BACKGROUND: Trauma is considered as a worldwide problem despite socio-economic development. Motor vehicle accidents(MVAs) are the most important cause of trauma. Trauma related deaths are mostly preventable. This stud...BACKGROUND: Trauma is considered as a worldwide problem despite socio-economic development. Motor vehicle accidents(MVAs) are the most important cause of trauma. Trauma related deaths are mostly preventable. This study aimed to investigate the causes and prevention of death in trauma patients.METHODS: This retrospective, descriptive-analytic study assessed 100 trauma patients referred to our emergency department(ED) from January 2013 to Januanry 2015. The included patients were those with trauma died after arrival at our ED. Age, sex, cause of trauma, clinical causes of death, causes of death def ined by autopsy, way of transfer to the ED, time of ambulance arrival at the scene of trauma, and time elapsed to enter the ED from the scene of trauma were studied.RESULTS: In the 100 patients, 21(21%) patients were female and 79(79%) male. Fortythree patients were older than 60 years. Trauma was largely due to pedestrian accidents in 31% of the patients, and 33% had a hypo-volemic shock. About 80% of deaths were due to intra-cranial hemorrhage(ICH) or intra-ventricular hemorrhage(IVH), and spinal injuries were not preventable. Autopsy revealed that 28% of the patients suffered from internal injuries. Autopsy revealed that 19% of the deaths were not preventable and 81% were considered preventable. In our patients, 76 were transferred to the hospital by emergency medicine services(EMS). Analysis of time for ambulance arrival to the scene and frequency of death revealed that 52.2% of the deaths occurred between 11 and 15 minutes. Analysis of time for admission to the ED from the scene of trauma showed that 74.6% deaths occurred between 6 and 10 minutes.CONCLUSIONS: The rate of hospital preventable deaths is about 80%, a high mortality rate, which denotes a lack of proper diagnosis and treatment. The time for arrival of EMS at the scene of trauma is longer than that in other countries.展开更多
Aim: To analyze the reasons for epidemic outbreaks of measles, mumps and viral hepatitis A and to propose measures to prevent them in future. Materials and methods: Тhe incidence of measles, mumps and hepatitis A in ...Aim: To analyze the reasons for epidemic outbreaks of measles, mumps and viral hepatitis A and to propose measures to prevent them in future. Materials and methods: Тhe incidence of measles, mumps and hepatitis A in Plovdiv region was studied for the period 2006-2010. An analysis of the age structure of the patients was made, while taking into account the time for routine immunization performed against measles and mumps (first and second dose). Results: In 2006-2009 single cases of measles were found occasionally, but in 2010 they were 2787 (incidence 395/100,000). Most of them (51%) were for ages 13 months-12years, 27%-0-13 months and 11%-13 to 18 years. The incidence of mumps for 2006-2010 varied widely, and has increased significantly in 2007 (130/100,000) and 2008 (169/100,000). The majority of patients (over 34%) during the epidemics were aged 13 months-12years, and over 26% of them-13-19 years. For the period 2006-2010 the incidence of hepatitis A ranged from 2.98/100, 000 (2009) to 426/100,000 (2006). Over 50% of the cases involved children aged up to 9 years. For the three diseases over 80% of patients were individuals of Roma origin. Conclusions: 1. Epidemic spread of measles in 2010 was mainly due to shortcomings in the routine immunization carried as a prevention of the disease. 2. There are two reasons for the outbreak of mumps: А) Failure to administer the second vaccine dose at 12 years in Bulgaria until 2001. B) Shortcomings in routinely performed immunization. 3. The extremely high incidence of hepatitis A in 2006 (and in the rest of the years) is due to the lack of routine immunization. 4. Essential for the outbreaks in all three diseases are the poor hygienic living conditions, the low social status and the lack of health promotion of the population at risk 5. To prevent future outbreaks of the diseases hereby in question, we suggest it is appropriate: А) To introduce compulsory immunization against hepatitis A;B) To carry out periodic catch-up vaccination campaigns against measles and mumps.展开更多
Background: In Tanzania elders are respected as repositories of inherited wisdom, experienced and principal decision makers in the community. However, evidence shows that such repositories are no longer considered imp...Background: In Tanzania elders are respected as repositories of inherited wisdom, experienced and principal decision makers in the community. However, evidence shows that such repositories are no longer considered important in most societies. As a result elders are neglected with some mistreatment in terms of provision of health and social services for instance;at times they get denied and ignored of their obvious rights, ignoring their retirement benefits and the rights onto free social services as per the Tanzania National Ageing Policy of 2003. Elders are therefore faced with physical, psychological and geriatric social suffering. It is on this basis that this study tries to explore the common preventable health and social problems encountered by elderly in Shinyanga Region in northern part of Tanzania. Methods: Across sectional community based study of 465 subjects randomly selected was done in three wards of Kahama District. The district was selected randomly out of 8 districts of Shinyanga Region, structured questionnaires with both closed and opened endower used;the information was collected from house to house and other information collected from health facilities within the wards as every ward had one public health facility;subjects (respondents) were obtained using purposive sampling technique aiming at elderly with 60 years of age and above. Results: Kahama district has a population of approximately 36,014 of which 1500 (4%) are in the elderly age group of 60 years and above. The study population was 465 which is 30% (465/1500) of the geriatric population of Kahama. Among this group 5% were female while 41% were male and 53% (248/465) were married. 64% (297/465) were taking care of themselves, 32% (150/465) cared by relatives and 4% (18/465) cared by the community. Among the respondents, 40% (185/465) were affected by HIV/AIDs in one way or another either living with orphans whose parents died of HIV/AIDS or asking care of the infected patients within the family. It was also found that 73% of the geriatrics were not exempted from medical treatment fees so they had to pay for their medical care. However, only 32% were aware of getting free treatment and 61% of the study populations were not satisfied with the medical care provided at the public health facilities. The common diseases affecting this age group are: Eye problem 59% (273/465);Arthritis 52% (241/465);Dental problems 27% (124/465);Hypertension 23% (107/465);Backache 22% (105/465);Malaria 28% (132/465);Hearing problems 26% (121/645);Urinary tract Infection 35% (165/465);Depression 8% (36/465). Dementia was also a problem though we had no tools to confirm the diagnosis;some of the geriatrics had more than two diseases. Conclusion: The majority of the elderly age group in Kahama District are not aware of their rights that they deserve free treatment according to Tanzania policy, furthermore for assessment and screening of health problems. A majority of the elderly die prematurely due to preventable diseases and more than half of the diseases affecting geriatrics are preventable.展开更多
AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).
