ABSTRACT
This paper put forward suggestions on the Human Organ Transplantation Ordinance, including: clarify the priority of the protection of the rights and interests of organ owner in Article 1; conditionally increase the range of relatives who can donate cadaver organs; clarify whether relatives can donate cadaver organs of people without full civil capacity and strictly regulate them; allow matured juveniles to donate living organs under strict restrictions; distinguish between donor and organ owner in legal expression.
ABSTRACT
Nursing is the largest group in the health sector accounting for approximately 59 percent of health care professionals. Nurses play a key role in rendering preventive, promotive and rehabilitative health care services. The work of nurses at all stages of their careers and at every level of prac- tice is essential in achieving Sustainable Development Goals (SDGs). Hence an opinion on SWOT in nursing and the priority areas of investment was undertaken among nurses. A quantitative research approach and a descriptive survey design were used. This study was conducted among nurses working in educational institutions and hospitals. A non-probability convenient sampling technique and snowball sampling were used. The tool consisted of items to elicit demographic data of nurses and an opinion scale to elicit the nurses'#39; opinion about SWOT in Nursing. A rating scale was used to rate the opinion about priority areas of investment in Nursing. A Google form was developed and circulated to the nurses. A total of 213 responses were received. Incomplete responses were deleted and finally, 195 responses were included for final analysis. Both de- scriptive and inferential statistics were used. Permission from IEC and informed consent were obtained. Confidentiality was maintained. The results revealed that the majority of the nurses had high opinion by having agreement with the factors of SWOT in nursing and had high priority in the areas of investment.
ABSTRACT
As práticas corporais e atividades físicas (PCAF) estão relacionadas à saúde individual e coletiva. Considerando-se que no último ciclo governamental federal (2019-2022) houve medidas de austeridade fiscal, com consequências para o Sistema Único de Saúde (SUS) e para os programas e ações de PCAF, este ensaio tem o objetivo de apresentar desafios para que tais práticas avancem como política pública de Saúde no ciclo governamental federal de 2023-2026. Destacam-se: a) financiamento; b) vigilância; c) educação, formação e pesquisa; d) comitê participativo; e) política nacional. Espera-se que as proposições fomentem um amplo debate que favoreça a ampliação da oferta na Atenção Primária à Saúde do SUS, buscando efetivar o direito às PCAF, contribuindo para o cuidado integral em saúde (AU).
Physical activities and body practices (PABP) are related to individual and collective health. Considering that in the last federal government cycle (2019-2022) there was a fiscal austerity measures, with consequences for the Unified Health System (SUS) and for PABP programs, this essay aims to present the challenges for such practices to advance as a public Health policy in the 2023-2026 federal government cycle. We highlight: a) financing; b) surveillance; c) education, training, and research; d) participative committee; e) national policy. It is expected that the proposals will promote a wide debate that will contribute to the expansion of the offer of these practices in SUS primary health care, seeking to guarantee the right to PABP, contributing to comprehensive health care (AU).
Las prácticas corporales y actividades físicas (PCAF) están relacionadas con la salud individual y colectiva. Considerando que de 2019 a 2022 hubo una serie de medidas de austeridad fiscal, con consecuencias para el Sistema Único de Salud (SUS) y para las PCAF, este ensayo tiene como objetivo presentar desafíos para que estas prácticas avancen como política de salud pública en el período de 2023 a 2026. Se destacan: a) financiamiento; b) vigilancia; c) educación, formación e investigación; d) comité participativo; e) política nacional. Se espera que las proposiciones fomenten un amplio debate que favorezca la ampliación de la oferta en la Atención Primaria de Salud del SUS, buscando la implementación del derecho al PCAF, contribuyendo para la atención integral a la salud (AU).
