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Accessibility of primary healthcare in low and middle income countries: a systematic review 低收入和中等收入国家初级卫生保健的可及性:系统回顾
Pub Date : 2021-08-05 DOI: 10.33140/mcr.06.08.04
Background: Accessibility to healthcare is the capability of a population to obtain a specified set of healthcare services. There is a direct link between the distance patients travel to access health and the reduction of ill health and suffering in a country. This has an important impact on the quality of life of people. Objective: To find the spatial or geographic determinants of accessibility of primary healthcare provision in low and middle income countries during last two decades. Methods: Systematic review was done according to PRISMA guidelines. Data bases used were Google scholar, PubMed and Science direct. We found ten different studies from eight different economic groups of countries. Accessibility of primary healthcare in low and middle Income countries published during the period of last two decades were included using the key words like Spatial Accessibility;Geographical Accessibility; Primary Health Care; Primary Care; Low and middle income countries. The countries included were Afghanistan, Bangladesh, Bhutan, Democratic Republic of Congo, India, Indonesia, Sudan, Mozambique /Rural Africa. Two studies each from India and Mozambique (Rural Africa) were included. The categorization as low and middle income counties was as per World Bank classification. Results: We found that accessibility to primary healthcare was worse in low income countries like Afghanistan, Mozambique and South Sudan where more than two third of the population lived in underserved or difficult to access areas while rest of the countries, which come under category of lower middle income countries, more than half of the population lived in underserved or difficult to access areas.] Conclusion: Health care ease of access is a single most important component for equitable and adequate health system. Guaranteeing a healthcare system which is easily accessible to the people is a basic consideration for public health policy makers, policy implementers and academicians.
背景:医疗保健可及性是指人群获得一组特定医疗保健服务的能力。在一个国家,病人前往获得医疗服务的距离与减少健康不良和痛苦之间存在直接联系。这对人们的生活质量有着重要的影响。目的:寻找在过去二十年中低收入和中等收入国家初级卫生保健服务可及性的空间或地理决定因素。方法:根据PRISMA指南进行系统评价。使用的数据库是Google scholar, PubMed和Science direct。我们找到了来自8个不同国家经济集团的10项不同研究。在过去二十年中公布的低收入和中等收入国家初级卫生保健的可及性使用诸如空间可及性;地理可及性;初级卫生保健;初级保健;低收入和中等收入国家。这些国家包括阿富汗、孟加拉国、不丹、刚果民主共和国、印度、印度尼西亚、苏丹、莫桑比克/非洲农村地区。印度和莫桑比克(非洲农村)各纳入两项研究。低收入和中等收入国家的分类是按照世界银行的分类。结果:我们发现,在阿富汗、莫桑比克和南苏丹等低收入国家,初级卫生保健的可及性更差,这些国家超过三分之二的人口生活在服务不足或难以进入的地区,而其他国家,这些国家属于中低收入国家,超过一半的人口生活在服务不足或难以进入的地区。结论:卫生保健的可及性是公平和充足卫生系统的一个最重要的组成部分。保障人民群众容易获得的医疗保健体系是公共卫生政策制定者、政策执行者和学者的基本考虑。
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引用次数: 0
Ibrutinib induced atrial fibrillation complicated with massive hemoptysis 依鲁替尼诱发心房颤动并大咯血
Pub Date : 2021-08-05 DOI: 10.33140/mcr.06.08.02
Background: The oncologic patient faces multiple adverse effects with cytotoxic medications, from tissue damage and intoxications that could be evident from muscle damage, neurologic to cardiac toxicity. Case: This is a case of a 79-year-old female who presented to our ED with the complaint of hemoptysis for one day, denied any associated cough, fever, chills, chest pain, SOB, nausea, vomiting, or abdominal pain. No history of trauma. Her medical history includes hypertension, uterine cancer status post-resection. The patient denied prior similar episodes, family history of similar complaints. Chest X-ray showed extensive bilateral infiltrates and cardiomegaly. CT chest ruled out pulmonary em-bolism but showed extensive multifocal pneumonia vs. ARDS, lymphoproliferative changes. While in the ED, the patient started having bloody nasal secretions noted, requiring nasogastric lavage revealing dark blood secretions, and then started having massive hemoptysis and rapidly decompensated requir-ing endotracheal intubation hypoxic respiratory failure. An emergent bronchoscopy was performed, which showed suspected alveolar hemorrhage (Figure 1). The CBC showed severe anemia requiring multiple transfusions due to active bleeding (Table 1). The patient was admitted to ICU. The patient’s PCP was contacted to obtain further information that reported a new history of atrial fi-brillation on rivaroxaban recently started, CLL on ibrutinib, and Coombs Hemolytic Anemia. The hospital course was complicated by distributive shock and ARDS. She was covered with broad-spectrum antibiotics and required fresh frozen plasma due to persistent bleeding. The patient improved after anticoagulation and ibrutinib were held. The patient was eventually extubated, required physical therapy for deconditioning, and then was discharged. Conclusion: This case represents clear evidence of how an appropriate assessment on time and the collateral gath-ering of medical history could impact the outcome of our patients. The literature review has shown new-onset atrial fibrillation and bleeding events related to ibrutinib. Given the risk for bleeding with rivaroxaban, their combination could present with massive alveolar hemorrhage that could become fa-tal if not recognized early.
