Suchergebnisse

In the coastal countries of East Asia and Southeast Asia, ciguatera should be common because of the extensive tropical and subtropical coral reefs along the coasts and in the neighboring seas with ciguatoxic fishes. An extensive search of journal databases, the Internet and the government websites was performed to identify all reports of ciguatera from the regions. Based on the official data and large published case series, the incidence of ciguatera was higher in the coastal cities (Hong Kong, Foshan, Zhongshan) of southern China than in Japan (Okinawa Prefecture). In Singapore, ciguatera appeared to be almost unknown. In other countries, only isolated cases or small case series were reported, but under-reporting was assumed to be common. Ciguatera may cause severe acute illness and prolonged neurological symptoms. Ciguatera represents an important public health issue for endemic regions, with significant socio-economic impact. Coordinated strategies to improve risk assessment, risk management and risk communication are required. The systematic collection of accurate data on the incidence and epidemiology of ciguatera should enable better assessment and management of its risk. Much more work needs to be done to define the size threshold for important coral reef fish species from different regions, above which the risk of ciguatera significantly increases.

In the present review, the main objective was to describe the epidemiology and clinical features of ciguatera fish poisoning in Hong Kong. From 1989 to 2008, the annual incidence of ciguatera varied between 3.3 and 64.9 (median 10.2) per million people. The groupers have replaced the snappers as the most important cause of ciguatera. Pacific-ciguatoxins (CTX) are most commonly present in reef fish samples implicated in ciguatera outbreaks. In affected subjects, the gastrointestinal symptoms often subside within days, whereas the neurological symptoms can persist for weeks or even months. Bradycardia and hypotension, which can be life-threatening, are common. Treatment of ciguatera is primarily supportive and symptomatic. Intravenous mannitol (1 g/kg) has also been suggested. To prevent ciguatera outbreaks, the public should be educated to avoid eating large coral reef fishes, especially the CTX-rich parts. A Code of Practice on Import and Sale of Live Marine Fish for Human Consumption for Prevention and Control of Ciguatera Fish Poisoning was introduced from 2004 to 2013. The Food Safety Ordinance with a tracing mechanism came into full effect in February 2012. The Government would be able to trace the sources of the fishes more effectively and take prompt action when dealing with ciguatera incidents.

An analysis of the causes and consequences of China's transformation from a minor player to the world's tenth largest trader in less than two decades. It locates the transformation in the synergy created by new forces unleashed in China and their interaction with entrepreneurs in Hong Kong, Taiwan and Southeast Asia, who invested capital, transferred production facilities and provided the marketing channels by which Chinese goods reached world markets. The book also examines the dynamics behind Japan's increasing role in China's foreign trade in the late 1990s and the growing trade friction between China and the United States, which it argues is produced by the failure of the latter to recognise the dynamics of China's export growth.

