Suchergebnisse

BACKGROUND: Type 2 diabetes is associated with substantial cardiovascular morbidity and mortality arising from the high prevalence of cardiovascular risk factors such as hypertension, dyslipidaemia, obesity, poor glycaemic control and albuminuria. Adequacy of control of these risk factors determines the frequency and outcome of cardiovascular events in the patients. Current clinical practice guidelines emphasize primary prevention of cardiovascular disease in type 2 diabetes. There is scarce data from the developing countries, Kenya included, on clinical care of patients with type 2 diabetes in the regions that are far away from tertiary health facilities. So we determined the adequacy of control of the modifiable risk factors: glycaemic control, hypertension, dyslipidemia, obesity and albuminuria in the study patients from rural and peri-urban dwelling. METHODS: This was a cross-sectional study on 385 randomly selected ambulatory patients with type 2 diabetes without overt complications. They were on follow up for at least 6 months at the Out-patient diabetes clinic of Nyeri County Hospital, a public health facility located in the central region of Kenya. RESULTS: Females were 65.5%. The study subjects had a mean duration of diabetes of 9.4 years, IQR of 3.0-14 years. Their mean age was 63.3 years, IQR of 56-71 years. Only 20.3% of our subjects had simultaneous optimal control of the three (3) main cardiovascular risk factors of hypertension, high LDL-C and hyperglycaemia at the time of the study. The prevalence of cardiovascular risk factors were as follows: HbA1c above 7% was 60.5% (95% CI, 55.6-65.5), hypertension, 49.6% of whom 76.6% (95% CI, 72.5-80.8) were poorly controlled. High LDL-Cholesterol above 2.0 mmol/L was found in 77.1% (95% CI 73.0-81.3) and Albuminuria occurred in 32.7% (95% CI 27.8-37.4). The prevalence of the other habits with cardiovascular disease risk were: excess alcohol intake at 26.5% (95% CI 27.8-37.4) and cigarette-smoking at 23.6%. A modest 23.4% of the treated patients with hypertension attained target blood pressure of <140/90 mmHg. Out of a paltry 12.5% of the statin-treated patients and others not actively treated, only 22.9% had LDL-Cholesterol of target <2.0 mmol/L. There were no obvious socio-demographic and clinical determinants of poor glycaemic control. However, old age above 50 yrs., longer duration with diabetes above 5 yrs. and advanced stages of CKD were significantly associated with hypertension. Female gender and age, statin non-use and socio-economic factor of employment were the significant determinants of high levels of serum LDL-cholesterol. CONCLUSION: The majority of the study patients attending this government-funded health facility had high prevalence of cardiovascular risk factors that were inadequately controlled. Therefore patients with type 2 diabetes should be risk-stratified by their age, duration of diabetes and cardiovascular risk factor loading. Consequently, composite risk factor reduction strategies are needed in management of these patients to achieve the desired targets safely. This would be achieved through innovative care systems and modes of delivery which would translate into maximum benefit of primary cardiovascular disease prevention in those at high risk. It is a desirable quality objective to have a higher proportion of the patients who access care benefiting maximally more than the numbers we are achieving now.

The bacground of this study is the issue of Act Number 39, 2009 concerning Health, which is considered destrimental to tobaccoo industry, especially farmers, and also raises some debates. Theoretical framework of this study consists of agency and stucturization theories. This study was analyzed with discourse analysis using three strategies: (1) institutional strategy, i.e. to see institutionally the pro and contra about health regulation on addictive substances and tobacco; (2) social strategy, i.e. to see arguments of group of society as a respond to the regulation and to defferentiate empowering and disempowering orientation; (3) ironic strategy: to place the discourse of tobacco in relation to public health by explaining the increase of self-monitoring and discipline, which seems to foster the new growth quickly (proleferation), but ironically tends to lower the ceredibility. This study found that: (1) Parties that reject the regulation argue that government does not consider the contribution of the income from tobacco custom, the job vacancy offered by tobacco industry, tobacco farmers, and local government commodity. (2) Parties that support the regulation argue that cigarettes contain addictive substance, are dangerous to active and passive smokers, can cause cancer, heart attack, and increase mortality rate. (3) Nahdlatul Ulama is one of Islamic social organizations that reject the regulation as well as reject the disagree with the statement 'haram' for smoking with the consideration that there is no text to judge that law. Latar belakang penelitian ini adalah Undang-Undang Nomor 36 Tahun 2009 tentang Kesehatan diundangkan oleh Negara, dianggap merugikan industri pertembakauan, dan khususnya para petani, dan mengundang berbagai perdebatan. Framework teoretis yang membangun sistem berpikir dalam kajian ini adalah agency dan strukturisasi. Teknis analisisnya adalah analisis wacana menggunakan tiga strategi, yaitu (1) Strategi institusional; sejauhmana melihat wacana pro kontra regulasi Kesehatan tentang zat adictive dan tembakau secara institusional. (2) strategi sosial, dengan melihat argumentasi kelompok masyarakat atas respon regulasi tersebut dengan membedakan orientasi pemberdayaan (empowering) dan bukan pemberdayaan (disempowering). (3) strategi ironic, dengan menempatkan wacana tembakau dari perspektif spesifik terkait dengan kesehatan masyarakat yang menjelaskan peningkatan self-monitoring and discipline, yang seolah-olah mendorong pertumbuhan baru secara cepat (proleferation), dan ironis yang cenderung menurunkan kredibilitas. Hasil penelitian ini adalah: 1) Pihak yang menolak pemberlakuan regulasi, berargumentasi bahwa pemerintah tidak memperhatikan kontribusi melalui cukai kepada pendapatan negara, penyerapan tenaga kerja yang sangat signifikan untuk masyarakat industri, dan para petani tembakau dan menjadi komoditas andalan pemerintah daerah. Di samping itu, kontrol industri multinasional asing, WHO, FCTC, dan Kementerian Kesehatan, serta NGO masuk kawasan negara berkembang, baik melalui kegiatan akademis, keagamaan, industri global untuk menguasai dan menggantikan produk rokok yang bebas 'zat adiktif', dan berakhir meminggirkan produksi kretek lokal. 2) Pihak yang mendukung pemberlakuan regulasi rokok, berdasar pada kandungan rokok yang mengandung zat adiktif; membahayakan bagi perokok aktif dan pasif, dan mengakibatkan kanker, jantung, dan bahkan meningkatkan angka kematian. Hal ini didukung oleh lembaga WHO, FCTC, Kementerian kesehatan, berbagai ormas Islam (Muhammadiyah dan ormas Islam lain) melalui MUI, dan Kelompok LSM yang konsern di bidang kesehatan dan lingkungan hidup. 3) Nahdlatul Ulama adalah salah satu ormas Islam yang menolak atas pemberlakuan regulasi tersebut dan juga menolak penetapan rokok/merokok adalah haram atas pertimbangan secara teks, bahwa tidak ada dalil yang dapat digunakan untuk penetapan "haram mutlak".