背景:肿瘤患者面临细胞毒性药物的多重不良反应,从组织损伤和中毒,可能从肌肉损伤,神经系统到心脏毒性。病例:这是一个79岁的女性病例,她到我们的急诊科就诊,主诉咯血一天,否认有任何相关的咳嗽、发烧、寒战、胸痛、哽咽、恶心、呕吐或腹痛。没有外伤史。病史包括高血压、子宫癌切除后情况。患者否认既往有类似发作,家族史。胸部x线显示双侧广泛浸润及心脏肿大。胸部CT排除肺栓塞,但显示广泛的多灶性肺炎与ARDS,淋巴增生性改变。在急诊科,患者开始出现鼻分泌物血性,需要鼻洗胃,发现深色血分泌物,然后开始大量咯血,迅速失代偿,需要气管内插管,缺氧呼吸衰竭。急诊支气管镜检查显示疑似肺泡出血(图1)。CBC显示活动性出血导致严重贫血,需要多次输血(表1)。患者被送入ICU。联系了患者的PCP以获得进一步的信息,报告了最近开始使用利伐沙班的心房颤动的新病史,伊鲁替尼的CLL和库姆斯溶血性贫血。住院过程因分布性休克和ARDS而复杂化。她使用了广谱抗生素,由于持续出血需要新鲜冷冻血浆。抗凝及依鲁替尼治疗后病情好转。患者最终拔管,需要物理治疗,然后出院。结论:该病例清楚地证明了适当的时间评估和病史的附带收集如何影响我们患者的结果。文献综述显示新发心房颤动和出血事件与依鲁替尼有关。考虑到利伐沙班有出血的风险,这两种药物联合使用可能导致大量肺泡出血,如果不及早发现,可能会致命。
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引用次数: 0
Giant cell glioblastoma in childhood-Pathohistological and immunohistochemical analysis, forecast and complex treatment 儿童巨细胞胶质母细胞瘤的病理组织学和免疫组织化学分析、预测和综合治疗
Pub Date : 2021-07-12 DOI: 10.33140/mcr.06.07.06
A six year old child is presented with giant cell glioblastoma multiforme. The importance of pathohistological and immunohistochemical analysis is discussed for the diagnosis of this rare pathohistological subtype glioblastoma in childhood. The Magnetic Resonance Image Characteristics, unfavorable prognosis and high cancer cell resistance to radiotherapy (RT) and chemotherapy (Ch) are also highlighted. The risk of local recurrences and tumor progression is high, despite the complex treatment, including visibly total tumor surgery, postoperative RT and adjuvant Ch. By this pediatric clinical case of childhood giant cell glioblastoma multiforme, we emphasize the emerging need to optimize early diagnostics and the multidisciplinary healing approach.