BACKGROUND:Readmission to intensive care unit(ICU)after discharge to ward has been reported to be associated with increased hospital mortality and longer length of stay(LOS).The objective of this study was to investig...BACKGROUND:Readmission to intensive care unit(ICU)after discharge to ward has been reported to be associated with increased hospital mortality and longer length of stay(LOS).The objective of this study was to investigate whether ICU readmission are preventable in critically ill cancer patients.METHODS:Data of patients who readmitted to intensive care unit(ICU)at National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences(CAMS)and Peking Union Medical College(PUMC)between January 2013 and November 2016 were retrospectively collected and reviewed.RESULTS:A total of 39 patients were included in the final analysis,and the overall readmission rate between 2013 and 2016 was 1.32%(39/2,961).Of 39 patients,32(82.1%)patients were judged as unpreventable and 7(17.9%)patients were preventable.There were no significant differences in duration of mechanical ventilation,ICU LOS,hospital LOS,ICU mortality and in-hospital mortality between patients who were unpreventable and preventable.For 24 early readmission patients,7(29.2%)patients were preventable and 17(70.8%)patients were unpreventable.Patients who were late readmission were all unpreventable.There was a trend that patients who were preventable had longer 1-year survival compared with patients who were unpreventable(100%vs.66.8%,log rank=1.668,P=0.196).CONCLUSION:Most readmission patients were unpreventable,and all preventable readmissions occurred in early period after discharge to ward.There were no significant differences in short term outcomes and 1-year survival in critically ill cancer patients whose readmissions were preventable or not.展开更多
Tuberculosis (TB) incidence within Healthcare workers remains one of the lowest occupation specific rates in the United States. We report a case of a 33-year-old African American male presented with a right chest mass...Tuberculosis (TB) incidence within Healthcare workers remains one of the lowest occupation specific rates in the United States. We report a case of a 33-year-old African American male presented with a right chest mass and without fever, chills or cough. Bacterial and Fungal cultures were sent during the initial visit and were negative throughout the entire management of his care. After several months of surgical interventions, the patient appeared positive for TB;however a staff member contracted the disease. The patient was managed successfully with the four-drug regimen of Isoniazid, Rifampin, Pyrazinamide and Ethambutol and recovered well from his surgeries.展开更多
Objectives Coroners in England and Wales have a duty to write Prevention of Future Deaths(PFDs)reports when they believe that action should be taken to prevent similar deaths.We conducted a systematic case series of t...Objectives Coroners in England and Wales have a duty to write Prevention of Future Deaths(PFDs)reports when they believe that action should be taken to prevent similar deaths.We conducted a systematic case series of the reports involving maternal deaths to characterise these deaths in terms of demographics,explore the concerns raised by the coroners and understand what actions were reported by organisations in their responses to the coroner.Methods All coroners'PFDs published between July 2013 and 1 August 2023 in England and Wales were collected and reviewed(n=4435).Reports were searched for keywords related to maternal deaths.Case information was extracted into pre-specified domains and compared to other data on maternal deaths.Results Twenty nine(n=29)cases were found involving a maternal death.The median age at death was 33.5 years(IQR 29±36 years)and three-quarters(75.9%)of deaths occurred in hospitals.The most common cause of death was haemorrhage.Coroners frequently voiced concerns around the failure to provide appropriate treatment(48.2%)and failure of timely escalation(37.9%).Specific lessons we have highlighted include gaps in national guidance,failure to follow national protocols,communication issues and lack of resources or staff cover.Only 38%of PFDs had published responses from the organisations they were sent to.When organisations did respond to the coroner,80%reported that they implemented changes,including publishing new local policies,increasing training or committing to increased staffing.Conclusions Poor response rates to PFDs indicate underutilisation of these reports as a resource for improvement in maternal care.PFDs highlighted gaps in obstetric care and national guidance which,if appropriately addressed and regularly and routinely monitored,could prevent similar deaths.展开更多
BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehe...BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk.METHODS We searched PubMed,EMBASE,Scopus,and Cochrane Library databases to identify randomized controlled trials(RCTs)that compared rectal indomethacin with a control group to prevent PEP.Duplicates were removed,and studies were included based on the established inclusion criteria.We used the Cochrane Collaboration’s tool to assess the risk of bias in the RCTs.A random-effects model was applied to produce pooled risk ratios(RRs)with 95%confidence intervals(CIs).RESULTS We included a total of 30 RCTs involving 16977 patients.Compared to the control group,rectal indomethacin showed comparable rates of overall PEP(PEP;RR=0.85,95%CI:0.69-1.04,I2=79%)with no statistically significant difference of RR in mild(RR=0.92,95%CI:0.74-1.14),moderate(RR=0.78,95%CI:0.59-1.02),or severe PEP(RR=1.12,95%CI:0.75-1.67).There was also no difference in cases of adverse events(RR=0.97,95%CI:0.69-1.35),abdominal pain(RR=1.14,95%CI:0.80-1.62),bleeding(RR=1.07,95%CI:0.70-1.63),or mortality(RR=0.86,95%CI:0.56-1.33)between the two groups.Subgroup analyses were also performed.CONCLUSION Rectal indomethacin appears to be safe and may offer benefit in selected high-risk patients,though findings should be interpreted with caution due to high heterogeneity.展开更多