Актуальность. Тромбоз глубоких вен и тромбоэмболия легочной артерии являются важной проблемой здравоохранения с потенциально тяжелыми последствиями. Так, среди причин материнской смертности в Украине тромбоэмболия легочной артерии занимает 4–5-е ранговое место, а в странах Евросоюза, США, Канаде, Японии она входит в первую тройку.Цель — изучить влияние препарата Латрен на агрегационную способность тромбоцитов на этапе преконцепционной подготовки женщин, относящихся к группе риска развития венозной тромбоэмболии.Пациенты и методы. Исследование агрегационной способности тромбоцитов проведено у 24 женщин с хронической венозной недостаточностью II–III степени, обусловленной варикозной болезнью нижних конечностей.Результаты и выводы. Достоверные показатели снижения адреналін- и колаген-индуцированной агрегации тромбоцитов более чем в 1,5 раза у исследуемых женщин после лечения пентоксифиллином, что доказывает комплексное действие препарата на агрегацию тромбоцитов под. действием различных индукторов, что в дальнейшем позволяет предотвратить полипрагмазию. Использование в комплексной прегравидарной профилактике у женщин с хронической венозной недостаточностью препарата Латрен (Юрия-Фарм) позволяет улучшить реологические свойства крови и минимизировать риск возникновения внутрисосудистого тромбообразования за счет компенсации состояния тромбоцитарного звена гемостаза во время будущей беременности. ; Rationale. Deep vein thrombosis and pulmonary artery thromboembolia are important health problems with potentially severe consequences. Thus, pulmonary embolism ranks 4–5th for the causes of maternal mortality in Ukraine, and in the European Union, the USA, Canada, Japan, it makes the top three.Purpose — to study the effect of Latrenum on the platelet aggregation at the stage of preconceptional preparation of women, who belong to the risk group of venous thromboembolism.Materials and methods. Investigation of platelet aggregation was performed in 24 women with chronic venous insufficiency II–III grade, which is caused by varicose veins of the lower extremities.Results and conclusions. The statistically significant decrease of adrenaline- and collagen-induced platelet aggregation rates by more than 1.5 times was observed in the examined women after pentoxifylline treatment that proves the comprehensive effect of the drug on platelet aggregation under the influence of various inductors and prevents polypragmasy in future. An administration of Latrenum (manufactured by Yuria-Farm LLC) in the integrated preconceptional prevention in women with chronic venous insufficiency improves the blood rheological properties and minimizes the risk of intravascular thrombosis by means of compensation of thrombolytic component hemostasis during the future pregnancy. ; Актуальнiсть. Тромбоз глибоких вен і тромбоемболія легеневої артерії є важливими проблемами охорони здоров'я з потенційно тяжкими наслідками. Так, серед причин материнської смертності в Україні тромбоемболія легеневої артерії посідає 4–5-те рангове місце, а в країнах Євросоюзу, США, Канаді, Японії вона входить у першу трійку.Мета — вивчити вплив препарату Латрен на агрегаційну здатність тромбоцитів на етапі преконцепційної підготовки жінок, що належать до групи ризику розвитку венозних тромбоемболій.Пацієнти та методи. Дослідження агрегаційної здатності тромбоцитів проведено у 24 жінок із хронічною венозною недостатністю ІІ–ІІІ ступеня, яка обумовлена варикозною хворобою нижніх кінцівок.Результати та висновки. Достовірними є показники зниження адреналін- і колаген-індукованої агрегації тромбоцитів більше ніж у 1,5 разу в досліджуваних жінок після лікування пентоксифіліном, що доводить комплексну дію препарату на агрегацію тромбоцитів під дією різних індукторів, що в подальшому дає змогу запобігти поліпрагмазії. Використання в комплексній прегравідарній профілактиці жінок із хронічною венозною недостатністю препарату Латрен (виробництво «Юрія-Фарм») дозволяє поліпшити реологічні властивості крові та мінімізувати ризики виникнення внутрішньосудинного тромбоутворення за рахунок компенсації стану тромбоцитарної ланки гемостазу під час майбутньої вагітності.