一个六岁的儿童患有多形性巨细胞胶质母细胞瘤。病理组织学和免疫组织化学分析的重要性,以诊断这种罕见的病理组织学亚型胶质母细胞瘤在儿童。同时也强调了其磁共振影像特征、不良预后及肿瘤细胞对放疗和化疗的高耐药性。尽管治疗复杂,包括明显的全肿瘤手术、术后RT和辅助Ch,但局部复发和肿瘤进展的风险很高。通过这例儿童多形性巨细胞胶质母细胞瘤的临床病例,我们强调需要优化早期诊断和多学科治疗方法。
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引用次数: 0
The corona returns to israel-this thime with the indian triple mutant 2delta 日冕病毒返回以色列,这次携带的是印度三突变体2delta
Pub Date : 2021-07-12 DOI: 10.33140/mcr.06.07.05
The biggest threat: “Not only in Israel-the” Delta”variant worries the world [1-5] report. ‘Delta’ variant evolves to form ‘Delta Plus’, is there a cause to worry? Covid-19 The ‘delta’ variant of COVID-19-a version first detected in India- has evolved to form the ‘delta plus’ or AY.1 variant. Scientists say it has acquired a mutation associated with escaping immunity, but there is no cause for concern yet.
最大的威胁:不仅在以色列——“德尔塔”变种令世界担忧[1-5]的报道。“Delta”变体演变成“Delta Plus”,有什么值得担心的吗?Covid-19的“delta”变体-首次在印度发现的版本-已经演变成“delta +”或ay -1变体。科学家说,它已经获得了一种与逃避免疫有关的突变,但目前还没有理由担心。
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引用次数: 0
How Antioxidant Have an Effect on Scavenger Receptors Action 抗氧化剂如何影响清道夫受体的作用
Pub Date : 2021-07-01 DOI: 10.33140/mcr.06.07.02
Today’s lifestyle has changed in comparison with the past. Using junk foods and unhealthy foods leads to increasing the risk of heart attacks. Atherosclerosis is an inflammation disease made by many factors that lead to cardiovascular diseases (CVD). Macrophages, endothelial cells, OX-LDL, and some oxidants such as reactive oxygen species (ROS) are the reasons for this transformation, and they have an important role in causing cardiovascular disease. Hyperlipidemia is a major reason for atherosclerosis. Increase in the use of fatty food and fast food can lead to a rise in the risk of atherosclerosis. Macrophages are special cells derived from monocytes and can make plaque which led to increased risk of atherosclerosis. Curcumin is one of important ant inflammation can reduce the risk of CVD. Some studies illustrate that a class SRs, SR-AI and SR-AII, and 2 members of the B class, CD36 and SR-BI, involved in atherosclerosis process. Some studies strongly suggest that oral antioxidants are effective in atherosclerosis treatment, most of them have been unsuccessful except probucol. The aim of this study is illustrating that how curcumin as antioxidant can effect on atherosclerosis proses and scavenger receptor’s activation.
与过去相比,今天的生活方式发生了变化。食用垃圾食品和不健康食品会增加心脏病发作的风险。动脉粥样硬化是一种由多种因素引起的炎症性疾病,可导致心血管疾病。巨噬细胞、内皮细胞、OX-LDL和一些氧化剂如活性氧(ROS)是这种转化的原因,它们在引起心血管疾病中起重要作用。高脂血症是动脉粥样硬化的主要原因。多吃高脂肪食物和快餐会增加患动脉粥样硬化的风险。巨噬细胞是源自单核细胞的特殊细胞,可以形成斑块,从而增加动脉粥样硬化的风险。姜黄素是一种重要的抗炎症物质,可以降低心血管疾病的风险。一些研究表明,一类SRs, SR-AI和SR-AII,以及B类的2个成员,CD36和SR-BI参与了动脉粥样硬化的过程。一些研究强烈表明口服抗氧化剂对动脉粥样硬化的治疗是有效的,但除普罗布考外,大多数研究都不成功。本研究的目的是阐明姜黄素作为抗氧化剂对动脉粥样硬化过程和清道夫受体激活的影响。
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引用次数: 0
The Impact of exposure to screen during COVID-19 Lockdown on the General health of students in Punjab, Pakistan 2019冠状病毒病封锁期间接触筛查对巴基斯坦旁遮普省学生总体健康的影响
Pub Date : 2021-07-01 DOI: 10.33140/mcr.06.07.04
Background: Since Covid-19 was declared a pandemic and a worldwide lockdown was imposed, it was predicted that there would be an increase in screen usage, especially among students, which could potentially have a lot of negative symptomology associated with it. Objective: The objective of our study was to determine the extent of screen exposure among medical students during lockdown and to study the symptoms that they faced due to it along with their frequency. Methods: In our descriptive cross-sectional study, we distributed the specifically designed questionnaire through online media to the concerned population, in order to gather important data about the physical and mental symptoms experienced by the medical students as a result of excessive screen