Primer registro de procedimientos de intervencionismo cardiovascular pediátrico realizados en un laboratorio estatal de hemodinamia pediátrica en El Salvador / First record of pediatric cardiovascular interventional procedures performed in a state pediatric catheterization laboratory in El Salvador

Resumen Objetivo: Describir los tipos de cateterismo cardiaco que se realizan en el único laboratorio de hemodinamia pediátrica dentro de la red de salud pública de El Salvador, en colaboración con organizaciones sin fines de lucro. Material y método: Se realizó un estudio descriptivo retrospectivo de corte transversal en el periodo entre mayo de 2022 a enero de 2023, revisando los expedientes de todos los pacientes que pasaron a cateterismo cardiaco. Resultados: Se realizaron 54 procedimientos dentro de la sala de hemodinamia, 37 pacientes de sexo femenino. El peso fue de 20.6 ± 14.5 kg, de los procedimientos, 47 (87%) fueron terapéuticos y 7 (13%) diagnósticos. La oclusión del conducto arterioso se realizó en el 46% de los pacientes. No se reportaron complicaciones, los pacientes fueron dados de alta luego de 12 horas, todos los insumos fueron donados por fundaciones sin fines de lucro. Conclusiones: Nuestro laboratorio de hemodinamia realiza procedimientos de complejidad variada sin reportar hasta el momento complicaciones mayores. Nos vemos limitados debido al costo alto de algunos dispositivos, a la baja frecuencia de la utilización de estos y a la imposibilidad para adquirirlos en el mercado nacional.

Abstract Objective: To describe the types of cardiac catheterization that are performed in the only pediatric catheterization laboratory within the public health network of El Salvador, in collaboration with non-profit organizations. Material and method: A descriptive, retrospective, cross-sectional study was conducted in the period from May 2022 to January 2023, reviewing the records of all patients who underwent cardiac catheterization. Results: 54 procedures were performed in the catheterization room, 37 female patients. The weight was 20.6 ± 14.5 kg, of the procedures, 47 (87%) were therapeutic and 7 (13%) diagnostic. Occlusion of the ductus arteriosus was performed in 46% of the patients. No complications were reported, the patients were discharged after 12 hours, all supplies were donated by non-profit foundations. Conclusions: Our catheterization laboratory performs procedures of varied complexity without reporting any major complications to date. We are limited due to the high cost of some devices, the low frequency of their use and the impossibility of acquiring them in the national market.

A Study On Impact Of Goods And Service Tax On Small Traders With Reference Mysuru District, Karnataka

The study investigates the impact of Goods and Services Taxes on small businesses. Tax policies have such a big impact on the economy in terms of both efficiencies and equity. For Indian government small traders and medium traders are one of the pillars. Here small traders can fill the registration through online itself. In VAT the tax payment where differed from state to state in some states we have earn 10 lakhs we should pay VAT but for some states if its 5 lakhs itself we need to pay VAT. So it leads to confusion and its not much effective. So compare to that in GST we have one nation one tax. So that small and medium traders can go anywhere and can expand there revenue and business anywhere in India. This study is based on both primary data and secondary data. For collecting of primary data from sample respondents used structured questionnaire. Statistical tools like Garrett ranking method and chi-squre test, ANOVA are used for analysis of data

Research on the Value Implications of Ethics Education of Science and Technology in Medical Colleges and Universities / 中国医学伦理学

In the new era, with the accelerated evolution of the information technology revolution and industrial transformation, scientific and technological innovation not only brings dividends and benefits to the world, but also brings serious challenges to human beings. To effectively cope with ethical challenges and avoid ethical risks effectively, systematically carrying out ethics education of science and technology in accordance with the times and circumstances to cultivate medical students’ upward and forward-looking ethics of science and technology for medical colleges and universities is necessary, feasible, scientific, and sustainable. Ethics education of science and technology in medical colleges and universities should take the guidance of respecting and seeking truth, adhere to the development concept of righteousness and innovation, take the red line and bottom line as the core action points, and regard the equal importance of the country and the people as the values adherence.