Subject(s)
Humans , /adverse effectsABSTRACT
Objective:The present study delves into the realm of scientific unknowns, which serve as the primary representation of major scientific challenges and often give rise to subversive, non-consensus, and high-risk scientific problems. Addressing this pivotal aspect, we focus on the development of scientific unknown identification methods and tool platforms to provide essential data support for priority setting of basic research through a problem-oriented approach. Such efforts are imperative for managing the scientific and technological innovation system within the context of demands and problem-solving.Methods:While numerous knowledge bases have been established in the medical field, there remains a notable lack of focus on the unknown base. The paper synthesizes relevant literature and existing research, amalgamating the methodological paradigm of scientific big data research with text mining. This integration facilitates comprehensive interpretations and enlightening insights concerning the concept, identification methods, and construction of an unknown-base.Results:By systematically analyzing the concept of scientific unknowns, we present a recognition method based on cognitive state and logical rules. Furthermore, we discuss a classification framework and realization path for scientific unknowns from the dimensions of attribute, relationship, and disease, thereby providing foundational insights for the construction of a medical unknown database.Conclusions:Notably, the research on unknowns in medical science transcends disciplinary boundaries, encompassing the confluence of information science, data science, medical informatics, and science and technology management. As such, this paper seeks to expound upon the significance and application scenarios of unknown research in science, furnishing valuable ideas and references for scholars in the field.
ABSTRACT
The global morbidity of invasive fungal diseases (IFD) tends to increase, especially in immunocompromised people.Due to the atypical symptoms, unclear etiological mechanism, and emerging antifungal resistance, IFD challenge current clinical diagnosis and treatment.The World Health Organization (WHO) developed the first WHO fungal priority pathogens list in 2022.The most concerning fungal pathogens were listed and summarized to promote further understanding of the epidemiology of IFD and antifungal drug resistance.It is hoped to provide a basis for the prevention and interventions of IFD.
ABSTRACT
Objective:To explore the safety, effectiveness, economy and surgical techniques of bronchial priority treatment in single-port thoracoscopic right upper lobectomy by comparing it with conventional single-port thoracoscopic right upper lobectomy.Methods:Clinical data of 72 patients who underwent single-port thoracoscopic right upper lobectomy from Mar. 2019 to Feb. 2022 were collected. According to different surgical treatment sequences, the patients were divided into observation group (bronchial priority treatment, 36 cases) and control group (conventional surgery, 36 cases). The general clinical characteristics, operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications, postoperative pain score, and number of staplers used in the two groups were compared.Results:All operations were successfully completed without conversion to thoracotomy. There was no significant difference between the two groups in clinical characteristics, intraoperative blood loss [ (25.3±12.8) ml vs 32.5±14.2) ml, P>0.05], postoperative hospital stay[ (4.7±1.6) d vs (4.9±1.5) d, P>0.05], postoperative pain score [ (3.3±1.1), (4.8±1.4), (3.7±1.1) vs (3.5±1.2), (5.5±1.4), (4.1±1.4), P>0.05], number of lymph node dissection (9.1±1.8 vs 8.3±1.7, P>0.05), or postoperative complications (16.7% vs 27.8%, P>0.05). Compared with the control group, the observation group had significant advantages in the operation time [ (87.2±6.1) vs (106.4±21.8) min, P<0.05] and the number of staplers used (3.7±0.8 vs 5.8±1.3, P<0.05) . Conclusions:Single-port video-assisted thoracoscopic right upper lobe resection with bronchial priority treatment is safe and effective. It simplifies the surgical procedure, reduces the use of disposable consumables, does not increase the risk of perioperative period, and has clinical application prospects.
ABSTRACT
OBJECTIVE To provide reference for better implementation of the priority review system for generic drugs of encouraged generic drug catalogues. METHODS Based on literature research， practical status of the priority review system for generic drugs in two batches of encouraged generic drug catalogues in China was analyzed， and the problems existing in the application of the system were compared to propose corresponding solutions. RESULTS & CONCLUSIONS China has issued two batches of encouraged generic drug catalogues， and there were 49 varieties of generic drugs included in the catalogues. In the implementation of the priority review system for generic drugs of encouraged generic drug catalogues， there were some problems in legislation， incentive system for the first generic drug， post-marketing re-evaluation system， and cross-departmental coordination and linkage mechanism. It is suggested to strengthen legislation， improve the “first generic market exclusivity period” system， perfect the post-marketing re-evaluation system and form a normalized cross-departmental coordination mechanism so as to ensure the safety， effectiveness and accessibility of generic drugs in China.