exposure. Results: Of the 400 participants, 93.75 % reported an increase in screen time during the lockdown. As a consequence of increased screen usage, 207 (51.75%) of the participants reported headache, 267 (66.75%) reported fatigue, 283 (70.75%) reported eye strain, 121 (30.25%) reported dry eyes, 143 (35.75%) reported blurry vision, 154 (38.5%) reported teary eyes, 154 (38.5%) reported ear ache, 247 (61.75%) reported neck and back stiffness and 148 (37%) participants agreed to having experienced fingers and hand fatigue. We also established that increasing screen time was associated with a progressive decrease in physical activity (p=0.11) and increase in food consumption (p=0.002). A significant association was also recorded with weight gain (p=0.03). We found that the students previously diagnosed with a refractive error were more likely to complain of eye strain (p=0.004) and those diagnosed with migraine experienced more screen related headache (p=0.001). Of the 11 symptoms related to mental health in the questionnaire, students with screen usage of less than 4 hours marked a median of 2 symptoms, those with screen time of 4-8 hours marked a median of 4 symptoms and those with a screen usage >8 hours ticked a median of 5 symptoms. Students who had been diagnosed with anxiety or depression in the past checked an average of 5.24 symptoms while those with no such diagnosis had only 3.51 symptoms on average. Conclusion: The results proved a potential impact on the general health of the medical students. A significant increase in weight was observed along with other serious short and long term effects on their physical and mental wellbeing.
背景:自2019冠状病毒病被宣布为大流行并在全球范围内实施封锁以来,预计屏幕的使用将会增加,尤其是在学生中,这可能会带来许多与之相关的负面症状。目的:本研究的目的是确定医科学生在封锁期间的屏幕暴露程度,并研究他们因此而面临的症状及其频率。方法:采用描述性横断面研究方法,通过网络媒体向相关人群发放专门设计的问卷,以收集医学生因过度屏幕暴露而出现的身心症状的重要数据。结果:在400名参与者中,93.75%的人报告在封锁期间屏幕时间增加了。由于屏幕使用增加,207名(51.75%)参与者报告头痛,267名(66.75%)报告疲劳,283名(70.75%)报告眼睛疲劳,121名(30.25%)报告眼睛干涩,143名(35.75%)报告视力模糊,154名(38.5%)报告泪眼,154名(38.5%)报告耳朵疼痛,247名(61.75%)报告颈部和背部僵硬,148名(37%)参与者同意经历手指和手疲劳。我们还确定,屏幕时间的增加与体力活动的逐渐减少(p=0.11)和食物消耗的增加(p=0.002)有关。与体重增加也有显著关联(p=0.03)。我们发现,以前被诊断为屈光不正的学生更有可能抱怨眼睛疲劳(p=0.004),而那些被诊断为偏头痛的学生更有可能经历与屏幕相关的头痛(p=0.001)。在问卷中与心理健康相关的11种症状中,使用屏幕时间少于4小时的学生有2种症状的中位数,使用屏幕时间为4-8小时的学生有4种症状的中位数,使用屏幕时间为80小时的学生有5种症状的中位数。过去被诊断为焦虑或抑郁的学生平均检查了5.24种症状,而没有被诊断为焦虑或抑郁的学生平均检查了3.51种症状。结论:本研究结果对医学生整体健康有潜在影响。他们的体重显著增加,并对他们的身心健康产生了其他严重的短期和长期影响。
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引用次数: 0
Remembering the footsteps of five distinguished ophthalmologists from the present in the era of the COVID-19 pandemic 在新冠肺炎大流行时代,追忆五位杰出眼科医生的足迹
Pub Date : 2021-06-26 DOI: 10.33140/mcr.06.06.14
We have reported that 40 specific intractable diseases and 24 types of cancer and malignancies as well as Kawasaki disease may be triggered by pollen in our previous papers. Further, we reported in 2021 two articles regarding relation of outbreak of Influenza and COVID-19, and pollen exposure. In this paper, five distinguished ophthalmologists will be considered and described. Mikito Takayasu was the first person to report the discovery of Takayasu’s arteritis, one of the vasculitis syndromes, which may be a pollen-induced disease as well as Kawasaki disease. Next, Einosuke Harada, Alfred Vogt and Yoshizo Koyanagi are considered and described as the reporters of Vogt-Koyanagi-Harada disease. The fifth ophthalmologist is Li Wenliang who was the first person in the world to report the outbreak of SARS-COV-2 infection. Many people are still unaware of the fact that exposure to pollen can lead to many diseases. The author hopes that those who are involved in medical care will consider the scientific facts, keep their eyes open, and use this knowledge in their daily activities, although clear proof in experimental medicine is craved.