ABSTRACTBackground: Antibiotic IV-to-oral (IV–PO) conversion is a key initiative of antimicrobial stewardship programs. Guidelines and education are commonly described interventions to promote IV–PO conversion; however, technological interventions may be more effective in changing practice. Objective: To determine the impact of a clinical decision support (CDS) tool on the adoption and sustainability of an antibiotic IV–PO conversion program at a community-academic hospital.Methods: A quasi-experimental study consisting of 3 phases was conducted. During phase 1, the pre-intervention antibiotic IV–PO conversion rate was determined. During phase 2, the IV–PO conversion policy was updated, education was provided to pharmacists and physicians, and a post-intervention evaluation was conducted. During phase 3, a CDS tool was developed to generate real-time electronic alerts prompting pharmacists to assess antibiotic therapy, and post-intervention audits were performed 1 month, 3 months, and 15 months after implementation of the tool. Pantoprazole IV–PO conversion was assessed during each phase as a non-equivalent dependent variable. The primary outcome was the proportion of patients eligible for IV–PO conversion who were switched to oral therapy. Results: Of 332 patients receiving targeted IV antibiotic therapy during the overall study period, 122 (37%) met the criteria for IV–PO conversion. The phase 2 IV–PO conversion rate of 35% (9/26) was comparable to the pre-intervention rate of 29% (10/35) (p = 0.61). Implementation of the CDS tool significantly increased the conversion rate to 78% (14/18), an increase that was sustained at 3 months (71% [17/24]) and 15 months (74% [14/19]) after implementation (p < 0.05 for all comparisons with phases 1 and 2). Pantoprazole conversion rates were similar across all phases.Conclusions: Implementation of the CDS tool was effective in improving and sustaining antibiotic IV–PO conversion rates and enhancing policy compliance beyond the effects of policy revision and education. Refinement of both the policy and the tool is warranted to maximize adoption of the IV–PO conversion program.RÉSUMÉContexte: Le passage de l'antibiothérapie par voie intraveineuse (IV) à la voie orale (PO) (IV-PO) est une initiative clé des programmes de gestion des antimicrobiens. On a communément recours à des formations et à des lignes directrices pour encourager le passage d'une voie à l'autre; cependant, les interventions technologiques sont parfois plus efficaces pour favoriser le changement de pratique. Objectif : Déterminer l'impact d'un outil d'aide à la décision clinique (ADC) sur l'adoption et la viabilité d'un programme de conversion IV-PO dans un hôpital universitaire.Méthodes : Une étude quasi expérimentale en trois phases a été menée. La première phase a permis la détermination du taux de conversion IV-PO avant l'intervention. La deuxième phase concernait l'actualisation de la politique de conversion IV-PO, la formation des pharmaciens et médecins et la conduite d'une évaluation après l'intervention. La troisième phase a vu le développement d'un outil ADC qui génère des alertes électroniques en temps réel pour inciter les pharmaciens à évaluer l'antibiothérapie. Des évaluations ont en outre été effectuées 1 mois, 3 mois et 15 mois après la mise en place de l'outil. Le passage de l'administration du pantoprazole par voie intraveineuse (IV) à voie orale (PO) a été évalué au cours de chaque phase comme une variable dépendante non équivalente. Le résultat principal fut la proportion de patients admissibles à la conversion IV–PO qui ont été orientés vers un traitement par voie orale.Résultats : Des 332 patients recevant une antibiothérapie ciblée par voie intraveineuse (IV) pendant l'étude, 122 (37 %) répondaient au critère de la conversion IV–PO. Le taux de conversion IV–PO de 35 % (9/26) de la phase 2 était comparable au taux avant l'intervention de 29 % (10/35)(p = 0,61). La mise en place de l'outil ADC a grandement augmenté le taux de conversion, qui est passé à 78 % (14/18) : une augmentation maintenue trois mois (71 % [17/24]) et 15 mois (74 % [14/19]) après la mise en place (p < 0,05 par rapport aux phases 1 et 2). Les taux de conversion du pantoprazole étaient similaires durant toutes les phases.Conclusions : La mise en place de l'outil ADC a permis d'améliorer et de maintenir les taux de conversion IV–PO et de renforcer le respect des politiques au-delà des effets de la révision des politiques et de la formation à celles-ci. Le perfectionnement de la politique et de l'outil se justifie pour maximiser l'adoption du programme de conversion IV–PO.

Mentors that guide young people in their transition to adulthood provide support in a variety of domains that set the stage for happier adult lives. While mentoring during emerging adulthood is associated with shorter-term social and professional success—less is known about whether mentoring for career and committed relationships, specifically, are linked to downstream well-being. This study uses nationally representative data from the Panel Study of Income Dynamics ( N = 6,197) to examine whether receiving mentoring in emerging adulthood is linked to later flourishing and subjective well-being. Structural Equation Models indicate that people with career mentors in emerging adulthood reported higher levels of flourishing and subjective well-being and those with committed relationship mentors reported more flourishing in later life. Findings suggest that emerging adults who receive career supports may have better chances of experiencing well-being downstream.