This paper is an attempt to apply an analysis of negative freedom to the position of handicapped people. Negative freedom is defined in terms of both possibility and eligibility of action and, in addition, the emphasis is placed upon the intention of human agents to restrict action (or the omission to prevent such restriction). This analysis of freedom is applied to the areas of prevention of handicap and the employment, access problems, and education of handicapped people in Britain. The conclusion is that, though we recognize that aspects of handicapping conditions inevitably restrict some activities, handicapped people are, either through intention or omission, less free than the able-bodied.
Metadata only record ; The world's 58 poorest countries share the characteristic of a labour force overwhelmingly dependent on agriculture. Challenging the assumption that mass poverty and chronic hunger are unsolvable problems, this book explores the multiple aspects of economic development in these countries, which are home to 60% of the world's population. A broad based development strategy to raise incomes through agricultural productivity growth and expanded rural employment is offered. Information on the rural informal sector and on agriculture-industry interactions are presented, and the impact of macroeconomic and social policies on the rural economy are analysed. Policy instruments aimed at bringing a broad based development are assessed, from fiscal policy to development of new seeds and farm implements. The book includes case studies of countries that have seized or missed development opportunities. Comparison of the successful economic transformations of Japan and the USA shows how key ideas have enabled policymakers to act with foresight. Analyses of strategic choices in China, the USSR, Taiwan, Mexico, Kenya, and Tanzania also show how development strategies that emerge from the real-world political economy reflect a mix of individual interests and strategic notions.
ABSTRACTBackground: Antimicrobial resistance results in increased morbidity, mortality, and costs to the health care system. Evidence suggests an association between the use of antimicrobials in hospitals and the development of antimicrobial resistance. Fluoroquinolones constitute one group of antimicrobials that are effective against a variety of bacterial infections, yet they may be subject to misuse. Many hospitals in Nova Scotia have implemented policies to improve antimicrobial prescribing, but the impact of these policies on utilization is unknown.Objectives: To evaluate the use of fluoroquinolones in Nova Scotia hospitals using the World Health Organization's Anatomical Therapeutic Chemical classification system with defined daily doses (ATC/DDD) and to examine the influence of hospital policies for utilization of fluoroquinolones in community-acquired pneumonia.Methods: During the study period (April 1, 1997, to March 31, 2003), fluoroquinolones were administered at 31 of the 37 hospitals in Nova Scotia's 9 district health authorities. Hospital administrative data, hospital characteristics, and pharmaceutical purchasing data related to use of these drugs were aggregated using the ATC/DDD methodology for the fiscal years 1997/1998 to 2002/2003. District pharmacy directors were surveyed to obtain information about district and individual hospital antibiotic policies. Descriptive statistics were calculated, and univariable regression and multilevel analyses were performed.Results: Mean overall fluoroquinolone use increased over the study period, from 47.2 DDD/1000 bed-days per year in fiscal year 1997/1998 to 163.8 DDD/1000 bed-days per year in fiscal year 2002/2003 (p < 0.001). Multilevel analysis showed that utilization policies aimed at appropriate prescribing did not affect the use of fluoroquinolones.Conclusion: This study revealed that drug purchasing, hospital administrative, and diagnostic data could be combined to compare the utilization of fluoroquinolones among different hospitals and district health authorities. Utilization policies had little effect on the amount, type, or route of fluoroquinolone use. ; RÉSUMÉContexte : La résistance aux antimicrobiens se traduit par une hausse de la morbidité, de la mortalité et des coûts pour le système de santé. Des données suggèrent un lien entre l'utilisation des antimicrobiens dans les hôpitaux et l'apparition de résistance antimicrobienne. Les fluoroquinolones, qui