Challenges in the prevention and treatment of mild cognitive impairment associated with Alzheimer's disease:Increased life expectancy due to advancements in medical care has given rise to an aging population,accom...Challenges in the prevention and treatment of mild cognitive impairment associated with Alzheimer's disease:Increased life expectancy due to advancements in medical care has given rise to an aging population,accompanied by a surge in the incidence of incurable neurodegenerative diseases(NDDs).These diseases primarily affect the cognitive and behavioral functions of older adults by impacting brain activity.Mild cognitive impairment(MCI)is a neurodegenerative condition that affects a significant portion of the population.展开更多
Alzheimer’s disease,a devastating neurodegenerative disorder,is characterized by progressive cognitive decline,primarily due to amyloid-beta protein deposition and tau protein phosphorylation.Effectively reducing the...Alzheimer’s disease,a devastating neurodegenerative disorder,is characterized by progressive cognitive decline,primarily due to amyloid-beta protein deposition and tau protein phosphorylation.Effectively reducing the cytotoxicity of amyloid-beta42 aggregates and tau oligomers may help slow the progression of Alzheimer’s disease.Conventional drugs,such as donepezil,can only alleviate symptoms and are not able to prevent the underlying pathological processes or cognitive decline.Currently,active and passive immunotherapies targeting amyloid-beta and tau have shown some efficacy in mice with asymptomatic Alzheimer’s disease and other transgenic animal models,attracting considerable attention.However,the clinical application of these immunotherapies demonstrated only limited efficacy before the discovery of lecanemab and donanemab.This review first discusses the advancements in the pathogenesis of Alzheimer’s disease and active and passive immunotherapies targeting amyloid-beta and tau proteins.Furthermore,it reviews the advantages and disadvantages of various immunotherapies and considers their future prospects.Although some antibodies have shown promise in patients with mild Alzheimer’s disease,substantial clinical data are still lacking to validate their effectiveness in individuals with moderate Alzheimer’s disease.展开更多
The rise of the aging population parallels the rapidly increasing cases of neurological disorders. This puts pressure on scientists and physicians to find novel methods that can prevent and treat neurodegeneration. Th...The rise of the aging population parallels the rapidly increasing cases of neurological disorders. This puts pressure on scientists and physicians to find novel methods that can prevent and treat neurodegeneration. The brain is made up of a complex network of different cell types that work in tandem to maintain systemic homeostasis.展开更多
I am pleased to present this special issue of Family Medicine and Community Health,entitled“The Global Burden of Preventable Cancer Mortality.”This issue was completed in collaboration with the Baylor College of Med...I am pleased to present this special issue of Family Medicine and Community Health,entitled“The Global Burden of Preventable Cancer Mortality.”This issue was completed in collaboration with the Baylor College of Medicine(BCM)Department of Family and Community Medicine in Houston,Texas,USA.The mission of the department is to enhance population health and advance the primary care discipline through rigorous and evidence-based prevention and research.We focus our research efforts on a broad range of research areas including,but not limited to,cancer con-trol,nutrition and health,medical education,and health disparities.展开更多
Good vision is fundamental to human experience,profoundly influencing educational attainment,economic productivity and overall quality of life.Currently,it is estimated that at least 2.2 billion people globally suffer...Good vision is fundamental to human experience,profoundly influencing educational attainment,economic productivity and overall quality of life.Currently,it is estimated that at least 2.2 billion people globally suffer from vision impairment(VI),with over 1 billion of these cases being preventable or treatable yet remaining unaddressed.Despite significant advancements in global eye care services over the past few decades,which have yielded considerable benefits,the challenges continue to mount.展开更多
Objective Alzheimer’s disease(AD)presents a significant global health challenge with a steadily increasing prevalence and impact.This comprehensive review aimed to delve into the epidemiology,pathophysiology,pharmaco...Objective Alzheimer’s disease(AD)presents a significant global health challenge with a steadily increasing prevalence and impact.This comprehensive review aimed to delve into the epidemiology,pathophysiology,pharmacological therapies,emerging research,challenges,and future directions of AD.Major findings from recent studies were synthesised,encompassing insights into the global prevalence,molecular pathology,high-risk factors,and therapeutic interventions,including cholinesterase inhibitors,glutamate receptor antagonists,and antibodies against Aβand tau proteins.Additionally,emerging research areas such as gene therapy and lipid nanoparticles were highlighted.This review emphasised the urgent need for ongoing research on novel therapeutic avenues and addressing the challenges in AD diagnosis,treatment,and care.Future perspectives underscore the potential of disease-modifying treatments,personalised medical approaches,and holistic interventions to alleviate the growing burden of AD on individuals,families,and healthcare systems worldwide.By fostering collaboration and innovation,we can strive towards a future where effective prevention,early detection,and personalised treatments enhance the lives of millions affected by AD globally.展开更多