我们在之前的文章中报道了40种特定的顽固性疾病和24种癌症和恶性肿瘤以及川崎病可能由花粉引起。此外,我们在2021年报道了两篇关于流感和COVID-19爆发以及花粉暴露的关系的文章。在本文中,五位杰出的眼科医生将考虑和描述。Mikito Takayasu是第一个报告发现Takayasu动脉炎的人,这是血管炎综合征之一,可能是一种花粉引起的疾病,也可能是川崎病。其次,原田Einosuke Harada, Alfred Vogt和yoshiizo Koyanagi被认为是Vogt-Koyanagi-Harada病的记者。第五位是李文亮,他是世界上第一个报告SARS-COV-2感染爆发的眼科医生。许多人仍然不知道接触花粉会导致许多疾病。作者希望那些参与医疗保健的人能够考虑科学事实,睁大眼睛,并在日常活动中使用这些知识,尽管需要实验医学的明确证据。
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引用次数: 0
Remembering the footsteps of five distinguished ophthalmologists during the COVID-19 pandemic(epidemic) 纪念新冠肺炎大流行期间五位杰出眼科医生的足迹
Pub Date : 2021-06-19 DOI: 10.33140/mcr.06.06.014
A. Awaya, Y. Kuroiwa
We have reported that 40 specific intractable diseases and 24 types of cancer and malignancies as well as Kawasaki disease may be triggered by pollen in our previous papers. Further, we reported in 2021 two articles regarding relation of outbreak of Influenza and COVID-19, and pollen exposure. In this paper, five distinguished ophthalmologists will be considered and described. Mikito Takayasu was the first person to report the discovery of Takayasu’s arteritis, one of the vasculitis syndromes, which may be a pollen-induced disease as well as Kawasaki disease. Next, Einosuke Harada, Alfred Vogt and Yoshizo Koyanagi are considered and described as the reporters of Vogt-Koyanagi-Harada disease. The fifth ophthalmologist is Li Wenliang who was the first person in the world to report the outbreak of SARS-COV-2 infection. Many people are still unaware of the fact that exposure to pollen can lead to many diseases. The author hopes that those who are involved in medical care will consider the scientific facts, keep their eyes open, and use this knowledge in their daily activities, although clear proof in experimental medicine is craved.