Mechanical demands and pacing profile adopted by elite mountain bikers during different cross-country events / Demandas mecânicas e perfil de ritmo adotado por ciclistas de montanha de elite durante diferentes eventos do cross-country

ABSTRACT Different competitive environments appears to affect the physical demands during the sports competitions. Thus, the aim of this study was to report the mechanical demand and pacing behaviour of twelve male elite mountain bikers on cross-country short track (XCC) and cross-country Olympic (XCO). During both competition, total race time, speed, power output (PO) and cadence (CA) were recorded. As the race time in the XCC is shorter (21.0 ± 0.5 vs 84.0 ± 3.0 min; p<0.01), the average speed (26.6 ± 0.6 vs 17.8 ± 0.6 km/h; p<0.01), PO (365.0 ± 26.7 vs 301.0 ± 26.2 watts; p<0.01) and CA (81.2 ± 4.7 vs 77.4 ± 4.3 rev∙min−1; p=0.01) were higher than the XCO. While a variable pacing was adopted during XCC, a positive profile was adopted in XCO. In addition, athletes adopted a more conservative starting pace during XCC (below average race speed) but a faster start during XCO (above average race speed). These findings demonstrated that mechanical parameters and pacing profile adopted by cyclists are different between XCC and XCO. Therefore, mountain bikers and coaches must develop specific strategy and training methods in order to obtain success in each competition.

RESUMO Diferentes ambientes competitivos parecem afetar as demandas físicas durante as competições esportivas. Assim, o objetivo deste estudo foi reportar as demandas mecânicas e o comportamento do pacing de doze homens ciclistas de montanha da categoria elite durante o cross-country de pista curta (XCC) e o cross-country Olímpico (XCO). Durante ambas as competições, o tempo total de corrida, velocidade, potência (PO) e cadência (CA) foram gravados. Como o tempo de prova do XCC é menor (21,0±0,5 vs 84,0±3,0 min; p<0,01), a velocidade média (26,6±0,6 vs 17,8±0,6 km/h; p<0,01), PO (365,0±26,7 vs 301,0±26,2 watts; p<0,01) e CA (81,2±4,7 vs 77,4±4,3 rev∙min−1; p=0,01) foram maiores que no XCO. Enquanto um ritmo variável foi adotado no XCC, um perfil positivo foi adotado no XCO. Além disso, os atletas adotaram um ritmo inicial mais conservador durante o XCC (abaixo da velocidade média da prova), mas um início mais rápido durante o XCO (velocidade acima da média da prova). Esses achados demonstraram que os parâmetros mecânicos e o ritmo adotados pelos ciclistas são diferentes entre o XCC e XCO. Portanto, ciclistas e treinadores devem desenvolver estratégias e métodos de treinamento específicos para obter sucesso em cada competição.

Monitoring progress on antimicrobial resistance response in the WHO African Region: insights from the TrACSS 2021. Results for the Human Health Sector

Background: Antimicrobial resistance (AMR) is a major 21st Century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan (GAP). Objective: The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. Methods: This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Results: Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. 15 (37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for huBackground: Antimicrobial resistance (AMR) is a major 21st Century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan (GAP). Objective: The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. Methods: This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Results: Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. 15 (37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for Background: Antimicrobial resistance (AMR) is a major 21st Century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan (GAP). Objective: The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. Methods: This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Results: Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. 15 (37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for human health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Conclusion: Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanism sin the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical. human health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Conclusion: Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanisms in the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical. man health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Conclusion: Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanisms in the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical.

Ethiopian Health Extension Workers' Training Status and Perceived Competency

BACKGROUND: Training and work experience are critical inputs for delivering quality health services. However, no nationwide assessment has been conducted on the status of training and the competency of Health Extension Workers (HEWs). Therefore, this study aimed to assess HEWs' pre service training status and perceived competency in Ethiopia. METHODS: The study was conducted in all regions and all HEWs training institutions in Ethiopia. We used cross sectional study design with a mixed method approach that included 585 HEWs, 1,245 HEW trainees, 192 instructors, and 43 key informants. Descriptive statistics and thematic analysis were used to analyse quantitative and quantitative data respectively. RESULT: Twenty-six percent of the HEWs said that they were competent to deliver all the HEP activities, and 73% of the HEWs said that they could confidently deliver 75% of the HEP activities. Receiving in-service training and having level III/IV qualifications are positively associated with the competency of HEWs. Similarly, HEP trainees perceived themselves as highly competent in executing their professional work, except in using computer and mobile health technology. Both instructors and trainees rated the quality of the curriculum and course materials positively. However, basic services and facilities in most training institutions were perceived to be inadequate. Additionally, individual learning, problem-solving, case-analysis, and assessment methods such as project work and portfolios were rarely practiced. CONCLUSIONS: Although the perceived competence of HEW trainees is high, the HEWs' training is not provided as per the curriculum because of limited resources. All the necessary resources should be made available to produce competent HEWs

Use of sirolimus and sclerotherapy for lymphatic malformations in a developing country: a case series / Uso de sirolimus y escleroterapia para malformaciones linfáticas en un país en vías de desarrollo: una serie de casos

Las malformaciones linfáticas y su manejo no han sido bien descritas en República Dominicana. Es por ello, que el objetivo de este artículo es la presentación de tres casos, con diferentes patrones y necesidades de tratamiento, de modo que sirva como referencia para trabajadores de la salud en países en vías de desarrollo.