sont un groupe d'antimicrobiens efficaces contre une variété d'infections bactériennes, peuvent pourtant être mal utilisées. De nombreux hôpitaux en Nouvelle-Écosse ont donc mis de l'avant des politiques visant à améliorer la prescription des antimicrobiens, mais on ignore quelle est leur incidence sur l'emploi de ces derniers.Objectifs : Évaluer l'utilisation des fluoroquinolones dans les hôpitaux de la Nouvelle-Écosse, à l'aide du système de classification anatomique, thérapeutique et chimique (ATC) et des doses journalières définies (DDD) de l'Organisation mondiale de la Santé, et analyser l'influence des politiques des hôpitaux sur l'utilisation des fluoroquinolones dans le traitement des pneumonies extrahospitalières.Méthodes : Au cours de la période de l'étude (du 1er avril 1997 au 31 mars 2003), des fluoroquinolones ont été administrées dans 31 des 37 hôpitaux des 9 régies régionales de la santé de la Nouvelle-Écosse. Des données sur les caractéristiques démographiques, les diagnostics et l'achat des médicaments concernant l'utilisation des fluoroquinolones dans ces hôpitaux ont été groupées à l'aide de la méthode ATC/DDD pour les exercices financiers de 1997–1998 à 2002–2003. Les directeurs de pharmacie des régies ont répondu à un sondage pour obtenir des renseignements sur les politiques d'utilisation des antibiotiques des régies et de chaque hôpital. Des statistiques descriptives ont été compilées, et des analyses de régression à variable simple et de modélisation hiérarchique ont été effectuées.Résultats : L'utilisation moyenne globale de fluoroquinolones a augmenté pendant la période de l'étude, passant de 47,2 DDD/1000 jours-lits par année pour l'exercice financier de 1997–1998 à 163,8 DDD/1000 jours-lits pour l'exercice financier de 2002–2003 (p < 0,001). L'analyse hiérarchique a montré que les politiques d'utilisation visant une meilleure prescription des fluoroquinolones n'ont pas eu d'effet sur leur utilisation.Conclusion : Cette étude a révélé que les données sur l'achat des médicaments, les caractéristiques démographiques et les diagnostics pouvaient être combinées pour comparer l'utilisation des fluoroquinolones dans divers hôpitaux et régies régionales de la santé. Les politiques sur l'utilisation des antimicrobiens ont eu très peu d'effet sur la quantité et le type de fluoroquinolones utilisées ou leur voie d'administration.
BACKGROUND: Infectious agents, such as bloodborne viruses (BBVs), can potentially be transmitted from healthcare workers (HCWs) to patients. In an effort to reduce this risk to patients, this guideline, which provides a framework for policies on the management of HCWs infected with BBVs in Canada, was developed. METHODS: A total of six systematic reviews (1995–2016) were conducted to inform the risk of transmission of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) from infected HCWs to patients and the infectivity of each virus related to source serum viral load. Three environmental scans were conducted to inform sections on disclosure of HCW's serologic status, Expert Review Panels, and lookback investigations. Government partners and key stakeholder organizations were consulted and a Task Group provided technical expertise. RESULTS: The risk of HCW-to-patient BBV transmission is negligible, except during exposure-prone procedures where there is a risk of HCW injury and possible exposure of a patient's open tissues to the HCW's blood. Transmission rates were lowest with HIV and highest with HBV (Table 1). Rates varied with several factors including source viral load, nature of potential exposure, infection prevention and control breaches, susceptibility of exposed patient, and use of post-exposure prophylaxis where relevant. The extent of reporting bias for exposure incidents where transmission did not occur is unknown. Current antiviral therapy informed guideline recommendations, with viral load thresholds provided to assist treating physician, Expert Review Panels and regulatory authorities in determining a HCW's fitness for practice. CONCLUSION: Routine Practices (or Standard Precautions) are critical to prevent HCW-to-patient transmission of infections; including BBVs. Recommendations provided in this guideline aim to further reduce the already minimal risk of HCW-to-patient transmission. The guideline provides a pan-Canadian approach for managing HCWs infected with ...
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.