我们在之前的文章中报道了40种特定的顽固性疾病和24种癌症和恶性肿瘤以及川崎病可能由花粉引起。此外,我们在2021年报道了两篇关于流感和COVID-19爆发以及花粉暴露的关系的文章。在本文中,五位杰出的眼科医生将考虑和描述。Mikito Takayasu是第一个报告发现Takayasu动脉炎的人,这是血管炎综合征之一,可能是一种花粉引起的疾病,也可能是川崎病。其次,原田Einosuke Harada, Alfred Vogt和yoshiizo Koyanagi被认为是Vogt-Koyanagi-Harada病的记者。第五位是李文亮,他是世界上第一个报告SARS-COV-2感染爆发的眼科医生。许多人仍然不知道接触花粉会导致许多疾病。作者希望那些参与医疗保健的人能够考虑科学事实,睁大眼睛,并在日常活动中使用这些知识,尽管需要实验医学的明确证据。
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引用次数: 0
The Application of the Novel “Six-Step Teaching Method” In the Teaching Management for the Nursing Interns 新颖的“六步教学法”在护理实习生教学管理中的应用
Pub Date : 2021-06-10 DOI: 10.33140/mcr.06.06.08
Objective: To study the application of the novel “Six-Step Teaching Method” in the teaching management for the nursing interns. Methods: Seventy nursing interns in the year of 2018 and 2019 practiced in The Fourth Hospital of Shijiazhuang were selected and divide into control group and observation group. The control group received the traditional teaching method for nursing practice, and the observation group was given the new “Six-Step Teaching Method” for nursing practice. The novel “Six-Step Teaching Method” includes the teachers showing the operation, the teacher guiding the interns operation, the interns independent operation, the interns self-evaluation, the evaluation between of teachers and interns, and the head nurses’ appraisal. After the interns practiced 10 months, the theoretical achievement, the practical operation skills achievement, the satisfaction between the teachers and interns each other and adverse events happened in the interns of two groups were recorded and compared. Results: Compared with the control group, the theoretical achievement increased by 29.82% (P<0.05) and the practical operation skills achievement increased by 22.60% (P<0.05). The satisfaction of teachers to interns of each other was raised 13.40% and 19.83%, respectively. The adverse events happened in interns was lowered by 62.50% in the observation group, as compared with control group. Conclusion: The novel “Six-Step Teaching Method” can raise the theory and practice level, enhance the satisfaction between the teacher and the nursing interns and lower the adverse events happened. These results suggested that the novel “Six-Step Teaching Method” has a good practical value in the teaching management for nursing interns and is worth for application in the clinic.
目的:探讨新颖的“六步教学法”在护理实习生教学管理中的应用。方法:选取石家庄市第四医院2018年和2019年实习的护理实习生70名,分为对照组和观察组。对照组采用传统护理实践教学方法,观察组采用新的护理实践“六步教学法”。新颖的“六步教学法”包括教师示范操作、教师指导实习生操作、实习生自主操作、实习生自我评价、教师与实习生评价、护士长评价。实习10个月后,记录两组实习生的理论成绩、实际操作技能成绩、教师与实习生之间的满意度及实习生不良事件发生情况。结果:与对照组比较,理论成绩提高29.82% (P<0.05),实际操作技能成绩提高22.60% (P<0.05)。教师对实习生彼此的满意度分别提高了13.40%和19.83%。观察组实习生不良事件发生率较对照组降低62.50%。结论:新颖的“六步教学法”能提高理论水平和实践水平,提高教师与实习护士的满意度,降低不良事件的发生。结果表明,新型的“六步教学法”在护理实习生教学管理中具有较好的实用价值,值得在临床推广应用。
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引用次数: 0
Clinical Prognosis of AKT2 and COX2 Mutation on Colorectal Cancer 结直肠癌患者AKT2和COX2突变的临床预后
Pub Date : 2021-06-10 DOI: 10.33140/mcr.06.06.07
Cancer has become one of the most mortal diseases in the world. It was estimated in 2018 18.1 millions new cancer cases. The colorectal cancer (CRC) is the third most common type of cancer in men and the second in women around the world [1]. The incidence risk in the occidental population is 5% to 6%, and it can increase to 15% to 30% when a first degree relative has the diagnoses. In hereditary predisposition cancer syndrome like the Lynch syndrome it can grow up to 80% [2].
癌症已成为世界上最致命的疾病之一。据估计,2018年新增癌症病例为1810万例。结直肠癌(colorectal cancer, CRC)是世界范围内男性第三大常见癌症,女性第二常见癌症[1]。西方人群的发病率为5%至6%,如果有一级亲属被诊断患有此病,发病率可增加至15%至30%。在像Lynch综合征这样的遗传性易感性癌症综合征中,它可以增长到80%[2]。
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引用次数: 0
期刊
British Medical Journal (Clinical research ed.)
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