Lymphatic malformations and its management are not well described in the Dominican Republic. That is why this article's objective is to present 3 cases, with different patterns and treatment needs, so it will work as a reference for healthcare workers in developing countries.

Cucumber mosaic virus: Global genome comparison and beyond

Aims@#The cucumber mosaic virus (CMV) is categorized under the genus Cucumovirus and family Bromoviridae. This virus is known to infect over 1200 plant species from 100 families, including ornamental and horticultural plants. In this study, we pioneered a global genome comparison to decipher the unknown orchestrators behind the virulence and pathogenicity of CMV via the discovery of important single nucleotide polymorphic markers.@*Methodology and results@#As a result, the genome size was found to be a potential preliminary country-specific marker for South Korea and the GC content can be utilized to preliminarily differentiate Turkey isolates from the others. The motif analysis as well as whole genome and coat protein phylogenetic trees were unable to form country-specific clusters. However, the coat protein haplotype analysis had successfully unconcealed country-specific single nucleotide polymorphic markers for Iran, Turkey and Japan isolates. Moreover, coat protein modelling and gene ontology prediction depicted high conservation across CMV isolates from different countries.@*Conclusion, significance and impact of study@#The country-specific single nucleotide polymorphic markers unearthed in this study may provide significant data towards the profiling of varying virulence and pathogenicity of CMV across the globe in time to combat the yield loss driven by this virus thru the most efficacious biological control measures in the future.

O universo do futebol, a seleção brasileira e a nação: reflexões sobre a ascensão e queda da "pátria de chuteiras" / The universe of football, the Brazilian National team, and the nation: reflections on the rise and fall of the "country in soccer shoes" / El universo del fútbol, la selección brasileña y la nación: reflexiones sobre el ascenso y la caída de la "patria de botines"

Introdução: As reflexões de Arno Vogel no livro Universo do futebol, são primordiais para entendermos os significados das derrotas e conquistas da seleção brasileira em copas do mundo. A derrota em 1950 e o tricampeonato em 1970 foram sentidas como derrota e vitória de projetos de nação. A seleção gerava sentimentos antagônicos de tragédia e carnaval, de pessimismo e ufanismo. Objetivos: Neste artigo dissertaremos sobre o esmaecimento da equação futebol-nação a partir dos anos 1990. O período das Copas de 1994 a 2002 é primordial, já que a seleção conseguiu um feito inédito de participar de três finais consecutivas, tendo vencido duas e se consagrado pentacampeã do mundo. Outro momento relevante é o mundial de 2014, realizado no brasil, ocasião em que a seleção perdeu de 7 a 1 para a equipe da Alemanha nas semifinais, bem como a Copa de 2018. Metodologia: O corpus da análise é composto por material coletado nos jornais de circulação nacional O Globo e Folha de São Paulo sobre a participação da seleção brasileira masculina de futebol em Copas do Mundo dos jornais. Considerações provisórias: As narrativas jornalísticas já não tratam o futebol como metonímia da nação. As conquistas de 1994 e de 2002 e a derrota na final de 1998, não transcenderam o universo esportivo. A derrota por 7 a 1 para a Alemanha em 2014 gerou memes, que evidenciavam que a identidade nacional não tinha sido afetada. Em 2018, a eliminação para a Bélgica gerou narrativas de ordem técnica.

Introduction: Arno Vogel's reflections in the book Universo do Futebol are essential to understand the meaning of the defeats and victories of the Brazilian national team in the World Cups. The defeat of 1950 and the three-time championship of 1970 were felt like defeat and victory of national projects. The national team generated antagonistic feelings of tragedy and carnival, of pessimism and exacerbated patriotism. Objectives: In this article, we will talk about the fading of the soccer-nation equation starting in the 1990s. The period of the World Cups from 1994 to 2002 is pivotal, as the team achieved an unprecedented feat by participating in three finals consecutive, having won two and became five-time world champion. Another relevant moment is the 2014 World Cup, hosted in Brazil, when the team lost 7-1 to the German team in the semi-finals, as well as the 2018 World Cup. Methodology: The corpus of the analysis consists of material collected in the newspapers O Globo and Folha de São Paulo on the participation of the Brazilian national team in the World Cups. Temporary Considerations: journalistic narratives no longer treat soccer as a metonym of the nation. The achievements of 1994 and 2002 and the defeat in the 1998 final did not transcend the sports universe. The 7-1 loss to Germany in 2014 generated memes that showed that the national identity had not been affected. In 2018, the elimination against Belgium generated narratives of a technical nature.