ABSTRACT
Health research priority setting， based on the existing disease burden or healthcare needs， screens out specific areas or topics with relatively high research priority by scientific and systematic methods， and optimizes the allocation of health resources by influencing healthcare decision-making， so as to alleviate the imbalance between regional or global health and development. Many developed countries have carried out related research and practical work on different scales， and the World Health Organization （WHO） attaches great importance to the transformation and application of relevant achievements in developing countries. As the largest developing country in the world， China's research in this field started relatively late， and only a small number of scholars have carried out part of the localization methodology research and practice according to the specific national conditions. However， health research priority setting has not yet attracted the attention of large-scale research institutions or government organizations in China. Although the priority setting is rarely mentioned in the research on traditional Chinese medicine （TCM）， the research and decision-making on the diseases responding specifically to TCM can also be regarded as the practical work of exploring the priority of TCM. Policymakers have a sense of priority support in the "priority of TCM research"， but the decisions from the top design are mainly based on the consensus reached by high-level think tanks. There is a lack of extensive research， and moreover， the data of multiple stakeholders are not included. Therefore， it is urgent to introduce appropriate priority setting methods to solve the problem of transparency and scientificity in the decision-making process. Given the perspective of the specific implementation， the present study introduced three international priority setting methods， i.e.， the James Lind Alliance and Priority Setting Partnerships（JLAPSP，）the Child Health and Nutrition Research Initiative（CHNRI）， and the Council on Health Research and Development （COHRED）， and presented relevant recommendations on how to apply them in the research of TCM， which is expected to provide references for the local research.
ABSTRACT
Recent work in decision neuroscience suggests that visual saliency can interact with reward-based choice, and the lateral intraparietal cortex (LIP) is implicated in this process. In this study, we recorded from LIP neurons while monkeys performed a two alternative choice task in which the reward and luminance associated with each offer were varied independently. We discovered that the animal's choice was dictated by the reward amount while the luminance had a marginal effect. In the LIP, neuronal activity corresponded well with the animal's choice pattern, in that a majority of reward-modulated neurons encoded the reward amount in the neuron's preferred hemifield with a positive slope. In contrast, compared to their responses to low luminance, an approximately equal proportion of luminance-sensitive neurons responded to high luminance with increased or decreased activity, leading to a much weaker population-level response. Meanwhile, in the non-preferred hemifield, the strength of encoding for reward amount and luminance was positively correlated, suggesting the integration of these two factors in the LIP. Moreover, neurons encoding reward and luminance were homogeneously distributed along the anterior-posterior axis of the LIP. Overall, our study provides further evidence supporting the neural instantiation of a priority map in the LIP in reward-based decisions.
Subject(s)
Animals , Macaca mulatta/physiology , Parietal Lobe , Neurons/physiology , Saccades , Reward , Photic StimulationABSTRACT
In order to alleviate the conflict between medical supply and demand, and to improve the efficiency of medical image transmission, this study proposes an intelligent method for large-volume medical image transmission. This method extracts and generates keyword pairs by analyzing medical diagnostic reports, and uses a 3D-UNet to segment original image data into various sub-area based on its anatomy structure. Then, the sub-areas are scored through keyword pairs and preset scoring criteria, and transmitted to user frontend in the order of prioritization score. Experiments show that this method can fulfill physicians' requirements of radiology reading and diagnosis with only ten percent of data transmitted, which efficiently optimized traditional transmission procedures.
ABSTRACT
Resumen El gato andino es uno de los gatos más raros en Sudamérica. Si bien tiene una distribución amplia en los Andes, hay pocos registros confiables y muchos sitios cuya presencia no ha sido confirmada. El objetivo del estudio fue confirmar la presencia del gato andino (Leopardus jacobita) en el sitio prioritario Andenes de Cuyocuyo, ubicado al sureste del Perú. En el 2018, con un esfuerzo de 1275 cámaras-trampa/día, se obtuvo 123 detecciones de 11 mamíferos, los más frecuentes fueron: Lagidium viscacia, Leopardus jacobita, Hippocamelus antisensis y Leopardus garleppi. El índice de abundancia relativa del gato andino resultó en 9.09 (N= 12, DE= 32.20) y el patrón de actividad indica que tienen hábito diurno (Fr= 0.42) y nocturno (Fr= 0.33). La confirmación de presencia del gato andino en el sitio prioritario Andenes de Cuyocuyo resalta que es necesario implementar mecanismos de conservación con las comunidades campesinas que aseguren la conservación del gato andino y de los otros mamíferos en esta región del Perú.