Turtle is one of the vulnerable of megafauna and as a by-catch in tuna longline fisheries, however, management practices have not been done yet. This paper described the efforts to avoid the capture of turtles on the tuna longline fishery and its handling recommendation. It has been written based on the research results and observer programs of activities that have been implemented since 2005. It's also including a literature review rules and regulations regarding the management of sea turtles. The record results during 2005 - 2014 conducted by an independent scientific board on tuna longline in the Indian Ocean with 72 times number of setting and 89,441number of hooks. There are 105 turtles caught, which are leatherback, olive ridley turtles, hawksbill, loggerhead sea turtles as well as the unknown green turtle where the current status of turtles in the Indian Ocean is in a state of vulnerable, endangered, critically even endangered. The olive ridley turtle, loggerhead and leatherback turtles are in a vulnerable status. While, the green turtles are in a state endangered and even hawksbill in a state extremely endangered. Policy measures for handling of turtles in tuna longline fishery needs to be taken in order to be implemented include the socialization of the use of intensified circle hooks and if necessary the government issued regulations regarding the use of circle hooks, the implementation of the placement of fishing monitoring (observer) aboard the tuna longline in order to assist the skippers monitoring the catch of turtles and turtle handling training for the skippers and crew in order to hold the caught turtles can be handled directly on the boat to reduce the mortality turtles which can be released back into the sea alive.Penyu merupakan salah satu biota yang rawan punah dan sebagai hasil tangkapan sampingan pada perikanan rawai tuna dimana pengelolaannya belum banyak dilakukan. Makalah ini membahas tentang upaya bagaimana menghindari tertangkapnya penyu dan rekomendasi penanganan penyu pada perikanan rawai tuna. Tulisan disusun berdasarkan penelusuran hasil penelitian maupun kegiatan program observer yang telah dilaksanakan sejak tahun 2005, dilengkapi kajian pustaka serta peraturan terkait pengelolaan penyu. Hasil pencatatan selama periode 2005 – 2014 yang dilakukan oleh pemantau ilmiah di kapal rawai tuna di Samudera Hindia dengan jumlah setting sebanyak 72 kali dan 89.441 buah pancing tertangkap 105 ekor penyu, yang terdiri dari penyu belimbing, penyu lekang, penyu sisik, penyu tempayan dan penyu hijau serta penyu yang tidak diketahui jenisnya dimana saat ini status penyu di Samudera Hindia berada dalam kondisi rentan, terancam punah bahkan sangat terancam punah. Penyu lekang, penyu tempayan dan penyu belimbing berada dalam status rentan. Sementara penyu hijau berada dalam keadaan terancam punah dan bahkan penyu sisik berada dalam keadaan sangat terancam punah. Langkah-langkah kebijakan penanganan penyu pada perikanan rawai tuna yang perlu dilaksanakan adalah mengintensifkan penggunaan pancing lingkar, perlu regulasi penggunaan pancing lingkar, implementasi penempatan pemantau penangkapan ikan (observer) di atas kapal rawai tuna agar dapat membantu para nahkoda memonitoring hasil tangkapan penyu dan pelatihan penanganan penyu bagi para nahkoda maupun anak buah kapal yang bertujuan agar penyu-penyu yang tertangkap dapat ditangani secara langsung di atas kapal sehingga menurunkan tingkat kematian penyu-penyu tersebut kemudian dapat dilepas kembali ke laut dalam kondisi hidup.

Background The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings Worldwide, the age-standardised prevalence of daily smoking was 25.0% (95% uncertainty interval [UI] 24.2-25.7) for men and 5.4% (5.1-5.7) for women, representing 28.4% (25.8-31.1) and 34.4% (29.4-38.6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11.5% of global deaths (6.4 million [95% UI 5.7-7.0 million]) were attributable to smoking worldwide, of which 52.2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.

Проанализировано развитие органов здравоохранения на территории Забайкальской области в начале Гражданской войны. На основе обширного фактического материала раскрыта сущность производившихся в 1918-1919 гг. реформ в медицинской сфере. Анализируются причинно-следственные связи происходивших перемен. Разбираются такие разделы, как управление здравоохранением, функционирование медицинской сети, решение кадровой проблемы, обеспеченность медикаментами, борьба с эпидемиями, санитарно-гигиенические мероприятия, борьба с проституцией, помощь военнопленным Первой мировой войны. ; The article is devoted to the history of public health in Zabaikalskaya Oblast from the coming to power of Ataman G.M. Semenov to the normalization of relations between him and Admiral A.V. Kolchak in May 1919. The work is written on the basis of the first published archival materials, memoirs of contemporaries and data of periodicals. The attempt of the Zabaikalskaya Oblast administration to return to the model of health that emerged after the February revolution of 1917 is discussed. On the basis of extensive factual material the author reveals the essence of the 1918-1919 reforms in the medical field. The cause-and-effect relations of the occurring changes are analyzed. Information about military medicine and mobilization of health personnel in the Separate Eastern Siberian Army is considered. Attention is drawn to the conflict between the regional Zemstvo and the Zabaikalsky Cossack management; it led to the formation of an independent medical service for the Cossacks. The work of private practitioners is also described. Activities of foreign health workers is comprehensively studied. Information on establishing logistics in the region with medicine and medical goods is given. An important role in this work was played by the American Red Cross, the Young Men Christian Association, the Japanese Society for Economic Aid to Siberia and a number of other public organizations. Much of their work was to combat the epidemics in the winter of 1918-1919. In this regard, the causes of diseases, the scope of the disaster, mortality and control measures are analyzed. Information is provided about the sanitary cleaning in the cities, the opening of washing houses, the delivery of clean water to the population, the promotion of healthy lifestyles. Insufficient funding, lack of medicine, mobilization of health workers, mass migration of people, apathy of the military and civil administrations of Zabaikalskaya Oblast had a negative impact on fighting the infection. Despite the death of many health workers, belated, but effective measures were taken by the spring of 1919 which could cope with the flow of the diseases and suppress the epidemic. The article also provides data on social work: the condition of the kindergartens, the work of prisoners of war during the First World War, the legalization of prostitution. It also covers the scientific activities of the Zabaykalsky Society of Doctors. In conclusion, it is noted that the return to the democratic model of health organization, created after February 1917, did not happen. Zemstvo and urban self-government were pressed by the administration and due to financial dependence could not make independent decisions. Medical forces were weakened by the fact that medical institutions were passed on to different departments. Some positive facts do not change the overall picture of the decline and collapse of the system of health care in the remote Russian province.

