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1.
BMJ ; 367: l5873, 2019 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-31672760

RESUMO

OBJECTIVE: To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. DESIGN: International cross sectional survey. SETTING: International Society of Nephrology (ISN) survey of 182 countries from July to September 2018. PARTICIPANTS: Key stakeholders identified by ISN's national and regional leaders. MAIN OUTCOME MEASURES: Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management. RESULTS: Responses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world's population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management-namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (<10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level. CONCLUSIONS: These comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy.


Assuntos
Saúde Global/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Falência Renal Crônica/terapia , Nefrologia/estatística & dados numéricos , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Transversais , Países em Desenvolvimento/estatística & dados numéricos , Humanos
2.
Rev Prat ; 69(5): 546-549, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31626465

RESUMO

This paper introduces few concepts to help clinicians to get an idea of the health systems of the migrants they care for, on a daily basis. Health systems are complex to analyze, and is an open, dynamic system, facing diverse influences from multiple levels. Recent globalization has complexified an already complex system. The paper first sets some definitions and then describes succinctly the history of international health financing. It eventually compares several countries' health systems, drawing on few health indicators. Despite significant progresses in terms of global health, the gap between countries, and, within countries between wealthier and poorer people, is increasing. This is particularly worrying while the global aim is health equity.


Assuntos
Países em Desenvolvimento , Necessidades e Demandas de Serviços de Saúde , Migrantes , Saúde Global , Humanos
5.
Rev Sci Tech ; 38(1): 135-144, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31564734

RESUMO

Infectious diseases are known to disproportionately affect the poorer sectors of society, particularly those living in low- and middle-income countries. These vulnerable populations battle disease, debt, loss of livelihood and reduced economic well-being with consequences that extend to their families, communities, livestock and the environment. A strong One Health approach is acknowledged as a successful way of enhancing current capacity for the prevention and control of emerging infectious diseases. Furthermore, it is also an effective way to address the multifaceted nuances of poverty. In recognising the interconnectedness of human and animal health with the health of our shared environment, One Health offers a valuable framework to prevent and control emerging infectious diseases through collaboration, coordination and communication across the various sectors involved. In recent years, as examples of One Health implementation have been documented and assessed, the linkages between One Health interventions and poverty alleviation have become more obvious. One Health interventions have the potential to reduce the economic burden of disease and create more efficient systems and approaches that generate higher savings, both direct and indirect, at the human-animal-environment interface. This paper describes aspects of this potential in detail. Although, at present, examples of the relationship between One Health and poverty alleviation are few, they are compelling. The authors believe that they provide persuasive evidence to encourage governments and policy-makers to employ the One Health approach in their efforts to alleviate poverty. Measuring the impact of this link between One Health and poverty alleviation has its constraints since appropriate metrics are still evolving. However, this paper hopes to establish the wisdom of recognising the role that One Health can play in reducing poverty, as well as its capacity to enhance existing policy frameworks.


Assuntos
Política de Saúde , Saúde Única , Pobreza , Animais , Controle de Doenças Transmissíveis , Países em Desenvolvimento/economia , Política de Saúde/tendências , Humanos , Gado , Pobreza/prevenção & controle
11.
Stud Health Technol Inform ; 264: 616-619, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437997

RESUMO

The Portable Health Clinic (PHC) system endeavors to take healthcare facilities along with remote doctors' consultancy to the doorsteps of the unreached people using an advanced telemedicine system. Thus, the necessity of having physical healthcare peripheries specially in the developing countries can be mitigated. The PHC system promotes preventive healthcare by encouraging regular health checkups so that diseases can be prevented as well as their severity can be mitigated, leading to a reduction on healthcare expenses. Thus, the number of patients along with excessive workload on existing healthcare human resources can be minimized. The current project in rural Bangladesh alone has served more than 41,000 people so far by the PHC system and a simple analysis of this data shows some significant findings on regional health status. A simple expansion of this program, covering a wider service area, can produce a big data to reflect the whole country's health profile.


