedades Médicas/estatística & dados numéricos
11.
Science ; 363(6432): 1182-1186, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30872518

RESUMO

Each year ~429,000 children and adolescents aged 0 to 19 years are expected to develop cancer. Five-year survival rates exceed 80% for the 45,000 children with cancer in high-income countries (HICs) but are less than 30% for the 384,000 children in lower-middle-income countries (LMICs). Improved survival rates in HICs have been achieved through multidisciplinary care and research, with treatment regimens using mostly generic medicines and optimized risk stratification. Children's outcomes in LMICs can be improved through global collaborative partnerships that help local leaders adapt effective treatments to local resources and clinical needs, as well as address common problems such as delayed diagnosis and treatment abandonment. Together, these approaches may bring within reach the global survival target recently set by the World Health Organization: 60% survival for all children with cancer by 2030.


Assuntos
Saúde Global , Neoplasias , Adolescente , Adulto , Criança , Pré-Escolar , Diagnóstico Tardio/efeitos adversos , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Desenvolvimento de Medicamentos , Recursos em Saúde , Acesso aos Serviços de Saúde , Humanos , Incidência , Lactente , Recém-Nascido , Neoplasias/diagnóstico , Neoplasias/mortalidade , Neoplasias/terapia , Organização Mundial da Saúde , Adulto Jovem
13.
J Occup Health ; 61(3): 213-218, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30851057

RESUMO

OBJECTIVES: Industrial advances, as a result of globalization, causes many threats to the working life. These threats are generally associated with the level of economic development of countries. While threats from industrialization are decreasing in developed countries, developing countries are still faced with these threats. Therefore, this study aims to examine the relationship between fatal work accidents (FWA), and independent variables which are national income (NI) and employment rate (ER) in a number of selected countries. METHODS: In this study the relationship between FWA and independent variables which are NI and ER of 18 developed and developing countries and a region, between 2006 and 2015, was analyzed by applying panel data analysis. RESULTS: According to panel data analysis, whilst a 1% increase in the NI reduces the FWA rate by 1.1%, a 1% increase in the ER results in an increase of approximately 4% in the rate of FWA. CONCLUSIONS: As a result, there was a negative relationship between the FWA and NI growth and a positive relationship with the ER.


Assuntos
Acidentes de Trabalho/mortalidade , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Emprego/estatística & dados numéricos , Renda/estatística & dados numéricos , Humanos
16.
Am J Obstet Gynecol ; 221(3): 208-218, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30716286

RESUMO

OBJECTIVE DATA: The objective of this study was to evaluate the prevalence of placenta accreta spectrum in general population studies and the main maternal outcomes at delivery. STUDY: We searched PubMed, Google Scholar, clinicalTrials.gov, and MEDLINE between 1982 and 2018. Articles that provided data on the number of cases of placenta accreta spectrum per pregnancies, births, or deliveries in a defined population were used. STUDY APPRAISAL AND SYNTHESIS METHODS: Study characteristics were evaluated by 2 independent reviewers who used a predesigned protocol. Primary outcomes were the prevalence of placenta accreta spectrum and clinical diagnostic data at birth; the pathologic criteria were used to confirm the diagnosis. Secondary outcomes included cases that required transfusion, incidence of peripartum hysterectomy, and maternal mortality rates. Heterogeneity between studies was analyzed with the Cochran's Q-test and the I2 statistics. RESULTS: Of the 98 full-text studies that were identified, 29 articles met the defined criteria and included 22 retrospective and 7 prospective studies comprising 7001 cases of placenta accreta spectrum of 5,719,992 births. Prevalence rates ranged from 0.01-1.1% with an overall pooled prevalence of 0.17% (95% confidence interval, 0.14-0.19). Only 10 studies provided detailed histopathologic data. The pool prevalence for the adherent vs the invasive grades was 0.5 (95% confidence interval, 0.3-0.36) and 0.3 (95% confidence interval, 0.2-0.4) per 1000 births, respectively. The pooled incidence for peripartum hysterectomy was 52.2% (95% confidence interval, 38.3-66.4; I2=99.8%) and 46.9% (95 % confidence interval, 34-59.9; I2=98.8%) for hemorrhage that required transfusion. The pooled estimate of maternal death was 0.05% (95% confidence interval, 0.06-0.69; I2=73%). We found large amounts of heterogeneity between studies for all parameters and further quantification was limited because of methodologic inconsistencies between studies with regards to clinical criteria that were used for the diagnosis of the condition at birth and the histopathologic confirmation of the diagnosis and differential diagnosis between adherent and invasive accreta placentation. CONCLUSION: This meta-analysis indicated wide variation between studies for the prevalence rate of placenta accreta spectrum and for the different grades of accreta placentation that highlighted the need for consistency in definitions that are used to describe placenta accreta spectrum at birth and in the reporting of this increasing common obstetric complication.