The digital revolution significantly re-organizes the daily lifestyle of people and habitual ways and means of doing business. The public sector cannot disregard the new trends of postindustrial information economy. If public administrations are to remain responsive, accountable and efficient in the XXI century, they need to transform the way they function by making more and better use of information and communication technology. Implementation of e-government aims to support modernization of the public sector enabling its openness, transparency and effectiveness. The evidence from existing literature shows that besides the reduction of administrative burdens, improvement of information and service quality and cost reduction, e-government is able to streamline economic and social development of the nations. However, due to the lack of arguments that prove the importance of e-government adoption at the same level as resolution of other economic and social problems that occur on the national levels, some critical opinions were expressed against the need of investment in the digital government. This research applying correlation and regression analysis using the panel data of 34 European countries during the period of 2003 until 2014, aims to evaluate the impact of e-government strategy on economic and social development and its ability to enhance wealth creation and to improve exciting social policies. Results provide an evidence of the positive significant effect of e-government implementation on GDP growth and several social indices, such as Rule of law, Political stability and Health index with significant decrease of Mortality rate at the same time. ; A revolução digital reorganizou significativamente, tanto o estilo de vida diário das pessoas, como as formas habituais e meios de fazer negócios. O setor público não pode ignorar as novas tendências da economia da informação pós-industrial. Se as administrações públicas são para continuar a ser responsivas, responsáveis e eficientes no século XXI, precisam de transformar a forma como funcionam, fazendo mais e melhor uso da tecnologia da informação e da comunicação. A implementação de governo eletrónico tem como objetivo apoiar a modernização do setor público, possibilitando a sua abertura, transparência e eficácia. A evidência da literatura existente mostra que, além das reduções dos encargos administrativos, melhoria da informação, qualidade de serviço e redução de custos, governo eletrónico é capaz de agilizar o desenvolvimento económico e social das nações. No entanto, devido à falta de argumentos que demonstrem a importância da adoção do governo eletrónico ao mesmo nível que a resolução de outros problemas socioeconómicos que ocorrem aos níveis nacionais, algumas opiniões críticas foram expressas contra a necessidade de investimento no governo digital. Esta pesquisa, que aplicou uma análise de correlação e regressão, usando dados de um painel de 34 países europeus durante o período de 2003 a 2014, tem como objectivo avaliar o impacto da estratégia de implementação do governo eletrónico no desenvolvimento económico e social e a sua capacidade de potenciar a criação de riqueza e de melhorar políticas sociais estimulantes. Os resultados mostram sinais do efeito positive e significativo da implementação do governo eletrónico sobre o crescimento do PIB e em diversos indicadores sociais, tais como, no Estado de Direito, na estabilidade política e em índice de saúde com uma diminuição significativa da taxa de mortalidade ao mesmo tempo.