Abstract The Andean cat is one of the rarest cats in South America. Although it has a broad distribution in the Andes there are few reliable records and many sites whose presence has not been confirmed. The objective of this study was to confirm the presence of the Andean cat (Leopardus jacobita) in the Andenes of Cuyocuyo priority site, located in southeast Peru. In 2018, with an effort of 1275 camera-traps/day, 123 detections of 11 mammals were obtained, the most frequent being: Lagidium viscacia, Leopardus jacobita, Hippocamelus antisensis, and Leopardus garleppi. The relative abundance index of the Andean cat was 9.09 (N= 12, DE= 32.20) and the period of activity indicates that they have diurnal (Fr= 0.42) and nocturnal (Fr= 0.33) habits. The confirmation of the Andean cat in the priority site highlights the need to implement conservation mechanisms with the human communities that ensure the conservation of the Andean cat and other mammals in this region of Peru.
ABSTRACT
RESUMEN Objetivo : Evaluar la preferencia y aceptabilidad sobre seis diferentes diseños de aparatos ortodónticos fijos en adolescentes peruanos de dos colegios de Lima. Material y Métodos : Se realizó un estudio descriptivo y transversal en un total de 140 adolescentes con edades entre 10 y 16 años, que completaron una ficha de registro en donde se evaluó la preferencia, aceptabilidad, orden de preferencia y aceptabilidad al uso sobre seis diferentes diseños de aparatos fijos visualizados en un álbum de fotografías. Resultados : Los datos fueron analizados con el paquete estadístico SPSS versión 24.0. Se utilizó un nivel de significancia de 5% con un intervalo de confianza de 95%. Debido a la naturaleza de las variables se utilizó la prueba de Chi cuadrado Los adolescentes prefirieron los brackets metálicos con módulos elásticos de colores y arco de acero (24,3%, n=34); y la aceptabilidad fue de 92,1%. Para el orden de preferencia, se encontró la siguiente jerarquía de primer a sexto lugar: brackets metálicos con módulos elásticos de colores y arco de acero > brackets de zafiro con módulos elásticos transparentes y arco estético > brackets metálicos con módulos elásticos transparentes y arco de acero > brackets de zafiro con módulos elásticos transparentes y arco de acero > brackets de zafiro con módulos elásticos de colores y arco de acero > brackets metálicos autoligantes y arco de acero/brackets de zafiro con módulos elásticos de colores y arco de acero. Se encontró una asociación estadísticamente significativa para algunas preguntas sobre la aceptabilidad al uso en relación al grupo de edad, sexo e institución educativa. Conclusiones : Los adolescentes prefirieron los brackets metálicos con módulos elásticos de colores y arco de acero. Los brackets metálicos autoligantes con arco de acero y los brackets de zafiro con módulos elásticos de colores y arco de acero, presentaron menos preferencia.
ABSTRACT Objective : To evaluate the preference and acceptability of six different orthodontic fixed appliance designs in Peruvian adolescents from two schools in Lima. Material and Methods : A descriptive cross-sectional study was executed. A total of 140 adolescents aged between 10 and 16 years completed a registration form in which the preference, acceptability, order of preference and acceptability to use were evaluated on six different designs of fixed orthodontic appliances displayed in a photo album. Results : Data analysis was performed using the SPSS program version 24.0. A p-value of less than 0.05 was considered as a level for significance. Due to the nature of the variables the Chi square test was used. Adolescents preferred metal brackets with colored elastomeric modules and steel arch (24.3%, n= 34); and the acceptability was 92.1%. For the order of preference, the following hierarchy was found from the first to the sixth place: metal brackes with colored elastomeric modules and steel archwire > sapphire brackets with transparent elastomeric modules and aesthetic archwire > metal brackets with transparent elastomeric modules and steel archwire > sapphire brackets with transparent elastomeric modules and steel archwire > sapphire brackets with colored elastomeric modules and steel archwire > self-ligating metal brackets and steel archwire/sapphire brackets with colored elastomeric modules and steel archwire. A statistically significant association was found for some questions about acceptability to use in relation to the age group, sex and educational institution. Conclusions : Adolescents preferred metallic brackets with colored elastomeric modules and steel arches. The less preferred appliances were the self-ligating metallic brackets with steel archwire and the sapphire brackets with colored elastomeric modules and steel archwire.