Assuntos
Assistência à Saúde , Instituições de Assistência Ambulatorial , Bangladesh , Países em Desenvolvimento , Humanos , Telemedicina
12.
BMC Infect Dis ; 19(1): 679, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370800

RESUMO

BACKGROUND: Abnormal sexual behaviors presenting as manifestations of rabies have occasionally been reported in the literature, although little attention has been paid to these cases to date. This study aimed to analyze the clinical features of rabies cases with abnormal sexual behaviors as the presenting manifestations. CASE PRESENTATION: A case of 32-year-old man with frequent ejaculation as the initial symptom of rabies was first reported. Then, a literature review was conducted using databases including CNKI, SinoMed, VIP, Wanfang Data, ScienceDirect, ProQuest, OVID and PubMed. In addition to our case, 54 other rabies cases, with abnormal sexual behaviors as the presenting manifestations, have been reported since 1970. Among the 55 cases, 51 were male and three were female (unknown gender for one case), with ages ranging from 6 to 71 years. All cases were reported in developing countries, 46 in China. Dog bites were the major source of infection, and extremities were the main exposure sites. Overall, 46 (83.6%) cases had abnormal sexual behaviors as the initial symptoms. The major presenting manifestations were priapism and ejaculation in males and hypersexuality in females. All cases were clinically diagnosed based on medical history and clinical manifestations. Given no standardized post-exposure prophylaxis, all cases died with the survival time being between 1 and 15 days. CONCLUSIONS: The rabies patients with abnormal sexual behaviors have unique clinical features. To avoid misdiagnosis, unexplained abnormal sexual behaviors should raise clinical suspicion of rabies.


Assuntos
Mordeduras e Picadas , Raiva/diagnóstico , Raiva/etiologia , Comportamento Sexual , Adolescente , Adulto , Idoso , Animais , Mordeduras e Picadas/virologia , Criança , China , Países em Desenvolvimento , Cães , Ejaculação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
Pan Afr Med J ; 33: 71, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448033

RESUMO

The authors report the first case of successful peritoneal dialysis (PD) in a developing country performed about a 13-year-old adolescent followed-up for stage V chronic kidney disease (CKD) with anuria. After 3 months of hemodialysis, the parents opted for continuous ambulatory peritoneal dialysis (CAPD) as they wished to return home located 121km from Dakar. After PD catheter insertion, the plan proposed to the patient consisted 3-4 hours stasis of isotonic dialysate during the day and a night stasis of 8 hours of icodextrin for an injection volume of 1L per session. The patient and his mother were trained and assessed on the PD technique. After dialysis adequacy was tested while hospitalised, they were able to return home and continued the sessions following the same plan prescribed and while keeping in touch, by telephone, with the medical team. The technique assessment at the day hospital every 2 weeks revealed dialysis adequacy and satisfactory tolerance of PD at home after 04 months of observation. It was the first case of successful CAPD in the pediatrics unit in this context. Scaling this technique is a challenge for the pediatric nephrologist in developing countries like Senegal.


Assuntos
Hemodiálise no Domicílio/métodos , Diálise Peritoneal Ambulatorial Contínua/métodos , Insuficiência Renal Crônica/terapia , Adolescente , Países em Desenvolvimento , Soluções para Diálise/química , Humanos , Icodextrina/química , Masculino , Diálise Renal , Senegal
14.
Stud Health Technol Inform ; 264: 1676-1677, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438288

RESUMO

Most cases of maternal deaths could be avoided with timely access to quality healthcare, but a key challenge in addressing quality of care in maternal health is the lack of accurate data and analytics. Implementing online communities of practice is a way to resolve this, but in low-and middle-income countries this is particularly challenging. We discuss the design of the Alicanto Online Latin-American Community of Practice that focuses on both outcomes and process indicators.


Assuntos
Assistência à Saúde , Qualidade da Assistência à Saúde , Países em Desenvolvimento , América Latina
15.
J Environ Manage ; 248: 109275, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31466176

RESUMO

For most developing countries, local government faces a trade-off between economic growth and environmental protection. The intentions towards having a better environment as the economy grows will trigger a shift in the priorities of local government from economy to environment at a certain level of economic development. To investigate the "pollute first, control later" path in China and how environmental regulation performs differently due to economic development, this paper develops a conceptual model to depict the nexus between economic growth and environmental improvement. A panel threshold model is estimated based on Chinese data from different spatial scales - 30 provinces and 105 environmental monitoring cities. The results validate the threshold of economic development of approximately CNY 90,000 GDP per capita, which represents the turning point for the local government priority change; such that only when it is exceeded does environmental regulation significantly reduce emissions. Until 2016, only 4 provincial districts and 35 prefecture-level cities have crossed the threshold, these being mostly in the more prosperous eastern coastal areas. The results emphasize the need to consider timeliness when evaluating the effectiveness of environmental regulation and highlight the importance of adopting differentiated governance. Moreover, the need to enhance the effectiveness of environmental regulation requires driving the change of local government's priority to the environment and strengthening the institutional capacity of environmental protection agencies.