Актуальность. Тромбоз глубоких вен и тромбоэмболия легочной артерии являются важной проблемой здравоохранения с потенциально тяжелыми последствиями. Так, среди причин материнской смертности в Украине тромбоэмболия легочной артерии занимает 4–5-е ранговое место, а в странах Евросоюза, США, Канаде, Японии она входит в первую тройку.Цель — изучить влияние препарата Латрен на агрегационную способность тромбоцитов на этапе преконцепционной подготовки женщин, относящихся к группе риска развития венозной тромбоэмболии.Пациенты и методы. Исследование агрегационной способности тромбоцитов проведено у 24 женщин с хронической венозной недостаточностью II–III степени, обусловленной варикозной болезнью нижних конечностей.Результаты и выводы. Достоверные показатели снижения адреналін- и колаген-индуцированной агрегации тромбоцитов более чем в 1,5 раза у исследуемых женщин после лечения пентоксифиллином, что доказывает комплексное действие препарата на агрегацию тромбоцитов под. действием различных индукторов, что в дальнейшем позволяет предотвратить полипрагмазию. Использование в комплексной прегравидарной профилактике у женщин с хронической венозной недостаточностью препарата Латрен (Юрия-Фарм) позволяет улучшить реологические свойства крови и минимизировать риск возникновения внутрисосудистого тромбообразования за счет компенсации состояния тромбоцитарного звена гемостаза во время будущей беременности. ; Rationale. Deep vein thrombosis and pulmonary artery thromboembolia are important health problems with potentially severe consequences. Thus, pulmonary embolism ranks 4–5th for the causes of maternal mortality in Ukraine, and in the European Union, the USA, Canada, Japan, it makes the top three.Purpose — to study the effect of Latrenum on the platelet aggregation at the stage of preconceptional preparation of women, who belong to the risk group of venous thromboembolism.Materials and methods. Investigation of platelet aggregation was performed in 24 women with chronic venous insufficiency II–III grade, which is caused by varicose veins of the lower extremities.Results and conclusions. The statistically significant decrease of adrenaline- and collagen-induced platelet aggregation rates by more than 1.5 times was observed in the examined women after pentoxifylline treatment that proves the comprehensive effect of the drug on platelet aggregation under the influence of various inductors and prevents polypragmasy in future. An administration of Latrenum (manufactured by Yuria-Farm LLC) in the integrated preconceptional prevention in women with chronic venous insufficiency improves the blood rheological properties and minimizes the risk of intravascular thrombosis by means of compensation of thrombolytic component hemostasis during the future pregnancy. ; Актуальнiсть. Тромбоз глибоких вен і тромбоемболія легеневої артерії є важливими проблемами охорони здоров'я з потенційно тяжкими наслідками. Так, серед причин материнської смертності в Україні тромбоемболія легеневої артерії посідає 4–5-те рангове місце, а в країнах Євросоюзу, США, Канаді, Японії вона входить у першу трійку.Мета — вивчити вплив препарату Латрен на агрегаційну здатність тромбоцитів на етапі преконцепційної підготовки жінок, що належать до групи ризику розвитку венозних тромбоемболій.Пацієнти та методи. Дослідження агрегаційної здатності тромбоцитів проведено у 24 жінок із хронічною венозною недостатністю ІІ–ІІІ ступеня, яка обумовлена варикозною хворобою нижніх кінцівок.Результати та висновки. Достовірними є показники зниження адреналін- і колаген-індукованої агрегації тромбоцитів більше ніж у 1,5 разу в досліджуваних жінок після лікування пентоксифіліном, що доводить комплексну дію препарату на агрегацію тромбоцитів під дією різних індукторів, що в подальшому дає змогу запобігти поліпрагмазії. Використання в комплексній прегравідарній профілактиці жінок із хронічною венозною недостатністю препарату Латрен (виробництво «Юрія-Фарм») дозволяє поліпшити реологічні властивості крові та мінімізувати ризики виникнення внутрішньосудинного тромбоутворення за рахунок компенсації стану тромбоцитарної ланки гемостазу під час майбутньої вагітності.

Hoe kon de stad Groningen onderdeel worden van de Republiek? Lang was het onduidelijk of Groningen bij de Nederlandse of de Duitse gebieden ging horen, maar sinds 1594 maakt Groningen defintief deel uit vanRepubliek. Niet geheel vrijwillig, want niet iedereen in de stad was er blij mee en in het begin van de zeventiende eeuw werden regelmatig troepen vanuit Den Haag naar de stad gestuurd om de stad in het gareel te krijgen. Dat was niet gemakkelijk, want de stad liet zich niet zo makkelijk dwingen. De bestuurders in Den Haag zagen dat, en daarom probeerden ze via de bestuurlijke elite greep op de stad te krijgen. In dit proefschrift wordt deze bestuurlijke elite in de eerste eeuw na de aansluiting bij de Republiek bestudeerd. Het gangbare beeld is dat er een familieregering was, een patrimonial state, waarbij familiehoofden belangrijke posities op lokaal-, maar door de bijzondere inrichting van de Republiek, ook op bovenlokaal niveau bekleedden. In Groningen was echter, zo blijkt, geen sprake van een duidelijke familieregering. De oorzaak hiervan was deels demografisch: door een hoge sterfte konden families niet generaties lang stedelijke posities bekleedden. Daarboven was er in de stad een breed gedragen civic culture van brede betrokkenheid bij het bestuur en vanuit die gedachte probeerde men een stevige greep van een beperkt aantal families op het bestuur te voorkomen. Die brede betrokkenheid kwam tot uitdrukking in deelname aan verschillende stedelijke instellingen. Dit vormde het sociaal kapitaal van de stad, dat niet alleen verbindend was binnen de groep (bonding), maar ook overbruggend tussen de groepen (bridging). Zo werd de integratie in de Republiek (op den duur) verstevigd. ; How did the city of Groningen become a part of the Netherlands? For a long time it was unclear whether Groningen was to be a part of the Dutch or the German territories, but after 1594 Groningen definitely became a part of Dutch Republic. Not willingly however, and in the early seventeenth century troops were sent regularly from The Hague to to force the city into obedience. That was rather difficult, because the city was not easy to force. Therefore, the government in The Hague also tried to impose its authority by strenghtening its ties to the administrative elite in the city. In this thesis, this administrative elite has been studied in the century after Groningen joined the Republic. The prevailing view is that there was a family government, a so called patrimonial state. In a patrimonial state the heads of the families occupy the key positions on local, but also at federal level. Because they merged local and federal positions these family heads were important in the process of state building. In Groningen however, as this theis shows,there was no clear family government or patrimonial state. This was partly due to demographic reasons: because of a high mortality, families could not hold a position for more than three generations. Moreover, there was a broad-based civic culture of commitment to the city government and for that reason citizens tried to prevent a total control of a limited number of families on the city government. The civic culture was reflected in the participation of citizens in various urban institutions. This was the social capital of the city, which was not only able to bond people together, but also to form a bridge between the city and the federal government. In this way, the social capital of the city furthered its integration in the Dutch Republic.