ABSTRACT
Introducción: Uno de los indicadores del impacto del establecimiento de prioridades en investigación en salud es la producción científica. EsSalud planteó nueve temas de investigación prioritarios (TIP) y 20 preguntas de investigación prioritarias (PIP) 2017-2019. Evaluamos el alineamiento a estas prioridades de investigación en los artículos científicos publicados con filiación de EsSalud durante 2017-2020, y caracterizamos aquellos financiados por esta institución. Material y Métodos: Análisis de los artículos científicos registrados en la base de datos de producción científica de EsSalud 2017-2020. Empleamos una metodología estandarizada y por duplicado para evaluar el alineamiento a los TIP y PIP 2017-2019 de EsSalud. La evaluación del alineamiento a las PIP sólo lo realizamos en artículos originales y resúmenes de congreso. Reportamos frecuencias de alineamiento a cada TIP y PIP, y frecuencia de alineamiento a por lo menos un TIP según características de los artículos. Además, se reportó las características de los artículos financiados por EsSalud. Resultados: Un total de 170 de 1283 artículos se alinearon a al menos un TIP. Ocho de las veinte PIP no fueron respondidas. Los artículos con autores que pertenecen o recibieron financiamiento del IETSI-EsSalud tuvieron la mayor tasa de alineación. Finalmente, los artículos financiados por EsSalud fueron principalmente estudios observacionales, guías de práctica clínica y revisiones sistemáticas. Conclusión: Los artículos científicos publicados con filiación de EsSalud durante el 2017 al 2020 tienen baja alineación con las prioridades de investigación de la institución. Por lo tanto, es necesario generar un proceso de gestión de implementación, seguimiento y evaluación de las prioridades de investigación en la institución.
Background: One of the impact indicators of priorities in health research-setting is the scientific production that refers to these priorities. EsSalud raised nine priority research topics (PRT) and 20 priority research questions (PRQ) for the 2017-2019 period. We assess the alignment to these research priorities in the scientific articles published during the 2017-2020 period by EsSalud, and we characterize those financed by this institution. Material and Methods: Analysis of the scientific articles registered in the EsSalud scientific production database for the period 2017-2020. We used a standardized methodology and in duplicate to evaluate the alignment of a scientific article to the PRTand PRQ 2017-2019 of EsSalud. The evaluation of the alignment to the PRQs is only carried out in original articles and congress summaries. We report alignment frequencies to each PRTand PRQ, and we report the frequency of alignment to at least one PRT according to the articles' characteristics. In addition, the characteristics of the articles financed by EsSalud were reported. Results: 170 out of 1283 articles were aligned to at least one PRT. Eight of the twenty PRQs went unanswered. Articles with authors who belong to or received funding from IETSI-EsSalud had the highest alignment rate. Finally, the highly cited articles financed by EsSalud were mainly observational studies, clinical practice guidelines and systematic reviews. Conclusion: The articles published by EsSalud during 2017 to 2020 have low alignment with institutional research priorities. Furthermore, it is necessary a process of implementation, monitoring, and evaluation of research priorities in the institution.