The problem of gastric cancer(GC)prevention remains relevant for a long time.Various methods of population serological screening of atrophic gastritis and precancerous changes in the gastric mucosa have been created a...The problem of gastric cancer(GC)prevention remains relevant for a long time.Various methods of population serological screening of atrophic gastritis and precancerous changes in the gastric mucosa have been created at present.Modern endoscopic and morphological methods of verification of the diagnosis of precancerous diseases and changes in the gastric mucosa have been introduced into the practice of gastroenterologists and oncologists.GC risk stratification systems allow the formation of risk groups that require population screening.Practical hints for population serological screening of atrophic gastritis,endoscopic and morphological verification of precancerous changes and diseases of the stomach recommend using it:When developing state programs for the prevention of stomach cancer;when implementing preventive measures for stomach cancer by doctors of all specialties;the authors also offer the possibility of use by anyone over the age of 40,provided that they seek methodological help from their doctor;in the work of health schools in any medical and preventive institutions.The use of an assessment system of certain risk factor signatures with prognostic value would add significant assistance to preventive measures against GC.展开更多
Apical microsurgery is accurate and minimally invasive,produces few complications,and has a success rate of more than 90%.However,due to the lack of awareness and understanding of apical microsurgery by dental general...Apical microsurgery is accurate and minimally invasive,produces few complications,and has a success rate of more than 90%.However,due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists,many clinical problems remain to be overcome.The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus.This document specifies the indications,contraindications,preoperative preparations,operational procedures,complication prevention measures,and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.展开更多
In 1999,China released its first edition of the“Guidelines for the Prevention and Treatment of Hypertension”,which was subsequently updated in 2005,2010,and 2018,establishing a diagnostic,assessment,grading,stratifi...In 1999,China released its first edition of the“Guidelines for the Prevention and Treatment of Hypertension”,which was subsequently updated in 2005,2010,and 2018,establishing a diagnostic,assessment,grading,stratification,prevention,intervention,and management framework for hypertension tailored to the unique characteristics of the Chinese population.Over the past two decades,these guidelines have been widely implemented in clinical practice across China and have played a significant role in the management of hypertension and chronic diseases,the development of grassroots guidelines,the formulation of clinical pathways,and the implementation of health insurance policies.展开更多
To investigate the effect of saturation on the storage-dissipation properties and failure characteristics of red sandstone,as well as the energy mechanism of rockburst prevention by water,a series of uniaxial compress...To investigate the effect of saturation on the storage-dissipation properties and failure characteristics of red sandstone,as well as the energy mechanism of rockburst prevention by water,a series of uniaxial compression and uniaxial loading–unloading tests were conducted under five saturation levels.The effect of saturation on the mechanical properties and elastic energy density was analyzed,and a method for obtaining peak energy density was proposed.The effect of saturation on the energy evolution was examined,and the energy mechanism of water in preventing rockburst was revealed.The results indicate that an increase in saturation of red sandstone decreases the input energy density,elastic energy density,dissipated energy density,peak strength and peak strain;the compaction phase of the stress–strain curve becomes shorter;the failure mode transitions from X-conjugate oblique shear to single oblique shear;the variation in the debris ejection trajectory is as follows:radiation→X-ray→oblique upward parabola→horizontal parabola→oblique downward parabola;the degree of failure intensity and fragmentation is decreased gradually.Elastic energy density is interconnected with both saturation and stress but independent of the loading path.Saturation exhibits a dual effect on the energy storage property,i.e.,increasing saturation increases the energy storage efficiency and reduces the energy storage capacity.The ratio of peak elastic energy density to peak input energy density remains constant irrespective of saturation levels.Water prevents rockburst by decreasing the energy storage capacity of surrounding rock,alleviating the stress of surrounding rock to reduce energy storage,and elevating the energy release threshold of high-energy surrounding rock.The findings of this study contribute to understanding the effect of water on rock failure from an energy perspective,as well as provide theoretical guidance for rockburst prevention by water in deep tunnels.展开更多
BACKGROUND Elderly patients undergoing laparoscopic colorectal cancer surgery are at high risk for hypothermia-related complications.This study explores the efficacy of periop-erative composite insulation intervention...BACKGROUND Elderly patients undergoing laparoscopic colorectal cancer surgery are at high risk for hypothermia-related complications.This study explores the efficacy of periop-erative composite insulation interventions in maintaining normothermia and reducing postoperative risks in this vulnerable group.AIM To evaluate the efficacy of perioperative composite insulation in older patients undergoing colorectal cancer surgery.METHODS We selected 100 older patients who underwent laparoscopic surgery for colorectal cancer at Huzhou Central Hospital from September 2023 to April 2024.Using a random number table,patients were divided into a control group and inter-vention group of 50 patients each.After returning to the regular ward,the con-ventional group received traditional insulation intervention measures,while the intervention group received composite insulation nursing intervention.We ob-served and recorded postoperative blood pressure and heart rate changes,as well as postoperative anesthesia recovery time and incidence of complications.RESULTS The statistical results showed significant differences(P<0.05)in heart rate changes and systolic blood pressure between the two groups.There was a sig-nificant change in heart rate between the groups immediately after surgery and at 15 and 30 minutes after surgery(P<0.05).The heart rate and systolic blood pressure of the intervention group were significantly lower than those of the control group at 15 and 30 minutes after surgery(P<0.05).The rewarming time of the intervention group was shorter than that of the control group,and the overall incidence of postoperative complications was significantly lower than that of the control group(P<0.05).CONCLUSION For elderly patients undergoing laparoscopic colorectal cancer surgery,a composite insulation intervention during the perioperative period can maintain body temperature,reduce postoperative stress,and significantly reduce the incidence of hypothermia and related complications.展开更多