Introducción: Las reflexiones de Arno Vogel en el libro Universo do Futebol son fundamentales para que entendamos el significado de las derrotas y conquistas de la selección brasileña de fútbol en los mundiales. La derrota de 1950 y el tricampeonato de 1970 se sintieron como derrota y victoria de proyectos nacionales. La selección generaba sentimientos antagónicos de tragedia y carnaval, de pesimismo y patriotismo exacerbado. Objetivos: En este artículo, hablaremos sobre el desvanecimiento de la ecuación fútbol-nación a partir de la década de 1990. El período de los Mundiales de 1994 a 2002 es fundamental, ya que el equipo logró una hazaña sin precedentes al participar en tres finales consecutivas, habiendo ganado dos y se consagró pentacampeón del mundo. Otro momento relevante es el Mundial de 2014, organizado en Brasil, cuando el equipo perdió por 7-1 ante la selección alemana en las semifinales, así como el Mundial de 2018. Metodología: El corpus del análisis consiste en material recolectado en los periódicos O Globo y Folha de São Paulo sobre la participación de la selección brasileña de fútbol en los Mundiales. Consideraciones provisorias: las narrativas periodísticas ya no tratan al fútbol como metonimia de la nación. Los logros de 1994 y 2002 y la derrota en la final de 1998 no trascendieron el universo deportivo. La derrota por 7-1 ante Alemania en 2014 generó memes que demostraron que la identidad nacional no había sido afectada. En 2018, la eliminación ante Bélgica generó narrativas de carácter técnico.

Consequences of COVID-19 on access and delivery of mental health care in two rural Ethiopian districts. A mixed method study

Introduction: The impact of COVID-19 on people with Severe Mental Health Conditions (SMHCs) has been neglected. We aimed to describe the effect and explore the consequences of COVID-19 on people with SMHCs and mental health services in rural districts of Ethiopia. Methods: We conducted a mixed-method study nested within well-characterized population cohorts in Butajira and Sodo districts. We sampled 336 people (168 people with SMHCs, 168 comparisons) in a cross-sectional survey. We conducted qualitative key informant interviews with psychiatric nurses (n=3), primary health care workers (n=3), service users (n=4), family members (n=6) and community members (n=2). We assessed wellbeing (WHO wellbeing index), social support (Oslo social support scale; OSS) and food security quantitatively and used thematic analysis to explore impacts. Results: People with SMHCs reported significantly lower wellbeing (WHO wellbeing score 52 vs. 72; p<0.001), less social support (OSS score 8.68 vs. 9.29; p<0.001), worse living standards (47.0% vs. 29.0%; p<0.001) and increased food insecurity (26.0% vs. 12.5%; p<0.001). Household economic status worsened for over one-third of participants. Participants reported increased relapse, exacerbated stigma due to perceived susceptibility of people with SMHCs to COVID-19, and increased restraint. In mental healthcare settings, there was decreased patient flow but an increase in new cases. Innovations included flexible dispensing of medicines, longer appointment intervals and establishing new treatment centers. Conclusions: COVID-19 had negative consequences on people with SMHCs and mental health services, which must be anticipated and prevented in any future humanitarian crisis. Adaptive responses used during COVID may increase health system resilience

Effect of COVID-19 on older adults 50 years and above living with HIV in a less-developed country

Introduction: Globally, control measures have been communicated to reverse the COVID-19 pandemic. In Uganda, as soon as the first case of COVID-19 was identified, strict lockdown measures were enforced, including a ban on all public and private transport, night curfew, closure of schools, and suspension of religious and social gatherings and closure of non-essential shops and markets. These measures affected access to health services, which could have been worse for older people living with HIV (PLHIV). In this study, we explored how COVID-19 affected the health and social life of older PLHIV. Methods: We conducted a qualitative study in HIV clinics of two hospitals in Uganda. We completed 40 in-depth interviews with adults above 50 years who had lived with HIV for more than 10 years. The interviews explored the effect of COVID-19 on their health and social life during the lockdown. We analysed data thematically. Results: The overarching themes regarding the effects of COVID-19 on older adults living with HIV were fear and anxiety during the lockdown, lack of access to health care leading to missing HIV clinic appointments and not taking their ART medicines, financial burden, loss of loved ones, and effect on children's education. Some patients overcame health-related challenges by sending motorcycles to their health facilities with their identifying documents to get the medicines refilled. Some health care providers took the ART medicines to their patients' homes. Conclusion: The COVID-19 lockdown negatively affected the health and social well-being of older PLHIV. This calls for strategies to improve HIV care and treatment access during the lockdown to sustain the HIV program gains in this vulnerable population.