Assuntos
Conservação dos Recursos Naturais , Desenvolvimento Econômico , China , Cidades , Países em Desenvolvimento
16.
J Glob Health ; 9(2): 020413, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31448114

RESUMO

Background: Past studies have demonstrated how single non-communicable diseases (NCDs) affect health care utilisation and quality of life (QoL), but not how different NCD combinations interact to affect these. Our study aims to investigate the prevalence of NCD dyad and triad combinations, and the implications of different NCD dyad combinations on health care utilisation and QoL. Methods: Our study utilised cross-sectional data from the WHO SAGE study to examine the most prevalent NCD combinations in six large middle-income countries (MICs). Subjects were mostly aged 50 years and above, with a smaller proportion aged 18 to 49 years. Multivariable linear regression was applied to investigate which NCD dyads increased or decreased health care utilisation and QoL, compared with subjects with only one NCD. Results: The study included 41 557 subjects. Most prevalent NCD combinations differed by subgroups, including age, gender, income, and residence (urban vs rural). Diabetes, stroke, and depression had the largest effect on increasing mean number of outpatient visits, increasing mean number of hospitalisation days, and decreasing mean QoL scores, respectively. Out of the 36 NCD dyads in our study, thirteen, four, and five dyad combinations were associated with higher or lower mean number of outpatient visits, mean number of hospitalisations, or mean QoL scores, respectively, compared with treating separate patients with one NCD each. Dyads of depression were associated with fewer mean outpatient visits, more hospitalisations, and lower mean QoL scores, compared to patients with one NCD. Dyads of hypertension and diabetes were also associated with a reduced mean number of outpatient visits. Conclusions: Certain NCD combinations increase or decrease health care utilisation and QoL substantially more than treating separate patients with one NCD each. Health systems should consider the needs of patients with different multimorbidity patterns to effectively respond to the demands on health care utilisation and to mitigate adverse effects on QoL.


Assuntos
Países em Desenvolvimento , Multimorbidade/tendências , Doenças não Transmissíveis/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida , Adolescente , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Índia/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Federação Russa/epidemiologia , África do Sul/epidemiologia , Adulto Jovem
17.
Global Health ; 15(1): 51, 2019 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362751

RESUMO

BACKGROUND: Creating 'liveable' cities has become a priority for various sectors, including those tasked with improving population health and reducing inequities. Two-thirds of the world's population will live in cities by 2050, with the most rapid urbanisation in low- and middle-income countries (LMIC). However, there is limited guidance about what constitutes a liveable city from a LMIC perspective, with most of the evidence relating to high-income countries, such as Australia. Existing liveability frameworks include features such as public transport, affordable housing, and public open space; however, these frameworks may not capture all of the liveability considerations for cities in LMIC contexts. OBJECTIVES: This case study formed a multi-sectoral partnership between academics, policymakers (Bangkok Metropolitan Administration, Victorian (Australia) Department of Health and Human Services), and a non-government organisation (UN Global Compact - Cities Programme). This study aimed to: 1) conceptualise and prioritise components of urban liveability within the Bangkok, Thailand context; 2) identify alignment to or divergence from other existing liveability tools; and 3) identify potential indicators and data sources for use within a Pilot Bangkok Liveability Framework. METHODS: The Urban Liveability Workshop involving technical leaders from the Bangkok Metropolitan Administration and a rapid review of liveability literature informed the conceptualisation of liveability for Bangkok. The Bangkok Metropolitan Administration Working Group and key informants in Bangkok provided input into the liveability framework. Indicators identified for Bangkok were mapped onto existing liveability tools, including the UN Global Compact CityScan. RESULTS: Findings revealed commonalities with the Australian liveability definition, as well as new potential indicators for Bangkok. The resulting Pilot Bangkok Liveability Framework provides a structure for measuring liveability in Bangkok that can be implemented by the Bangkok Metropolitan Administration immediately, pending appropriate data acquisition and licensing. The Bangkok Metropolitan Administration Working Group and key informants identified core issues for implementation, including limited spatial data available at the district-level or lower. CONCLUSIONS: This study conceptualised urban liveability for Bangkok, a city in a LMIC context, with potential for adjustment to other cities. Future work should leverage opportunities for using open source data, building local capacity in spatial data expertise, and knowledge sharing between cities.