Purpose–This study aims to propose a cooperative adhesion control method for trains with multiple motors electric locomotives.The method is intended to optimize the output torque of each motor,maximize the utilizatio...Purpose–This study aims to propose a cooperative adhesion control method for trains with multiple motors electric locomotives.The method is intended to optimize the output torque of each motor,maximize the utilization of train adhesion within the total torque command,reduce the train skidding/sliding phenomenon and achieve optimal adhesion utilization for each axle,thus realizing the optimal allocation of the multi-motor electric locomotives.Design/methodology/approach–In this study,a model predictive control(MPC)-based cooperative maximum adhesion tracking control method for multi-motor electric locomotives is presented.Firstly,train traction system with multiple motors is constructed in accordance with Newton’s second law.These equations include the train dynamics equations,the axle dynamics equations,and the wheel-rail adhesion coefficient equations.Then,a new MPC-based multi-axle adhesion co-optimization method is put forward.This method calculates the optimal output torque through real-time iteration based on the known reference slip speed to achieve multi-axle co-optimization under different circumstances.Findings–This paper presents a MPC system designed for the cooperative control of multi-axle adhesion.The results indicate that the proposed control system is able to optimize the adhesion of multiple axles under numerous different conditions and achieve the optimal power distribution based on the reduction of train skidding/sliding.Originality/value–This study presents a novel cooperative adhesion tracking control scheme.It is designed for multi-motor electric locomotives,which has rarely been studied before.And simulations are carried out in different conditions,including variable surfaces and motor failing.展开更多
文摘BACKGROUND: Trauma is considered as a worldwide problem despite socio-economic development. Motor vehicle accidents(MVAs) are the most important cause of trauma. Trauma related deaths are mostly preventable. This study aimed to investigate the causes and prevention of death in trauma patients.METHODS: This retrospective, descriptive-analytic study assessed 100 trauma patients referred to our emergency department(ED) from January 2013 to Januanry 2015. The included patients were those with trauma died after arrival at our ED. Age, sex, cause of trauma, clinical causes of death, causes of death def ined by autopsy, way of transfer to the ED, time of ambulance arrival at the scene of trauma, and time elapsed to enter the ED from the scene of trauma were studied.RESULTS: In the 100 patients, 21(21%) patients were female and 79(79%) male. Fortythree patients were older than 60 years. Trauma was largely due to pedestrian accidents in 31% of the patients, and 33% had a hypo-volemic shock. About 80% of deaths were due to intra-cranial hemorrhage(ICH) or intra-ventricular hemorrhage(IVH), and spinal injuries were not preventable. Autopsy revealed that 28% of the patients suffered from internal injuries. Autopsy revealed that 19% of the deaths were not preventable and 81% were considered preventable. In our patients, 76 were transferred to the hospital by emergency medicine services(EMS). Analysis of time for ambulance arrival to the scene and frequency of death revealed that 52.2% of the deaths occurred between 11 and 15 minutes. Analysis of time for admission to the ED from the scene of trauma showed that 74.6% deaths occurred between 6 and 10 minutes.CONCLUSIONS: The rate of hospital preventable deaths is about 80%, a high mortality rate, which denotes a lack of proper diagnosis and treatment. The time for arrival of EMS at the scene of trauma is longer than that in other countries.
文摘Aim: To analyze the reasons for epidemic outbreaks of measles, mumps and viral hepatitis A and to propose measures to prevent them in future. Materials and methods: Тhe incidence of measles, mumps and hepatitis A in Plovdiv region was studied for the period 2006-2010. An analysis of the age structure of the patients was made, while taking into account the time for routine immunization performed against measles and mumps (first and second dose). Results: In 2006-2009 single cases of measles were found occasionally, but in 2010 they were 2787 (incidence 395/100,000). Most of them (51%) were for ages 13 months-12years, 27%-0-13 months and 11%-13 to 18 years. The incidence of mumps for 2006-2010 varied widely, and has increased significantly in 2007 (130/100,000) and 2008 (169/100,000). The majority of patients (over 34%) during the epidemics were aged 13 months-12years, and over 26% of them-13-19 years. For the period 2006-2010 the incidence of hepatitis A ranged from 2.98/100, 000 (2009) to 426/100,000 (2006). Over 50% of the cases involved children aged up to 9 years. For the three diseases over 80% of patients were individuals of Roma origin. Conclusions: 1. Epidemic spread of measles in 2010 was mainly due to shortcomings in the routine immunization carried as a prevention of the disease. 2. There are two reasons for the outbreak of mumps: А) Failure to administer the second vaccine dose at 12 years in Bulgaria until 2001. B) Shortcomings in routinely performed immunization. 3. The extremely high incidence of hepatitis A in 2006 (and in the rest of the years) is due to the lack of routine immunization. 4. Essential for the outbreaks in all three diseases are the poor hygienic living conditions, the low social status and the lack of health promotion of the population at risk 5. To prevent future outbreaks of the diseases hereby in question, we suggest it is appropriate: А) To introduce compulsory immunization against hepatitis A;B) To carry out periodic catch-up vaccination campaigns against measles and mumps.