Establishing communities of practice to improve health policy, systems and reproductive, maternal, newborn, child and adolescent health in West Africa

Objectives: To explore and analyse factors that facilitate and inhibit the initiation and functioning of a national and transnational Community of Practice (CoP) for health policy and systems (HPS) and Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) in West Africa and to identify lessons for CoP interventions in similar multilingual low and middle-income contexts. Design: A case study, with the case defined as processes, enablers and barriers to the initiation and functioning of a national and transnational CoP for HSP and RMNCAH in West Africa and drawing on a review and analysis of secondary data from the program, workshop, country team and project reports, and training sessions. Setting: The Economic Community of West African States (ECOWAS). Participants: Professionals from two Anglophone (Ghana and Sierra Leone) and four Francophone (Burkina Faso, Cote d'Ivoire, Niger e Senegal) ECOWAS countries. Interventions: Training and mentoring of multi-disciplinary country teams supported by small research grants to undertake formative evaluation and advocacy of priority HPS and RMNCAH issues; support for CoP development within and across country teams. Results: The desire to learn from peers and mentors was a major enabler of the process. Human and financial resource availability, competing demands for time, communication in the context of a Francophone-Anglophone official language divide and the arrival of COVID-19 were all constraints. Conclusions: This study highlights the processes, achievements, and challenges of establishing country-level and transnational CoPs in West Africa. CoPs require sustained human and financial resource investments, communication and medium-to-long-term implementation support for sustainability and impact.

A review of teleradiology in Africa ­ Towards mobile teleradiology in Nigeria

eHealth is promoted as a means to strengthen health systems and facilitate universal health coverage. Sub-components (e.g. telehealth, telemedicine, mhealth) are seen as mitigators of healthcare provider shortages and poor rural and remote access. Teleradiology (including mobile teleradiology), widespread in developed nations, is uncommon in developing nations. Decision- and policy-makers require evidence to inform their decisions regarding implementation of mobile teleradiology in Nigeria and other subSaharan countries. To gather evidence, Scopus and PubMed were searched using defined search strings (September 2020). Duplicates were removed, and titles and abstracts reviewed using specified selection criteria. Full-text papers of selected resources were retrieved and reviewed against the criteria. Insight from included studies was charted for eight a priori categories of information: needs assessment, implementation, connectivity, evaluation, costing, image display, image capture and concordance. Fifty-seven articles were identified, duplicates removed and titles and abstracts of remaining articles reviewed against study criteria. Twenty-six papers remained. After review of full-texts, ten met the study criteria. These were summarised, and key insights for the eight categories were charted. Few papers have been published on teleradiology in sub-Saharan Africa. Teleradiology, including mobile teleradiology, is feasible in sub-Saharan Africa for routine X-ray support of patients and healthcare providers in rural and remote locations. Former technical issues (image quality, transmission speed, image compression) have been largely obviated through the high-speed, high-resolution digital imaging and network transmission capabilities of contemporary smartphones and mobile networks, where accessible. Comprehensive studies within the region are needed to guide the widespread introduction of mobile teleradiology.

Complex social gradient in life expectancy in Costa Rica: an ecological study with 24-Million person-years follow-up / Complejo gradiente socioeconómico en esperanza de vida en Costa Rica: un estudio ecológico con seguimiento de 24 millones de personas-año

ABSTRACT: The knowledge of Costa Rica's situation regarding the social gradient in mortality is still incomplete. National Electoral Rolls, which included all adult Costa Rican citizens were used. The event was death between 2010 and 2018. The exhaustive final sample included 2,747,616 people for 23,985,602 person-years of follow-up. An ecological study at the electoral district level was performed. A negative social gradient was observed in men and in women, in particular in urban area. A protective effect of rural areas compared to urban areas was revealed in men, but not in women. As a result, in men, the poorest districts of mixed/rural areas had similar life expectancy than the richest districts in urban areas. These results partially contradicted the international literature on socioeconomic inequalities. It demonstrates the importance of studying contexts other than high-income countries to better understand the social inequalities in health worldwide.