Assuntos
Placenta Acreta/epidemiologia , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Saúde Global/estatística & dados numéricos , Humanos , Placenta Acreta/diagnóstico , Placenta Acreta/terapia , Gravidez , Resultado da Gravidez , Prevalência , Prognóstico , Estudos Retrospectivos
17.
Leg Med (Tokyo) ; 37: 67-75, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30716583

RESUMO

PURPOSE: The objective of this study was to illustrate the global research productivity and tendency of forensic anthropology in recent ten years (2008-2017) by bibliometric analysis. METHODS: "Forensic anthropology" was used as the Medical Subject Headings term and topic in PubMed and Web of Science Core Collection. RESULTS: As 5130 articles retrieved, two independent investigators evaluated all of them respectively. After restricting the published year, excluding duplicated and irrelevant articles, 1663 articles were available. The total of 219 countries and regions contributed to this research and the United States was the most productive country. There were 201 peer-reviewed journals including all of articles and two of them were identified as core journals according to Bradford's law. Eight of the top 10 productive authors were from developed countries. The top 10 cited articles were published by authors from developed countries with half in the United States. Sex estimation and age estimation were the most popular topics. CONCLUSIONS: With the basic and recognized methodology administered in this study, it provided a relative broad view to evaluate the scientific research capacity of forensic anthropology and reveal the worldwide tendency in this field.


Assuntos
Bases de Dados Bibliográficas/estatística & dados numéricos , Bases de Dados Bibliográficas/tendências , Antropologia Forense/estatística & dados numéricos , Antropologia Forense/tendências , Pesquisa/estatística & dados numéricos , Pesquisa/tendências , Determinação da Idade pelo Esqueleto/métodos , Determinação da Idade pelo Esqueleto/estatística & dados numéricos , Países Desenvolvidos/estatística & dados numéricos , Feminino , Humanos , Masculino , Análise para Determinação do Sexo/métodos , Análise para Determinação do Sexo/estatística & dados numéricos , Fatores de Tempo , Estados Unidos/epidemiologia
18.
Global Health ; 15(1): 9, 2019 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-30683119

RESUMO

BACKGROUND: China, which used to be an export country for migrants, has become a new destination for international migrants due to its rapid economic growth. However, little empirical data is available on the health status of and health service access barriers faced by these international migrants. METHODS: Foreigners who visited the Guangzhou Municipal Exit-Entry Administration Office to extend their visas were invited to participate in the study. Quantitative data were collected using electronic questionnaire in 13 languages. The participants were characterised by the income level of their country of origin (high-, middle- and low-income countries (HICs, MICs and LICs, respectively)), and the key factors associated with their health status, medical insurance coverage and perceptions of health services in China were examined. RESULTS: Overall, 1146 participants from 119 countries participated in the study, 57.1, 25.1 and 17.8% of whom were from MICs, HICs and LICs, respectively. Over one fifth of the participants experienced health problems while staying in China, and about half had no health insurance. Although the participants from HICs were more likely than those from MICs and LICs to have medical insurance, they were also more likely to have health problems. Furthermore, 43.0, 45.0 and 12.0% of the participants thought that the health services in China were good, fair and poor, respectively. Among the participants, those from HICs were less likely to have positive feedback. CONCLUSIONS: Our study is the first to report a quantitative survey of the health status, health insurance coverage, and health service perceptions of a diverse and surging population of international migrants in China. The findings call for more in-depth studies on the challenges presented by the increasing global migration to the health system.


Assuntos
Atitude Frente a Saúde , Nível de Saúde , Migrantes/psicologia , Migrantes/estatística & dados numéricos , Adulto , China , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
20.
Clin Nephrol ; 91(3): 155-161, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30663975

RESUMO

This review of 3,289 native kidney biopsies over the past four decades in Singapore documents the changing pattern of biopsy-proven glomerulonephritis (GN)from that of a third world country to that of a developed nation. In the 1st decade, mesangial proliferative GN was the most common form of primary GN, similar to the Asian region. In the 2nd decade, the percentage of mesangial proliferative GN decreased, but membranous GN became more common, as was seen in China and Thailand. In the 3rd decade, focal segmental glomerulosclerosis (FSGS) and membranous nephropathy continued to rise, but it was only recently, in the 4th decade, that FSGS prevalence increased dramatically, although membranous nephropathy continues to increase in some Asian countries. In the last decade in Singapore, Malaysia, and Japan, prevalence of IgA nephritis has decreased but remains the most common GN. The percentage of FSGS continues to increase in many countries like in Italy, United States of America, United Kingdom, China, and Malaysia. We surmise that socioeconomic factors play significant roles in the evolution of the renal biopsy pattern.
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Assuntos
Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Glomerulonefrite/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Glomerulonefrite/patologia , Glomerulonefrite Membranoproliferativa/epidemiologia , Glomerulonefrite Membranoproliferativa/patologia , Glomerulonefrite Membranosa/epidemiologia , Glomerulonefrite Membranosa/patologia , Glomerulosclerose Segmentar e Focal/epidemiologia , Glomerulosclerose Segmentar e Focal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Singapura/epidemiologia , Fatores Socioeconômicos , Fatores de Tempo , Adulto Jovem
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