文摘Background: In Tanzania elders are respected as repositories of inherited wisdom, experienced and principal decision makers in the community. However, evidence shows that such repositories are no longer considered important in most societies. As a result elders are neglected with some mistreatment in terms of provision of health and social services for instance;at times they get denied and ignored of their obvious rights, ignoring their retirement benefits and the rights onto free social services as per the Tanzania National Ageing Policy of 2003. Elders are therefore faced with physical, psychological and geriatric social suffering. It is on this basis that this study tries to explore the common preventable health and social problems encountered by elderly in Shinyanga Region in northern part of Tanzania. Methods: Across sectional community based study of 465 subjects randomly selected was done in three wards of Kahama District. The district was selected randomly out of 8 districts of Shinyanga Region, structured questionnaires with both closed and opened endower used;the information was collected from house to house and other information collected from health facilities within the wards as every ward had one public health facility;subjects (respondents) were obtained using purposive sampling technique aiming at elderly with 60 years of age and above. Results: Kahama district has a population of approximately 36,014 of which 1500 (4%) are in the elderly age group of 60 years and above. The study population was 465 which is 30% (465/1500) of the geriatric population of Kahama. Among this group 5% were female while 41% were male and 53% (248/465) were married. 64% (297/465) were taking care of themselves, 32% (150/465) cared by relatives and 4% (18/465) cared by the community. Among the respondents, 40% (185/465) were affected by HIV/AIDs in one way or another either living with orphans whose parents died of HIV/AIDS or asking care of the infected patients within the family. It was also found that 73% of the geriatrics were not exempted from medical treatment fees so they had to pay for their medical care. However, only 32% were aware of getting free treatment and 61% of the study populations were not satisfied with the medical care provided at the public health facilities. The common diseases affecting this age group are: Eye problem 59% (273/465);Arthritis 52% (241/465);Dental problems 27% (124/465);Hypertension 23% (107/465);Backache 22% (105/465);Malaria 28% (132/465);Hearing problems 26% (121/645);Urinary tract Infection 35% (165/465);Depression 8% (36/465). Dementia was also a problem though we had no tools to confirm the diagnosis;some of the geriatrics had more than two diseases. Conclusion: The majority of the elderly age group in Kahama District are not aware of their rights that they deserve free treatment according to Tanzania policy, furthermore for assessment and screening of health problems. A majority of the elderly die prematurely due to preventable diseases and more than half of the diseases affecting geriatrics are preventable.
文摘AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).
文摘BACKGROUND:Readmission to intensive care unit(ICU)after discharge to ward has been reported to be associated with increased hospital mortality and longer length of stay(LOS).The objective of this study was to investigate whether ICU readmission are preventable in critically ill cancer patients.METHODS:Data of patients who readmitted to intensive care unit(ICU)at National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences(CAMS)and Peking Union Medical College(PUMC)between January 2013 and November 2016 were retrospectively collected and reviewed.RESULTS:A total of 39 patients were included in the final analysis,and the overall readmission rate between 2013 and 2016 was 1.32%(39/2,961).Of 39 patients,32(82.1%)patients were judged as unpreventable and 7(17.9%)patients were preventable.There were no significant differences in duration of mechanical ventilation,ICU LOS,hospital LOS,ICU mortality and in-hospital mortality between patients who were unpreventable and preventable.For 24 early readmission patients,7(29.2%)patients were preventable and 17(70.8%)patients were unpreventable.Patients who were late readmission were all unpreventable.There was a trend that patients who were preventable had longer 1-year survival compared with patients who were unpreventable(100%vs.66.8%,log rank=1.668,P=0.196).CONCLUSION:Most readmission patients were unpreventable,and all preventable readmissions occurred in early period after discharge to ward.There were no significant differences in short term outcomes and 1-year survival in critically ill cancer patients whose readmissions were preventable or not.
文摘Tuberculosis (TB) incidence within Healthcare workers remains one of the lowest occupation specific rates in the United States. We report a case of a 33-year-old African American male presented with a right chest mass and without fever, chills or cough. Bacterial and Fungal cultures were sent during the initial visit and were negative throughout the entire management of his care. After several months of surgical interventions, the patient appeared positive for TB;however a staff member contracted the disease. The patient was managed successfully with the four-drug regimen of Isoniazid, Rifampin, Pyrazinamide and Ethambutol and recovered well from his surgeries.
文摘Objectives Coroners in England and Wales have a duty to write Prevention of Future Deaths(PFDs)reports when they believe that action should be taken to prevent similar deaths.We conducted a systematic case series of the reports involving maternal deaths to characterise these deaths in terms of demographics,explore the concerns raised by the coroners and understand what actions were reported by organisations in their responses to the coroner.Methods All coroners'PFDs published between July 2013 and 1 August 2023 in England and Wales were collected and reviewed(n=4435).Reports were searched for keywords related to maternal deaths.Case information was extracted into pre-specified domains and compared to other data on maternal deaths.Results Twenty nine(n=29)cases were found involving a maternal death.The median age at death was 33.5 years(IQR 29±36 years)and three-quarters(75.9%)of deaths occurred in hospitals.The most common cause of death was haemorrhage.Coroners frequently voiced concerns around the failure to provide appropriate treatment(48.2%)and failure of timely escalation(37.9%).Specific lessons we have highlighted include gaps in national guidance,failure to follow national protocols,communication issues and lack of resources or staff cover.Only 38%of PFDs had published responses from the organisations they were sent to.When organisations did respond to the coroner,80%reported that they implemented changes,including publishing new local policies,increasing training or committing to increased staffing.Conclusions Poor response rates to PFDs indicate underutilisation of these reports as a resource for improvement in maternal care.PFDs highlighted gaps in obstetric care and national guidance which,if appropriately addressed and regularly and routinely monitored,could prevent similar deaths.
