Estatinas en la prevención primaria, secundaria y terciaria del ictus isquémico / Statins in the Primary, Secondary and Tertiary Prevention of Ischemic Stroke

Introducción: El ictus isquémico representa la tercera causa de mortalidad en el mundo y la primera causa de discapacidad. Objetivos: Describir los efectos beneficiosos de la prescripción de las estatinas en la prevención primaria, secundaria y terciaria del ictus isquémico. Métodos: Se realizó una revisión bibliográfica sobre la prescripción de estatinas en la prevención primaria, secundaria y terciaria del ictus isquémico. Se revisaron más de 400 artículos publicados en PubMed, Cochrane y Medline. Conclusiones: El empleo de estatinas disminuye la mortalidad en la prevención primaria y secundaria, se utiliza precozmente en la fase aguda (prevención terciaria), disminuye el área infartada, existe una mejoría clínica y disminuyen los reactantes de la fase aguda como la proteína C reactiva(AU)

Introduction: Ischemic stroke represents the third cause of mortality worldwide and the first cause of disability. Objective: To describe the beneficial effects of the prescription of statins in the primary, secondary and tertiary prevention of ischemic stroke. Methods: A bibliographic review on the prescription of statins in the primary, secondary and tertiary prevention of ischemic stroke was carried out. More than 400 articles published in MEDLINE/PubMed and Cochrane were reviewed. Only 50 articles met the selection criteria, which were published from May 2021 to June 2022. Conclusions: The use of statins decreases mortality in primary and secondary prevention. If they are used early in the acute phase (tertiary prevention), the infarcted area decreases, there is clinical improvement and acute phase reactants such as C-reactive protein decrease(AU)

Perception of neonatology staff regarding the availability of equipment and supplies for the care of patients in need of nCPAP / Percepción del personal de neonatología sobre la disponibilidad de equipo e insumos para la atención de pacientes con necesidad de nCPAP

Abstract Background: Respiratory distress syndrome (RDS) is Mexico's second leading cause of neonatal mortality. The 75% reduction in mortality due to RDS has been attributed to the use of nasal continuous positive airway pressure (nCPAP). A survey was conducted to determine the perception of the medical staff regarding the availability of nCPAP equipment and supplies in Mexican hospitals with neonatal intensive care units (NICUs). Methods: We sent a survey via e-mail to several neonatologists in each state of the country, requesting only one response per hospital. We performed statistical analysis with SPSS software. Results: We received 195 surveys from private (HPri) and public (HPub) hospitals with NICUs nationwide: 100% of HPri and 39% of HPub. More than 75% of the nursing and medical staff had received formal training in nCPAP in 11% of HPri and 5% of HPub. The perceived availability of CPAP equipment was 83.7% vs. 52.1%; nasal cannula supply, 75.5% vs. 36.3%; air/oxygen blender availability, 51.0% vs. 32.9%, in HPri and HPub, respectively. The observed differences were statistically significant. Significant differences were also found among healthcare institutions. Conclusions: The availability of CPAP equipment and consumables between HPub and HPri is unbalanced and is lower in public institutions. Bubble CPAP is not included essential equipment in the national catalog of instruments and equipment for public hospitals, and its request is complicated. The training of CPAP staff and the availability of bubble CPAP and supplies in public hospitals should be improved.

Resumen Introducción: El síndrome de dificultad respiratoria (SDR) es la segunda causa de mortalidad neonatal en México. La reducción del 75% de la mortalidad por SDR se le ha atribuido al uso de la presión positiva nasal continua de las vías respiratorias (nCPAP). Se realizó una encuesta con el objetivo de conocer la percepción del personal médico acerca de la disponibilidad del equipo e insumos para nCPAP en hospitales de México que cuenten con unidades de cuidados intensivos neonatales (UCIN). Métodos: La encuesta se envió por correo electrónico a varios neonatólogos de cada estado del país y se solicitó una sola respuesta por cada hospital. El análisis estadístico se realizó con el software SPSS. Resultados: Se recibieron 195 encuestas respondidas tanto de hospitales privados (HPri) como públicos (HPub) que cuentan con UCIN a escala nacional: el 100% de HPri y el 39% de HPub. Más del 75% del personal de enfermería y médico recibió una capacitación formal en nCPAP en el 11% de HPri y el 5% de HPub. La percepción de disponibilidad de equipos de presión positiva continua de las vías respiratorias (CPAP) fue del 83.7% vs. el 52.1%; el abasto de cánulas nasales, del 75.5% vs. el 36.3%; la disponibilidad del mezclador aire/oxígeno, del 51.0 % vs. el 32.9%, en HPri y HPub, respectivamente. Las diferencias fueron estadísticamente significativas. También se encontraron diferencias significativas entre las instituciones de salud. Conclusiones: La disponibilidad de equipo y material de consumo para CPAP entre HPub y HPri es desequilibrada, y es menor en las instituciones públicas. El CPAP burbuja no se encuentra incluido en el cuadro básico de equipo médico y se dificulta su solicitud. Debe mejorarse la capacitación del personal en CPAP y la disponibilidad de CPAP burbuja e insumos en los hospitales públicos.

Evolutionary game of resources integration on secondary hospital and tertiary hospital in tiered medical care system / 中国卫生政策研究

The paper analyzed the decision-making process of the doctor's treatment and patient's decision-making. Then established the evolutionary game model of patient's and the secondary-tertiary hospital doctor's strate-gy. The Matlab simulation software were used to analyze the influencing factors of patient-doctor strategy-making sys-tem. We proposed the advice reducing critical patient's utility loss diagnosed in secondary hospital,improving medi-cal experience of common patient in secondary hospital,strengthening disease prevention of critical patient,and pro-moting labor division and cooperation between secondary and tertiary hospital to make result develop towards reduction the disorderly,chaotic and dislocated medical need and an integrated secondary and tertiary system.

Strategies for Prevention of Food Poisoning

Food poisoning is one of the major public health problems. Prevention is better than cure. Prevention of food poisoning is a hardly achievable goal, if we misunderstand the complex causality of food poisoning. For example, food hygiene and food safety are essential components of prevention of food poisoning, but not all of the components. Especially a viewpoint of public health is needed to the prevention of food poisoning. I described the conceptual model of prevention of food poisoning; the primary, secondary, and tertiary prevention of food poisoning at the individual level and at the population level. In case of primary prevention strategy, I applied the epidemiologic triangle model to explore the causality of food poisoning. I found that the both secondary and tertiary prevention activities at the population level had been very poor. However, these activities are enormously important to the prevention and control of food poisoning. We should develop an integrated strategy for the prevention of food poisoning at the multi-disciplinary level, especially public health.