Assuntos
Planejamento de Cidades , Saúde da População Urbana , Cidades , Países em Desenvolvimento , Humanos , Tailândia
18.
Infect Dis Poverty ; 8(1): 58, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31262365

RESUMO

There was no global guidance or agreement regarding when a country has an adequate system to report on the service packages among human immunodeficiency virus (HIV) key populations. This article describes an approach to categorizing the system in a country for reporting the service package among HIV key populations. The approach consists of four dimensions, namely the epidemiological significance, comprehensiveness of the service packages, geographic coverage of services, and adequacy of the monitoring system. The proposed categorization approach utilizes available information and can inform the improvement of the service delivery and monitoring systems among HIV key populations.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Infecções por HIV/virologia , Vigilância da População , Infecções por HIV/tratamento farmacológico , Humanos
19.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(7): 724-730, 2019 Jul 06.
Artigo em Chinês | MEDLINE | ID: mdl-31288345

RESUMO

Objective: To identify post-marketing active surveillance systems for vaccine safety around the world and understand their features and mechanisms, in order to provide guidance for vaccine administration activities in China. Methods: Following the steps of scoping review, literature about active surveillance system for vaccine safety and published by 30 June 2018 were identified by searching electronic databases, including PubMed, Scopus, and Cochrane Library. Grey literature were also sought by exploring relevant websites. Identified literature were screened according to eligibility criteria, and informative data from included literature were then charted. Framework Synthesis and Thematic Analysis were performed to integrate the charted data. Results: 97 pieces of literature were included for review, and 11 active surveillance systems for vaccine safety were identified, mostly located in developed countries. These systems were constructed by 3 types of organizations: administration departments, academic or research institutions, and health care providers. Their data sources included immunization registries, electronic medical records, claims data, case reports of adverse events following immunization electronic questionnaires, and epidemiologic study data. According to their operation procedures, these systems were grouped into 4 modes of active surveillance: Data Linkage, Investigator Network, Automatic Follow-up System, Studies Consortium. Conclusion: Practice of active surveillance for vaccine safety greatly varies across countries, with different conditions and advantages. It is suggested that developing countries should choose suitable mode of active surveillance considering their local situations.


Assuntos
Vigilância de Produtos Comercializados/métodos , Vacinas/efeitos adversos , China , Países em Desenvolvimento , Humanos
20.
Accid Anal Prev ; 131: 234-238, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326614

RESUMO

Pedestrian deaths and injuries are a major health issue in both developed and developing countries. In Vietnam, pedestrians account for about 10-11% of all road traffic deaths, while their travel distance contributes to approximately 2.4% of the total distance travelled by all modes. This paper aims to explore the use of pedestrian overpasses and identify influencing factors, particularly with regards to social and digital distractions, and overpass characteristics. An observational survey was conducted in Hanoi, Vietnam, in March 2017 at ten pedestrian overpasses. Behaviours of 608 pedestrians, including those who used an overpass to cross and those who illegally crossed, were observed. The rates of overpass usage varied significantly, between 35.9% and 96.5%. Modelling results suggest that pedestrians tended to compensate for the risks of illegal crossing by forming group and avoiding digital and social distractions (i.e., calling, operating a mobile phone's screen, listening to music, or talking to other pedestrians while crossing). In addition, overpass usage decreased with taller overpasses, but increased with wider overpasses. Effects of gender, weather, and illegal crossing speed on overpass use were also discussed.


Assuntos
Acidentes de Trânsito/prevenção & controle , Ambiente Construído/estatística & dados numéricos , Telefone Celular/estatística & dados numéricos , Pedestres/psicologia , Adolescente , Adulto , Países em Desenvolvimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pedestres/estatística & dados numéricos , Análise de Regressão , Segurança , Comportamento Social , Inquéritos e Questionários , Vietnã , Adulto Jovem
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