RESUMEN: El conocimiento sobre la distribución del gradiente social de la mortalidad en Costa Rica aún no ha sido totalmente comprendido y nuevos estudios pueden confirmar o refutar lo que anteriormente se ha observado. Se utilizaron las listas electorales nacionales, que incluían a todos los ciudadanos costarricenses adultos. El evento fue la muerte entre 2010 y 2018. Siendo la muestra exhaustiva final de 2.747.616 personas para 23.985.602 personas-año de seguimiento. Se realizó un estudio ecológico a nivel de distrito electoral, para caracterizar la situación socioeconómica de cada uno. Se observó un gradiente social negativo en hombres y mujeres, en particular en el área urbana. Se observó un efecto protector de las áreas rurales en comparación con las áreas urbanas en los hombres, pero no en las mujeres. Como resultado, en los hombres, los distritos más pobres de las áreas mixtas/rurales tenían una esperanza de vida similar a la de los distritos más ricos de las áreas urbanas. Estos resultados contradicen parcialmente la literatura internacional sobre las inequidades socioeconómicas en mortalidad. Demuestra la importancia de estudiar contextos distintos a los de los países de ingresos altos para comprender mejor las desigualdades sociales en salud en todo el mundo.

Cumplimiento de Gobierno Corporativo: un Análisis para Empresas Familiares y no Familiares Colombianas / Corporate Governance Compliance: an Analysis for Colombian Family and Non-Family Businesses / Conformidade com a Governança Corporativa: uma Análise para Empresas Familiares e não Familiares na Colômbia

Resumen Introducción. Recientemente el estudio del gobierno corporativo en las empresas familiares ha recibido mayor atención debido al predominio, la importancia y el impacto de estas empresas y a los problemas de agencia que por su estructura se presentan. En este sentido, el gobierno corporativo puede ayudar a las empresas familiares a monitorear eficientemente la gestión para reducir comportamientos oportunistas tanto de los gerentes como de aquellos accionistas que controlan la empresa. Objetivo. Estudiar la relación que se presenta entre el carácter familiar y la adopción de prácticas de gobierno corporativo en empresas listadas en el mercado de valores de Colombia. Materiales y métodos. Se realizó un análisis cuantitativo con datos de panel. Los modelos de regresión fueron estimados mediante efectos aleatorios para tratar la heterogeneidad no observable y las variables omitidas. La muestra correspondió a 479 observaciones-año de 124 empresas listadas en el mercado de valores de Colombia entre 2015 y 2018. Resultados. Se encontró un menor cumplimiento en cuanto a gobierno corporativo en las empresas familiares. Conclusión. El menor cumplimiento en las empresas familiares puede deberse a que estas empresas tienen menores incentivos para implementar buenas prácticas de gobierno corporativo dado que los costos de dicha implementación superan a los posibles beneficios, sumado a que estos beneficios terminan diluyéndose entre todos los accionistas que hacen parte de la familia.

Abstract Introduction. Recently, the study of corporate governance in family businesses has received greater attention due to the prevalence, importance, and impact of these companies and the agency problems that arise due to their structure. In this sense, corporate governance can help family businesses efficiently monitor management to reduce opportunistic behaviors both from managers and those shareholders who control the company. Objective. Study the relationship between family nature and the adoption of corporate governance practices in companies listed on the Colombian stock market. Materials and Methods. A quantitative analysis was performed with panel data. Regression models were estimated using random effects to deal with unobservable heterogeneity and omitted variables. The sample corresponded to 479 observations-year of 124 companies listed in the Colombian stock market between 2015 and 2018. Results. Lower compliance with corporate governance was found in family businesses. Conclusion. The lower compliance in family businesses may be since these companies have fewer incentives to implement good corporate governance practices given that the costs of such implementation exceed the possible benefits, added to the fact that these benefits end up being diluted among all the shareholders that are part of the family.

Resumo Introdução. Recentemente, o estudo da governança corporativa em empresas familiares tem recebido maior atenção devido à prevalência, importância e impacto dessas empresas e dos problemas de agência que surgem devido à sua estrutura. Nesse sentido, a governança corporativa pode ajudar as empresas familiares a monitorar de forma eficiente a gestão para reduzir comportamentos oportunistas tanto dos administradores quanto dos acionistas que controlam a empresa. Objetivo. Estudar a relação entre o caráter familiar e a adoção de práticas de governança corporativa em empresas listadas na bolsa de valores colombiana. Materiais e métodos. Uma análise quantitativa foi realizada com dados em painel. Modelos de regressão foram estimados usando efeitos aleatórios para lidar com heterogeneidade não observável e variáveis omitidas. A amostra correspondeu a 479 observações anuais de 124 empresas listadas na bolsa de valores colombiana entre 2015 e 2018. Resultados. Observou-se menor conformidade com a governança corporativa nas empresas familiares. Conclusão. A menor conformidade em empresas familiares pode ser devido ao fato de essas empresas terem menos incentivos para implementar boas práticas de governança corporativa tendo em vista que os custos dessa implantação superam os possíveis benefícios, somado ao fato de que esses benefícios acabam se diluindo entre todos os acionistas que fazem parte da família.