Introducción: Los tumores pediátricos primarios del sistema nervioso central (SNC), ocupan el segundo lugar en frecuencia, superados solamente por las neoplasias hematológicas. Objetivo: Realizar una revisión y análisis de la literatura médica existente sobre tumores del SNC en población entre los 0 y 14 años centrado en la epidemiologia, factores etiológicos, manifestaciones clÍnicas y diagnóstico. MetodologÍa: Se realizó una búsqueda en las bases de datos PubMed, MedlinePlus, BIREME y red interna de trabajos de grados y tesis de la Universidad Industrial de Santander. Además, se realizó revisión de las páginas de los entes gubernamentales encargados del registro epidemiológico sobre cáncer nacional e internacional. Resultados: Los tumores de SNC en la población pediátrica son la segunda causa de muerte infantil solo superado por la leucemia; tienen una clÍnica y factores etiológicos bien establecidos. La epidemiologÍa no difiere en el mundo. Los sÍntomas más frecuentes son vómito, cefalea, ataxia, sÍntomas visuales y alteraciones motoras. Los factores etiológicos más representativos son virus, sÍndromes genéticos, infecciones maternas y perinatales, exposición a radiación electromagnética e ionizante; algunos son muy discutidos como la presencia de trauma al momento del nacimiento. Además, existen documentados factores protectores tales como consumo de antioxidantes, frutas y verduras, e historia reportada de alergias. Conclusiones: El adecuado entrenamiento a los médicos de atención primaria en la identificación de los signos y sÍntomas para la sospecha y diagnóstico de los estadios iniciales de estos tumores pueden disminuir los Índices de mortalidad. [Nieves-Cuervo GM, Manrique-Hernández EF, Ojeda-Rincón SA, Galvis-Pabón S. Tumores del sistema nervioso central en población pediátrica entre 0 y 14 años. MedUNAB 2016; 19 (2): 124-133] ; Introduction: The primary pediatric tumors of the central nervous system (CNS) rank second in frequency, only surpassed by hematological malignancies. Objective. Conduct a review and analysis of existing literature on CNS tumors in population between 0 and 14 focused on the epidemiology, etiological factors, clinical manifestations, and diagnosis. Methodology: The search for articles was conducted using the databases PubMed, MedLinePlus, BIREME and intranet degrees and thesis work of the Universidad Industrial de Santander. Further review of the pages from government agencies in charge of epidemiological registry of cancer was made. Results: CNS tumors in pediatric population are the second leading cause of infant death second only to leukemia, have a clinic and etiological factors well established. The epidemiology don´t differs in the world. The most common symptoms are vomiting, headache, ataxia, visual symptoms and motor disturbances. The most representative etiologic factors are viruses, genetic syndromes, maternal and perinatal infections, exposure to electromagnetic and ionizing radiation, some others are discussed as the presence of trauma at birth. There are also documented protective factors such as consumption of antioxidant, fruits and vegetables, and reported history of allergies. Conclusions: The adequate training of primary care physicians in the identification of signs and symptoms for suspicion and diagnosis of the initial stages of these tumors can reduce mortality rates. [Nieves-Cuervo GM, Manrique-Hernández EF, Ojeda-Rincón SA, Galvis-Pabón S. Central nervous system tumors in pediatric population from 0 to 14 years. MedUNAB 2016; 19 (2): 124-133].

This dissertation deals with two issues related to the competitiveness of the Mongolian agricultural sector: pastoral livestock production and sea buckthorn farming. The pastoral livestock sector plays a vital role for rural development in Mongolia. Pastureland is a public good and herders are free to let their livestock graze. The number of livestock heavily influences sectoral development. Increasing numbers of goats causes pastureland degradation due to goats' grazing habits. Nonetheless, nomadic herders hold more goats than other types of livestock because cashmere is the basis for their cash income. However, it is unconfirmed whether goats are the most competitive/profitable animal compared with sheep, cattle, horse and camel. The aim of this study is to analyse the competitiveness of livestock production in Mongolia using the Policy Analysis Matrix approach. The approach takes into account private and social revenues and costs to analyse the competitiveness of production. The literature to date has not yet worked with primary, disaggregated, individual farm data for nomadic pastoral livestock husbandry in Mongolia. We use two years of panel data from 176 herder households in Bulgan County, Khovd province of Mongolia, and analyse five types of meat, milk and hides, and four types of hair/wool. We conclude that the estimated cost of pastureland has little effect on the competitiveness of livestock production. Our results show that pastoral livestock production in Mongolia is privately and socially competitive. Cattle is the most competitive livestock type from both the private and social perspectives, not the goat as the current management implies, in particular because cattle require less labour than goats. The most competitive households have larger numbers of livestock, lower mortality rates in Dzud disaster, cattle based production, and less mobility costs than the least competitive households. Sea buckthorn (Hippophae Rhamnoides) provides multiple products that are very nutritious and healthy. Plus, sea buckthorn mitigates against desertification. The most valuable output is oil, extracted from the pulp and seeds of the sea buckthorn berry. Scientists in the fields of ecology, botany, environmental sciences, food and medicine have studied sea buckthorn. However, there is no solid economic and market analysis for sea buckthorn, which traces back to a lack of data. We analyse the private and social competitiveness of sea buckthorn farming of 21 households in Bulgan county of Khovd province in Mongolia. We confirm that half of the interviewed sea buckthorn berry farmers are competitive, yet their level of competitiveness is not very high. This could be caused by lack of experience in sea buckthorn farming. Interestingly, the private competitiveness level is lower than the social one. Output prices are high due to government support policies; however input prices are also and even more distorted. Consequently, producers display low levels of private profitability. Hence, to improve the private competitiveness, the policies should focus towards decreasing the costs of inputs of the production system. The level of competitiveness of sea buckthorn farming has increased from 2012 to 2013, which might be due to the government's "Sea Buckthorn National Programme". According to interviewed producers, the most serious challenge facing sea buckthorn production is lack of finance, which is also evidenced that more than one third of the total cost of the farming is composed of investment costs.