ABSTRACT
Objective:To analyze the efficacy and safety of cranial approach priority, counterclockwise sequential comple mesocolic excision in laparoscopic right hemicolectomy.Methods:From Jan. 2020 to Dec. 2020, 30 patients with right colon cancer in Department of Gastrointestinal Surgery were retrospectively analyzed. Laparoscopic radical right hemicolectomy was performed via the approach of complete mesocolic excision. The general clinicopathological data of the patients, perioperative data such as operation time, intraoperative blood loss, number of cases of hemorrhage caused by Henle trunk and subordinate branch injury, whether or not converted to open surgery, postoperative pathological data (TNM staging, total number of dissected lymph nodes and the number of metastatic lymph nodes) , postoperative recovery (exhaust time, the time of fluid intake, drainage tube removal and hospital stay) , and complications (such as bleeding, anastomotic leakage, secondary surgery, lymphatic leakage, pulmonary infection, abdominal infection, incision infection, etc) were recorded. Follow-up was performed by telephone or outpatient in 1 year after surgery.Results:The total operation time was (197.80±31.20) minutes, ranging from 150 to 275 minutes, and the intraoperative blood loss was (58.33±30.30) ml, ranging from 10 to 100 ml. There were no cases of intraoperative Henle stem and branch injury bleeding or conversion to open surgery. Postoperative exhaust time was (2.97±0.67) d, ranging from 2 to 4d; postoperative fluid intake time was (3.67±0.76) d, ranging from 3 to 5d; postoperative drainage tube removal time was (6.60±4.00) d, ranging from 4 to 25 days; postoperative hospital stay was (7.87±3.94) days, ranging from 5 to 26 days. pTNM staging: 9 cases of stage I, 5 cases of stage IIA, 1 case of stage IIB, 6 cases of stage IIIA, 4 cases of stage IIIB, and 5 cases of stage IIIC. The total number of lymph nodes dissected was (29.50±8.18) , ranging from 19 to 51; the number of metastatic lymph nodes was (1.40±1.77) , ranging from 0 to 6. Postoperative complications included incision infection in 1 case, anastomotic leakage in 1 case, lymphatic leakage in 2 cases, and lung infection in 1 case. No tumor recurrence or metastasis was found during follow-up, and no patient died.Conclusion:Cranial approach priority, counterclockwise sequential complete mesocolic excision is safe and effective in laparoscopic right hemicolectomy.
ABSTRACT
Introduction: The marine biodiversity is well known in some areas and for some marine ecosystems of the Pacific coast of Costa Rica. The marine sector of Área de Conservación Guanacaste, in the North Pacific of the country, is a priority area for conservation of marine and coastal biodiversity. Objective: Our aim was to increase the knowledge of marine biodiversity in a conservation priority site in Costa Rica and in poorly or scarcely studied marine ecosystems, such as rocky reefs and Sargassum beds, respectively. Methods: The study was conducted in Bahía Salinas and Golfo de Santa Elena in 2013. In January, four rocky reefs were visited; while in February three rocky reefs and one Sargassum bed were visited. We identified the macroinvertebrates and conspicuous fish species through underwater visual census methods (timed swim and band transects). The mean density of each species was estimated through band transects method. Results: A total of 25 invertebrates and 34 fish species were identified. We found a high number of species of invertebrates (23) and fish species (33) in rocky reefs, but few species on Sargassum beds (eight invertebrates and ten fish species). Species composition differed between marine ecosystems. Conclusions: Our study further evidence the limited knowledge of invertebrates and fish communities in these marine ecosystems in the North Pacific of Costa Rica. Considerably more surveys and field work are required to support management decisions that are backed by sound scientific knowledge.
Introducción: La biodiversidad marina es bien conocida en algunas áreas y para algunos ecosistemas marinos de la costa Pacífica de Costa Rica. El sector marino del Área de Conservación Guanacaste, en el Pacífico norte del país, es un área prioritaria para la conservación de la biodiversidad marina y costera. Objetivo: Nuestro objetivo fue el de incrementar el conocimiento de la biodiversidad marina en un sitio prioritario de conservación de Costa Rica y en ecosistemas marinos poco o nulamente estudiados, como son los arrecifes rocosos y mantos de Sargassum, respectivamente. Métodos: El estudio se realizó en Bahía Salinas y Golfo de Santa Elena en el 2013. En enero, cuatro arrecifes rocosos fueron visitados; mientras que en febrero tres arrecifes rocosos y un manto de Sargassum fueron visitados. Identificamos las especies de invertebrados y peces conspicuos a través métodos de censos visuales submarinos (buceos cronometrados y transectos de banda). La densidad promedio de cada especie se estimó mediante el método de transectos de banda. Resultados: Se registró un total de 25 invertebrados y 34 especies de peces. Encontramos un mayor número de especies de invertebrados (23) y peces (33) en los arrecifes rocosos, pero pocas especies en el manto de Sargassum (ocho especies de invertebrados y diez de peces). La composición de especies difirió entre ecosistemas marinos. Conclusiones: Nuestro estudio evidencia el limitado conocimiento de las comunidades de invertebrados y peces en estos ecosistemas marinos en el Pacífico Norte de Costa Rica. Considerablemente más encuestas y trabajo de campo son requeridos para apoyar decisiones de manejo que sean respaldados por conocimientos científicos solidos.