Predominant low Hematopoietic Cell Transplantation Specific Comorbidity Index (HCT-CI) score in a Mexican referral center: a selection bias caused by limited-resources?

Abstract Introduction: To date, many studies have validated the Hematopoietic Cell Transplantation Specific Comorbidity Index (HCT-CI) scoring system in allogeneic hematopoietic stem cell transplantation (allo-HSCT), but studies from developing countries remain scarce. Objective: The aim of this study was to evaluate and categorize Mexican patients using the HCT-CI at a referral center. Methods: One hundred and nineteen consecutive patients undergoing allo-HSCT at the National Institute of Medical Sciences and Nutrition in Mexico City were included. Patients were classified according to the HCT-CI scores. Results: The median age was 31 years and most were males (56%). Most patients had hematological malignancies (73%) and a low HCT-CI score (72%). The non-relapse mortality and survival were predicted according to the score. Conclusions: This is one of the few studies to evaluate the HCT-CI in adults with HLA-matched donors in a developing country and our findings suggest that the high percentage of patients with a low HCT-CI scores, contrary to international reports, could be explained by different comorbidities and demographics, but mainly due to stricter filters applied to HSCT candidates and consequently, a potential selection bias caused by limited resources.

Prevalence of Dental Caries Among Costa Rican Male Students Aged 12-22 Years Using ICDAS-II / Prevalencia de caries en varones costarricenses escolarizados de 12 a 22 años utilizando ICDAS-II

ABSTRACT: Objective: Dental decay is a public health challenge in Low- and Middle- Income Countries, particularly for young people, often confronted to healthcare access barriers. The aim of this study was to determine the prevalence and severity of dental caries among young male students in Costa Rica. Study design: A cross-sectional study was performed in 428 Costa Rican male students aged 12-22 years, who attended a nonprofit social welfare boarding school in 2019. A clinical examination was ran by three calibrated examiners following the International Caries Detection and Assessment System (ICDAS-II). Results: Caries prevalence was estimated at 83%, 15% have lost a tooth due to dental decay, 61% have at least one filled tooth, 36% have at least one filled and decayed tooth. The most frequent caries lesions were codes 2-Inactive (46.7%) and code 1-Inactive (23.8%). DMFT indicated a mean index using ICDAS-II 1-6>0 codes of 7.89. Using ICDAS-II 3-6>0 as threshold, the index decreases to 3.94. Finally, the lower and upper first permanent molars were found to be the most affected teeth. Conclusions: Dental caries experience represents a significant public health burden in young people, requiring better access to public dental healthcare.

RESUMEN: Objetivo: La caries dental continúa siendo uno de los grandes desafíos de salud pública en los países de ingresos bajos y medios, en particular para los jóvenes, que a menudo se enfrentan a barreras de acceso a la atención médica y odontológica. El objetivo de este estudio es determinar la prevalencia y severidad de la caries dental entre jóvenes estudiantes varones en Costa Rica. Diseño del estudio: se realizó un estudio transversal con 428 estudiantes varones costarricenses de entre 12 y 22 años, que asistieron a un internado de asistencia social sin fines de lucro llamado Ciudad de los Niños en 2019. Tres examinadores calibrados realizaron un examen clínico siguiendo el Sistema Internacional de Detección y Evaluación de Caries. (ICDAS-II). Resultados: La prevalencia de caries se estimó en 83%, el 15% ha perdido un diente debido a caries dental, el 61% tiene al menos un diente obturado, el 36% tiene al menos un diente obturado y con caries. Las lesiones de caries más frecuentes fueron los códigos 2-Inactivo (46,7%) y el código 1-Inactivo (23,8%). CPOD indicó un índice medio utilizando códigos ICDAS-II 1-6>0 de 7,89. Usando ICDAS-II 3-6>0 como umbral, el índice disminuye a 3,94. Finalmente, los primeros molares permanentes inferiores y superiores resultaron ser los dientes más afectados. Conclusiones: La experiencia de la caries dental representa una carga de salud pública significativa en los jóvenes, que requiere un mejor acceso a la atención médica dental pública.