Background: To accelerate the coverage of skilled birth attendance, in 2005, the Indian government initiated a conditional cash transfer (CCT) programme, Janani Suraksha Yojana (JSY) that provides cash to women upon delivering in health facilities. The attempt to increase the utilization of facilities through the JSY, given the health system's fragile state, has raised concerns about the programme's success at achieving its intended goal of reducing maternal mortality ratio (MMR). Aim: To understand the implementation of the CCT policy to promote institutional births in India, with a special focus on nine of India's poorer states. Methods: Thesis uses both quantitative and qualitative methods. The changes in coverage and inequalities in institutional births in the nine states following the initiation of JSY were analysed by comparing levels before and during the programme using state and district level data. The association between the coverage of institutional births and MMR was assessed using regression analysis (I). The change in socioeconomic inequalities in institutional births was estimated using the concentration index and concentration curve, and contributions of different factors to inequalities was computed by decomposition analysis (II). The quality of referral services was studied by conducting a survey of health facilities (n=96) and post-partum women (n=1182) in three districts of Madhya Pradesh. Conditional logistic regression was used to study the association between maternal referrals and adverse birth outcomes, while spatial data for referrals were analysed using Geographical Information Systems (III). Semi-structured interviews were conducted with government and non-government stakeholders (n=11) to explore their perceptions of the JSY, and the data were analysed using a thematic framework approach (IV). Results: In five years, institutional births increased significantly from a pre-programme average of 20% to 49%. However, no significant association between district-level institutional birth proportions and MMR was found (I). The inequality in access to institutional delivery care, although reduced since the introduction of JSY, still persists. Differences in male literacy, availability of emergency obstetric care (EmOC) in public facilities and poverty explained 69% of the observed inequality. While MMR has decreased in all areas since the introduction of JSY, it has declined four times faster in the richest areas than in the poorest (II). Adjusted odds for adverse birth outcomes among those referred were twice than in those who were not referred (AOR 2.6, 95% CI 1.1-6.6). A spatial analysis of the inter-facility transfer time indicated that maternal deaths occurred despite good geographic access to EmOC facilities (III). While most health officials considered stimulus in the form of JSY money to be essential to promote institutional births, non-government stakeholders criticised JSY as an easy way of addressing basic developmental issues and emphasised the need for improvements to health services, instead. Supply-side constraints and poor care quality were cited as key challenges to programme success, also several implementation challenges were cited (IV). Conclusions: Although there was a sharp increase in coverage and a decline in institutional delivery care inequalities following the introduction of JSY, the availability of critical care is still poor. CCT programmes to increase service utilization need to be essentially supported by the provision of quality health care services, in order to achieve their intended impacts on health outcomes.

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Politics. Please check back later for the full article.Healthcare is an essential, but often expensive, good. It is largely a linear function of a country's wealth. Poorer countries have barebones care, primitive facilities, shortages of trained professionals, and usually very limited forms of social, or even private, insurance. Moreover, their public health systems are highly fragile and face shortages of basic sanitation facilities, potable water, and plumbing. Consequently, comparisons across systems are most meaningful when they are constrained by their level of wealth and public sanitation infrastructure. In this comparison, the United States stands as an outlier among other wealthy countries for the higher costs of its health care system and its relatively high level of inefficiency in achieving desirable health outcomes. Approximately 18% of U.S. Gross Domestic Product is spent on health care. That figure is considerably greater than the average for wealthy countries and is, indeed, the highest in the world. But that considerable input results in health outcomes that are among the worst of the wealthy countries.Why this is so has to do with historical developments, political values, the complexity of American political institutions, and the ability of well-heeled lobbies to successfully find champions to support their grievances. It also may have a good bit to do with some factors that lie outside the health care system but interact with it. The United States is among the leaders of the highly developed world in many risk factors: obesity and the illnesses it often leads to, lethal violence especially by guns, teen age pregnancy, infant mortality, and social inequality. Most notably, however, the United States is the only country in the highly developed world that, even with the passage and partial implementation of the Affordable Care Act, lacks universal accessibility through social insurance to the health care system. The United States also is unusual for its lack of pricing regulation and pricing transparency for medical procedures.Despite the fact that other health care systems seem to manage better with less, costs threaten to spiral in virtually all of the wealthy countries. This is because populations in all of these countries are getting older and most have a less than replacement birth rate. The demographic logic is that more people will be demanding more health care, and there will be fewer people to foot the bill. So, all systems are facing a cost crunch in the near future. While the United States is among these, thanks largely to immigration, it tends to have a more favorable ratio of donors to recipients than other rich countries.Ultimately, all health care systems have to juggle three critical factors: (1) access to the health care system; (2) costs of the system; and (3) the quality of the system. While all of these factors seem self-evident, none actually are. They involve trade-offs. All systems ration in some way. Rationing is a buzzword among some sectors of the American political class, but all systems do it and must do it, including the American system. But they do it in different ways. Why has much to do with politics, respect for evidence, or the lack of it, and high levels of social inequality.