ABSTRACT
Las pandemias y otras catástrofes de alto impacto sanitario azotan periódicamente a la humanidad, aumentando desproporcionadamente la demanda por atención en servicios de urgencia, unidades de cuidados intensivos y medios de soporte vital avanzado. Este desequilibrio obliga a una compleja toma de decisiones en que se deben asignar recursos proporcionalmente escasos en relación a una gran demanda. Así, los equipos clínicos asistenciales necesitan actuar bajo criterios consensuados, que orienten sus decisiones y alivien la pesada carga moral de seleccionar pacientes para terapias, en detrimento de otros. El triaje es una estrategia que permite establecer, bajo racionalidades propias a cada escenario, objetivos y criterios que faciliten la toma de decisiones complejas para el logro del mejor resultado. Estas estrategias deben considerar el marco de valores intangibles que apreciamos y que nos identifican cultural y socialmente, como son el respeto a la vida, la igualdad, la justicia y la libertad. Sin embargo, en escenarios excepcionales como el de la actual pandemia COVID-19, en que el sistema sanitario puede no dar abasto, deberán establecerse objetivos prioritarios, como salvar la mayor cantidad de vidas, del modo más humano, justo y eficiente posible. A la vez, deberán redefinirse jerarquías en los valores y principios clásicos de la práctica clínica cotidiana, adecuadas a la catástrofe sanitaria, bajo una ética propia de la salud pública, el mayor bien para la mayoría y el mejor cuidado de los que no pueden ser curados.
Pandemics and other global disasters regularly overwhelm humankind. These catastrophic events suddenly increase demand for health-care in emergency services, intensive care units, and for advanced life support devices. This imbalance requires complex decision-making in which scarce resources must be allocated in relation to high demand. Thus, health-care teams need to act under consensus criteria that guide their decisions and alleviate the heavy moral burden of selecting patients for therapies, excluding others. Triage is a strategy that allows to establish, under appropriate rationalities, objectives and criteria that facilitate complex decisions to achieve the best results. These strategies should consider the framework of intangible values that we appreciate and identify us culturally and socially, such as respect for life, equity, justice and freedom. However, in exceptional scenarios such as the current COVID-19 pandemic, where the health system may be overcome, priority goals should focus in order to save as many lives as possible and by mean the most humane, fair and efficient way possible. At the same time, hierarchies of classical values and principles of daily clinical practice should be redefined in an appropriate way to face this catastrophic scenario, under an ethics for public health, the greatest good for the most and the best care of those who cannot be cured.
Subject(s)
Humans , Health Care Rationing/ethics , Triage/ethics , COVID-19 , Public Health/ethics , Triage/methods , Pandemics , Resource Shortage for Health , SARS-CoV-2 , Health PrioritiesABSTRACT
Based on the general goal of the medium and long term development of basic science from 2021 to 2035 and the "14th Five-Year Plan" in China, combined with the national strategic needs, this paper discusses the five priority development areas of endemiology according to the development trends and characteristics of endemiology in the next 5 - 15 years. The five areas are study on the pathogenesis and prevention measures of endemic fluorosis; study on risk assessment, pathogenic mechanism and control strategy of environmental arsenic exposure; research on the basis and application transformation of the pathogenesis of iodine nutrition-related diseases; molecular mechanism and targeted intervention of cartilage injury in Kashin-Beck disease; precise prevention and treatment, preservation of biological samples and etiology study of Keshan disease. Combined with the scientific significance and national strategic needs of various field, the authors analyze its main study directions and core scientific issues.