Practice of medical care and rescue Amne Machin extreme cross-country challenge / 中华危重病急救医学

Objective:To share the practice of medical care and rescue in the 2017-2019 Amne Machin extreme cross-country challenge.Methods:At the invitation of the Organizing Committee of Amne Machin extreme cross-country challenge of Maqin County of Qinghai Province. More than 150 medical personnel were sent to make the rescue plan and implement the medical security for three consecutive years. The support was divided into leading command group, expert consulting group, on-site medical support group, rear medical support group, and medical material support group. The on-site medical support group was equipped with the ambulance, corresponding emergency medical equipments and medicines to provide medical support at eight medical stations from the starting point to the endpoint and along the route between each station.Results:There were no cardiac arrest and sudden death cases during the three competitions. A total of 56 patients (5 cases of combined injuries) were received, including 21 cases of mild altitude reaction, 8 cases of abrasions, 13 cases of muscle spasm and strain, 11 cases of hypoglycemia, and 3 cases of abdominal pain. All the injured were treated and observed in time. Each patient achieved a complete remission.Conclusions:To achieve the success of medical security of the highest average altitude cross-country race certified by International Trail Running Association (ITRA), we must formulate a scientific and perfect medical security work plan in the first place: pre competition physical examination, especially the application of sports cardiopulmonary function test, screen out athletes who may have medical accidents; during the competition, focus on monitoring and tracking the players who may have problems; each support point is closely connected with the support vehicle; do a good job of first aid training for all kinds of personnel, so that medical accidents can be found, aided, and transferred at the first time. The medical care and rescue of Amne Machin extreme cross-country challenge have played a good role in the security of the international plateau sports events, which provides a reference for the security of similar events.

Biomechanical Analysis of Chinese Male Cross-Country Skiers with Double Poling Technique on Uphill Terrain during Long Distance Classical Race / 医用生物力学

Objective By making biomechanical analysis of double poling (DP) technique on uphill terrain used by Chinese male cross-country (XC) skiers, to characterize biomechanical differences in DP for skiers at different levels, and determine the influence from motion techniques of skiers on their sports performance. Methods Twenty-four male XC skiers who participated in the 15 km classical race at the Beishan ski resort in Jilin, China, on Sept. 11-12, 2019 were selected in this study. On the basis of their race performance, they were divided into faster skiing group (n=12) and slower skiing group (n=12). The kinematic variables of the skiers were obtained by three-dimensional (3D) shooting, and the differences in cycle characteristics, action phases and key technique variables for skiers in two groups were analyzed. Results Faster skiers had a faster DP velocity. There was a positive correlation between swing distance and velocity. The swing distance was positively correlated with average angular velocity of elbow extension in poling phase, average angular velocity of shoulder extension in swing phase, and range of motion (ROM) of shoulder abduction. The swing distance was negatively correlated with extension of the elbow in poling phase. All the above variables showed statistical differences between faster and slower skiers. Conclusions For a long distance competition, the difference in DP velocity on uphill terrain was mainly casued by the difference in swing distance, which originated from the swing phase. Faster skier had a longer swing distance. The differences in the swing distance came mainly from the shoulder and elbow joints. Therefore, slower XC skiers in China should strengthen muscle strength of the upper limbs, especially the shoulder and elbow joint strength. More forward body leaning and larger hip and knee flexion angle at pole plant might help the skier to cover more distance.

Early detection of Pre-XDR TB with line probe assay in a high TB burden country

Background - Worldwide, tuberculosis (TB) is one of the top 10 causes of death. Drug resistant tuberculosis has lately become a major public health problem that threatens progress made in Tuberculosis (TB) care and control worldwide. The aim of this study was to determine the prevalence of Pre-extensive drug resistant TB among MDR TB in North Central of Nigeria. Methods - This study was conducted from October, 2018 to August, 2019 with 150 samples. In Nigeria, guidelines for DR-TB as recommended by WHO is followed. All the samples from the patients who gave their consent were transported to a zonal reference TB laboratory (ZRL). Results - Mean age was 38.6 ± 13.4 years with peak age at 35-44. Out of these 103 samples processed with LPA, 101(98%) were rifampicin resistant and 2 were rifampicin sensitive, 99(96%) were INH resistant and 4 (4%) were INH sensitive, 5(5%) were fluoroquinolone resistant, 98(95%) were fluoroquinolone sensitive, 12 (12%) were Aminoglycoside + Capreomycin resistant, 91(83%) were Aminoglycoside + Capreomycin sensitive. Conclusion - Multidrug resistant TB and its severe forms (Pre-extensive & extensively drug resistant TB) can be detected early with rapid tool- Line Probe Assay rapid and prevented timely by early initiation on treatment.