Отсутствие системы медико-социального сопровождения детей, находящихся в трудной жизненной ситуации, и их семей одна из главных причин предотвратимых потерь здоровья и жизни детей и подростков. В план мероприятий Рабочей группы № 3 при Координационном совете при Президенте Российской Федерации по реализации Национальной стратегии действий в интересах детей на 2012-2017 гг. включен пункт: "Разработка и внедрение типовой модели медико-социального сопровождения детей и подростков в субъектах РФ". Выполнение этой задачи возложено на отдел социальной педиатрии ФБГУ "НЦЗД" РАМН и Министерство здравоохранения Республики Татарстан (РТ). Методы исследования: изучение и обобщение передового опыта медико-социального сопровождения детского населения; экспертные оценки; моделирование. Результаты. Разработана и внедрена региональная модель трехуровневой системы медико-социального сопровождения детского населения, включающая I уровень (кабинеты медико-социальной помощи детских поликлиник, ФАП, травмпункты); II уровень межмуниципальный (отделения медико-социального сопровождения ЦРБ, ЛПУ, КДЦ); III уровень региональный (Республиканский центр медико-социального сопровождения детей и подростков). Были определены первоочередные задачи, необходимые для обеспечения эффективного функционирования системы медико-социального сопровождения. В рамках реализации пилотного проекта разработаны законодательные и нормативные правовые акты, регламентирующие деятельность региональной модели трехуровневой системы медико-социальной помощи, и другие необходимые для эффективного функционирования системы документы. Практическая значимость данной модели: внедрение эффективной трехуровневой модели медико-социального сопровождения детей и подростков будет способствовать снижению заболеваемости, смертности, "рискованных форм поведения", в том числе суицидального, профилактике безнадзорности и беспризорности, жестокого обращения с детьми. ; The absence of system of medical social monitoring of children being in difficult life situations is one of main causes of preventable losses of health and life of children and adolescents. The plan of activities of the working group №3 under the Coordination council under the President of the Russian Federation of the national strategy realization of actions in interest of children for 2012-2017 includes a point: "The development and implementation of standard model of medical social monitoring of children and adolescents in the subjects of the Russian Federation". The implementation of this task is assigned to the Department of social pediatrics of The research center of children health of Moscow and the Ministry of Health of the Republic of Tatarstan. The research methods included analysis and generalization of advanced experience of medical social monitoring of children population; expertise technique; modeling. The regional model of three-level system of medical social monitoring of children population is developed and implemented. The model includes level I (consulting rooms of medical social care of children polyclinics, feldsher obstetric stations, first-aid centers), level II inter-municipal (departments of medical social monitoring in central district hospitals, medical institutions, clinical diagnostic centers) and level III regional (the Republican center of medical social monitoring of children and adolescents). The immediate tasks necessary for effective functioning of system of medical social monitoring were determined. Within the framework of implementation of the pilot project the legal and normative legislative acts were developed to regulate functioning of regional model of three-level system of medical social care. The other documents necessary for effective functioning of this system were elaborated. The practical significance of this system is in the implementation of effective three-level model of medical social monitoring of children and adolescents supporting decrease of morbidity, mortality and "risk behaviors" suicidal included. The model is to prevent child neglect and homelessness and cruel treatment of children and adolescents.

Informe SESPAS ; [ES] Las crisis económicas pasadas han aumentado el impacto de algunas enfermedades transmisibles sobre todo a través de grupos especialmente vulnerables a las consecuencias sociales y sanitarias que producen. Sin embargo, se ha evidenciado que su repercusión depende en gran medida de la respuesta con que las enfrentan gobierno y población de los países afectados. Se razona sobre las consecuencias de la crisis actual en la cadena causal de la patología infecciosa, incluida la respuesta del sistema sanitario, y se explora si en España hay alguna evidencia de su repercusión. Se parte de que el posible efecto sobre las condiciones de vida y trabajo procede del endeudamiento público y privado sumado al alto nivel de paro como rasgos definitorios de la crisis. Se destacan las consecuencias negativas que pueden tener los recortes de atención sanitaria sobre las poblaciones vulnerables, en parte excluidas con la reciente reforma de la cobertura sanitaria. Se comparan datos de mortalidad y morbilidad de dos periodos, antes y después de 2008, integrando en lo posible las tendencias observadas y los informes institucionales. En general no se aprecia todavía un efecto sobre la patología infecciosa, pero se detectan algunos indicios de empeoramiento compatibles con los efectos de la crisis que requieren ser seguidos y contrastados. Se revisan las limitaciones de las fuentes consultadas, que pueden no ser suficientemente sensibles ni actualizadas para detectar cambios que requieran un tiempo de latencia para manifestarse. Se recomienda no recortar y mejorar los recursos en la vigilancia de esta patología, y garantizar una respuesta sociosanitaria equitativa, dirigida a los más afectados por la crisis. [EN] Past economic crises have increased the impact of communicable diseases especially on groups particularly vulnerable to the social and health consequences of the recession. However, it has been shown that the impact of these crises largely depends on the response of governments and the inhabitants of affected countries. We describe the consequences of the current crisis in the causal chain of infectious disease, including the response of the health system, and explore whether there is evidence of its impact in Spain. It is assumed that the possible effect of the crisis on living and working conditions is due to individual and social debt coupled with high unemployment as defining features of the crisis. We highlight the potential negative consequences of healthcare cuts on vulnerable populations, which have been partly excluded with the recent reform of health coverage. We compare mortality and morbidity data between two periods: before and after 2008, integrating, where possible, observed trends and institutional reports. Overall, no effect on infectious disease has been detected so far, although some signs of worsening, which could be compatible with the effects of the crisis, have been observed and need to be monitored and confirmed. We review the limitations of data sources that may not be sufficiently sensitive or up-to-date to detect changes that may require a latency period to become manifest. Instead of cutting resources, surveillance of these diseases should be improved, and an equitable social health response, which targets the population most affected by the crisis, should be guaranteed. ; Sí