文摘BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk.METHODS We searched PubMed,EMBASE,Scopus,and Cochrane Library databases to identify randomized controlled trials(RCTs)that compared rectal indomethacin with a control group to prevent PEP.Duplicates were removed,and studies were included based on the established inclusion criteria.We used the Cochrane Collaboration’s tool to assess the risk of bias in the RCTs.A random-effects model was applied to produce pooled risk ratios(RRs)with 95%confidence intervals(CIs).RESULTS We included a total of 30 RCTs involving 16977 patients.Compared to the control group,rectal indomethacin showed comparable rates of overall PEP(PEP;RR=0.85,95%CI:0.69-1.04,I2=79%)with no statistically significant difference of RR in mild(RR=0.92,95%CI:0.74-1.14),moderate(RR=0.78,95%CI:0.59-1.02),or severe PEP(RR=1.12,95%CI:0.75-1.67).There was also no difference in cases of adverse events(RR=0.97,95%CI:0.69-1.35),abdominal pain(RR=1.14,95%CI:0.80-1.62),bleeding(RR=1.07,95%CI:0.70-1.63),or mortality(RR=0.86,95%CI:0.56-1.33)between the two groups.Subgroup analyses were also performed.CONCLUSION Rectal indomethacin appears to be safe and may offer benefit in selected high-risk patients,though findings should be interpreted with caution due to high heterogeneity.
基金supported by The Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education(RS-2023-00244901)(to RB)。
文摘Challenges in the prevention and treatment of mild cognitive impairment associated with Alzheimer's disease:Increased life expectancy due to advancements in medical care has given rise to an aging population,accompanied by a surge in the incidence of incurable neurodegenerative diseases(NDDs).These diseases primarily affect the cognitive and behavioral functions of older adults by impacting brain activity.Mild cognitive impairment(MCI)is a neurodegenerative condition that affects a significant portion of the population.
基金supported by the Nature Science Foundation of Liaoning Province,Nos.2022-MS-211,2021-MS-064,and 2024-MS-048(all to YC).
文摘Alzheimer’s disease,a devastating neurodegenerative disorder,is characterized by progressive cognitive decline,primarily due to amyloid-beta protein deposition and tau protein phosphorylation.Effectively reducing the cytotoxicity of amyloid-beta42 aggregates and tau oligomers may help slow the progression of Alzheimer’s disease.Conventional drugs,such as donepezil,can only alleviate symptoms and are not able to prevent the underlying pathological processes or cognitive decline.Currently,active and passive immunotherapies targeting amyloid-beta and tau have shown some efficacy in mice with asymptomatic Alzheimer’s disease and other transgenic animal models,attracting considerable attention.However,the clinical application of these immunotherapies demonstrated only limited efficacy before the discovery of lecanemab and donanemab.This review first discusses the advancements in the pathogenesis of Alzheimer’s disease and active and passive immunotherapies targeting amyloid-beta and tau proteins.Furthermore,it reviews the advantages and disadvantages of various immunotherapies and considers their future prospects.Although some antibodies have shown promise in patients with mild Alzheimer’s disease,substantial clinical data are still lacking to validate their effectiveness in individuals with moderate Alzheimer’s disease.
文摘The rise of the aging population parallels the rapidly increasing cases of neurological disorders. This puts pressure on scientists and physicians to find novel methods that can prevent and treat neurodegeneration. The brain is made up of a complex network of different cell types that work in tandem to maintain systemic homeostasis.
文摘I am pleased to present this special issue of Family Medicine and Community Health,entitled“The Global Burden of Preventable Cancer Mortality.”This issue was completed in collaboration with the Baylor College of Medicine(BCM)Department of Family and Community Medicine in Houston,Texas,USA.The mission of the department is to enhance population health and advance the primary care discipline through rigorous and evidence-based prevention and research.We focus our research efforts on a broad range of research areas including,but not limited to,cancer con-trol,nutrition and health,medical education,and health disparities.
文摘Good vision is fundamental to human experience,profoundly influencing educational attainment,economic productivity and overall quality of life.Currently,it is estimated that at least 2.2 billion people globally suffer from vision impairment(VI),with over 1 billion of these cases being preventable or treatable yet remaining unaddressed.Despite significant advancements in global eye care services over the past few decades,which have yielded considerable benefits,the challenges continue to mount.
文摘Objective Alzheimer’s disease(AD)presents a significant global health challenge with a steadily increasing prevalence and impact.This comprehensive review aimed to delve into the epidemiology,pathophysiology,pharmacological therapies,emerging research,challenges,and future directions of AD.Major findings from recent studies were synthesised,encompassing insights into the global prevalence,molecular pathology,high-risk factors,and therapeutic interventions,including cholinesterase inhibitors,glutamate receptor antagonists,and antibodies against Aβand tau proteins.Additionally,emerging research areas such as gene therapy and lipid nanoparticles were highlighted.This review emphasised the urgent need for ongoing research on novel therapeutic avenues and addressing the challenges in AD diagnosis,treatment,and care.Future perspectives underscore the potential of disease-modifying treatments,personalised medical approaches,and holistic interventions to alleviate the growing burden of AD on individuals,families,and healthcare systems worldwide.By fostering collaboration and innovation,we can strive towards a future where effective prevention,early detection,and personalised treatments enhance the lives of millions affected by AD globally.
文摘The problem of gastric cancer(GC)prevention remains relevant for a long time.Various methods of population serological screening of atrophic gastritis and precancerous changes in the gastric mucosa have been created at present.Modern endoscopic and morphological methods of verification of the diagnosis of precancerous diseases and changes in the gastric mucosa have been introduced into the practice of gastroenterologists and oncologists.GC risk stratification systems allow the formation of risk groups that require population screening.Practical hints for population serological screening of atrophic gastritis,endoscopic and morphological verification of precancerous changes and diseases of the stomach recommend using it:When developing state programs for the prevention of stomach cancer;when implementing preventive measures for stomach cancer by doctors of all specialties;the authors also offer the possibility of use by anyone over the age of 40,provided that they seek methodological help from their doctor;in the work of health schools in any medical and preventive institutions.The use of an assessment system of certain risk factor signatures with prognostic value would add significant assistance to preventive measures against GC.