ABSTRACT
Resumo Em 1958, Eiseman e colaboradores publicaram o primeiro artigo científico relatando o uso de transplante de microbiota fecal para tratar casos graves de colite pseudomembranosa. A relevância desse trabalho inovador só foi reconhecida em 1990. A literatura acadêmica sobre o tema caracteriza-se por sucessivas reconstruções. Sugerimos que tais reconstruções foram orientadas por questões de atribuição de prioridade de descoberta científica nos termos propostos por Merton. A retomada do uso de transplantes de microbiota fecal é interpretada como processo de gênese de um fato científico, conforme Fleck: ocorre a mudança de um estilo de pensamento baseado no uso de antibióticos no tratamento de doenças infecciosas para outro que considera as relações ecológicas entre hospedeiros, vetores e agentes etiológicos de doenças.
Abstract In 1958, Eiseman and contributors published the first scientific paper reporting the use of fecal microbiota transplant for treating pseudomembranous colitis. The relevance of this innovative paper was only acknowledged in 1990. The academic literature on the theme is characterized by a narrative that has undergone successive revisions. We suggest that such revisions were based on claims of priority of scientific discoveries, as described by Merton. The revival of fecal microbiota transplants is interpreted as a process of genesis of a scientific fact, as defined by Fleck: there is a switch from a thought style based on the use of antibiotics to treat infectious diseases to another that accepts the ecological relations between hosts, vectors and parasites.
Subject(s)
Humans , History, 20th Century , History, 21st Century , Enterocolitis, Pseudomembranous/history , Fecal Microbiota Transplantation/history , Enterocolitis, Pseudomembranous/microbiology , Enterocolitis, Pseudomembranous/therapy , Gastrointestinal Microbiome , HistoriographyABSTRACT
Background: The first hour and day following childbirth is a period of rapid change within child and mother, with a potential for immediate crises as more than half of global maternal deaths occur during the postnatal period, of which 45 percent maternal and three- quarters of neonatal deaths occur within one day after deliver. Despite of the importance of this period, less than half of mother and newborn get the checkup done in first 24 hours in the state of Uttar Pradesh in India. This quantitative study explored the factors associated with early postpartum hospital discharge.Methods: This was a hospital-based study in which exit interviews were done using structured questionnaire from 278 recently delivered women at two randomly selected Community Health Centres of Gonda and Bareilly districts each, from Uttar Pradesh. The outcome variable was duration of hospital stay. Descriptive results were presented with comparison of factors within district, followed by bivariate analyses and linear regression was done to adjust for confounders.Results: Longer distance of house from facility (0.07; 95 percent CI 0.04, 0.01; p<0.001), if informed about new-born care (0.49; 95 percent CI 0.01, 0.85; p 0.01), if ASHA had fewer visits to women house (-0.06; 95 percent CI -0.12, -0.1; p 0.01) were found to be the determinant of longer stay after adjusting for all variables that were found significant in bivariate analysis and were biologically plausible.Conclusions: The present study concludes that there is lack of awareness among women and their relatives. Inadequate information provided by front line workers were some of the major factors influencing hospital stay pattern.
ABSTRACT
The demographic and microsatellite data on 25 markers along with non genetic information such as distribution, adaptation and utility pertaining to 24 Indian goat breeds were used to assess their conservation priorities. The effective population size (Ne) of Gohilwadi, Jharkhand Black and Sangamneri was greater than 200 and that of Black Bengal, Kutchi, Mehsana, Sirohi, Malabari and Zalawadi ranged from 100 to 200 but it was below 100 for rest (60%) of the breeds with Ganjam having the least value of 17.5 based on microsatellite data. All goat breeds whose effective population size is greater than 100 based on markers did have population size between 0.1 and 0.2 million except in few cases. The Ne based on microsatellite and demographic data revealed almost same order of ranking of goat populations. It was also revealed that Attappady and Kutchi were at highest risk of extinction probability (0.63) and more than half of the Indian goat breeds were having less than 50% extinction probability. Therefore, Attappady and Kutchi should be given top priority for conservation