文摘Apical microsurgery is accurate and minimally invasive,produces few complications,and has a success rate of more than 90%.However,due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists,many clinical problems remain to be overcome.The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus.This document specifies the indications,contraindications,preoperative preparations,operational procedures,complication prevention measures,and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.
文摘In 1999,China released its first edition of the“Guidelines for the Prevention and Treatment of Hypertension”,which was subsequently updated in 2005,2010,and 2018,establishing a diagnostic,assessment,grading,stratification,prevention,intervention,and management framework for hypertension tailored to the unique characteristics of the Chinese population.Over the past two decades,these guidelines have been widely implemented in clinical practice across China and have played a significant role in the management of hypertension and chronic diseases,the development of grassroots guidelines,the formulation of clinical pathways,and the implementation of health insurance policies.
基金supported by the National Natural Science Foundation of China(52104133,52304227)the Natural Science Foundation of Hunan Province(2021JJ40465,2023JJ40548)the Opening Foundation of the State Key Laboratory of Mining Response and Disaster Prevention and Control in Deep Coal Mines(SKLMRDPC20KF03).
文摘To investigate the effect of saturation on the storage-dissipation properties and failure characteristics of red sandstone,as well as the energy mechanism of rockburst prevention by water,a series of uniaxial compression and uniaxial loading–unloading tests were conducted under five saturation levels.The effect of saturation on the mechanical properties and elastic energy density was analyzed,and a method for obtaining peak energy density was proposed.The effect of saturation on the energy evolution was examined,and the energy mechanism of water in preventing rockburst was revealed.The results indicate that an increase in saturation of red sandstone decreases the input energy density,elastic energy density,dissipated energy density,peak strength and peak strain;the compaction phase of the stress–strain curve becomes shorter;the failure mode transitions from X-conjugate oblique shear to single oblique shear;the variation in the debris ejection trajectory is as follows:radiation→X-ray→oblique upward parabola→horizontal parabola→oblique downward parabola;the degree of failure intensity and fragmentation is decreased gradually.Elastic energy density is interconnected with both saturation and stress but independent of the loading path.Saturation exhibits a dual effect on the energy storage property,i.e.,increasing saturation increases the energy storage efficiency and reduces the energy storage capacity.The ratio of peak elastic energy density to peak input energy density remains constant irrespective of saturation levels.Water prevents rockburst by decreasing the energy storage capacity of surrounding rock,alleviating the stress of surrounding rock to reduce energy storage,and elevating the energy release threshold of high-energy surrounding rock.The findings of this study contribute to understanding the effect of water on rock failure from an energy perspective,as well as provide theoretical guidance for rockburst prevention by water in deep tunnels.
文摘BACKGROUND Elderly patients undergoing laparoscopic colorectal cancer surgery are at high risk for hypothermia-related complications.This study explores the efficacy of periop-erative composite insulation interventions in maintaining normothermia and reducing postoperative risks in this vulnerable group.AIM To evaluate the efficacy of perioperative composite insulation in older patients undergoing colorectal cancer surgery.METHODS We selected 100 older patients who underwent laparoscopic surgery for colorectal cancer at Huzhou Central Hospital from September 2023 to April 2024.Using a random number table,patients were divided into a control group and inter-vention group of 50 patients each.After returning to the regular ward,the con-ventional group received traditional insulation intervention measures,while the intervention group received composite insulation nursing intervention.We ob-served and recorded postoperative blood pressure and heart rate changes,as well as postoperative anesthesia recovery time and incidence of complications.RESULTS The statistical results showed significant differences(P<0.05)in heart rate changes and systolic blood pressure between the two groups.There was a sig-nificant change in heart rate between the groups immediately after surgery and at 15 and 30 minutes after surgery(P<0.05).The heart rate and systolic blood pressure of the intervention group were significantly lower than those of the control group at 15 and 30 minutes after surgery(P<0.05).The rewarming time of the intervention group was shorter than that of the control group,and the overall incidence of postoperative complications was significantly lower than that of the control group(P<0.05).CONCLUSION For elderly patients undergoing laparoscopic colorectal cancer surgery,a composite insulation intervention during the perioperative period can maintain body temperature,reduce postoperative stress,and significantly reduce the incidence of hypothermia and related complications.
基金supported by Scientific Research Projects of China Association of Metros(CAMET-KY-2022039)State Key Laboratory of Traction and Control System of EMU and Locomotive(2023YJ386).
文摘Purpose–This study aims to propose a cooperative adhesion control method for trains with multiple motors electric locomotives.The method is intended to optimize the output torque of each motor,maximize the utilization of train adhesion within the total torque command,reduce the train skidding/sliding phenomenon and achieve optimal adhesion utilization for each axle,thus realizing the optimal allocation of the multi-motor electric locomotives.Design/methodology/approach–In this study,a model predictive control(MPC)-based cooperative maximum adhesion tracking control method for multi-motor electric locomotives is presented.Firstly,train traction system with multiple motors is constructed in accordance with Newton’s second law.These equations include the train dynamics equations,the axle dynamics equations,and the wheel-rail adhesion coefficient equations.Then,a new MPC-based multi-axle adhesion co-optimization method is put forward.This method calculates the optimal output torque through real-time iteration based on the known reference slip speed to achieve multi-axle co-optimization under different circumstances.Findings–This paper presents a MPC system designed for the cooperative control of multi-axle adhesion.The results indicate that the proposed control system is able to optimize the adhesion of multiple axles under numerous different conditions and achieve the optimal power distribution based on the reduction of train skidding/sliding.Originality/value–This study presents a novel cooperative adhesion tracking control scheme.It is designed for multi-motor electric locomotives,which has rarely been studied before.And simulations are carried out in different conditions,including variable surfaces and motor failing.