• 1 Improving medical education in the Americas. 复制标题 收藏 收藏

    【改善美洲的医学教育。】 复制标题 收藏 收藏
    DOI:10.1097/00001888-199109000-00011 复制DOI
    作者列表:
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【美洲的生长和补充喂养。】 复制标题 收藏 收藏
    DOI:10.1016/j.numecd.2012.07.004 复制DOI
    作者列表:Lutter CK
    BACKGROUND & AIMS: BACKGROUND AND AIMS:To describe growth patterns of young children in Latin America and the Caribbean, the types of nationally representative data available on complementary feeding practices and complementary feeding practices. METHODS AND RESULTS:Data on growth, timing of introduction of liquids and foods, and complementary feeding practices were abstracted from nationally representative surveys. The high prevalence of stunting relative to the low prevalence of underweight is striking, with the "average" child in the region, with the exception of the Haitian child, short and chubby. The focus of the demographic and health surveys continues to be on undernutrition with only one question, intake of sugary foods, related foods that may have consequences for adult health. The United States has more comprehensive information; Mexico has information on beverage consumption and Brazil on soft drink and biscuit or snack consumption. In 14 of 19 countries, fewer than half of infants are exclusively breastfed for the first 6 months of life, indicating an early introduction of liquids and complementary foods. Among the 5 countries with data on the intake of sugary foods, intake in the previous 24 h among children 6-23 months of age ranged from 14% to 79%. CONCLUSIONS:The absence of data to characterize complementary feeding diets as they relate to risk of overweight and chronic diseases in the Region of the Americas calls attention to the need to improve data collection frameworks and methods to address this important gap in knowledge.
    背景与目标:
  • 【来自美洲的具有新突变和非典型特征的CARASIL患者: 病例介绍和文献综述。】 复制标题 收藏 收藏
    DOI:10.1159/000477358 复制DOI
    作者列表:Ibrahimi M,Nozaki H,Lee A,Onodera O,Reichwein R,Wicklund M,El-Ghanem M
    BACKGROUND & AIMS: OBJECTIVE:Reporting a novel mutation in the HTRA1 gene in a CARASIL patient from Americas. METHODS:Clinical presentation and neuroimaging were consistent with CARASIL. HTRA1 DNA sequencing was performed using advanced ("next generation") sequencing technology. The results revealed a homozygous missense mutation as c.616G>A (p.Gly206Arg) in the HTRA1 gene. RESULTS:A 24-year-old man with a history of chronic back pain presented with recurrent ischemic strokes. A diagnosis of CARASIL was made with the finding of a novel homozygous missense mutation c.616G>A in HTRA1 gene, resulting in change from Glycine to Arginine in the Serine Protease HTRA1. Brain imaging showed multiple lacunar infarcts with extensive abnormalities of the white matter that spared the external capsules. He also had unilateral decreased hearing with craniofacial asymmetry. None of the above features have been previously described in known CARASIL patients. Both parents of the proband were heterozygous for the same missense mutation. CONCLUSION:We discovered a novel missense mutation (c.616G>A) associated with a phenotype of CARASIL. This is the first genetically backed case of CARASIL in the new world. The patient's craniofacial abnormalities, including asymmetry of the head, may be related to impaired modulation of transforming growth factor-β1, the result of loss of proteolytic activity of HTRA1. External capsules remained unaffected, despite findings of advanced changes in the rest of the cerebral white matter. Literature is briefly reviewed. The patient's history, neurological exam, neuroimaging, and genetic testing are included.
    背景与目标:
  • 【美洲盘尾丝虫病消除计划 (OEPA)。】 复制标题 收藏 收藏
    DOI:10.1179/136485908X337454 复制DOI
    作者列表:Sauerbrey M
    BACKGROUND & AIMS: :Human onchocerciasis (river blindness) occurs in 13 foci distributed among six countries in Latin America (Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela), where about 500,000 people are considered at risk. An effort to eliminate the disease from the region was launched in response to a specific resolution adopted by the PanAmerican Health Organization (PAHO) in 1991: to eliminate onchocerciasis from the region, as a public-health problem, by 2007. The effort took advantage of the donation of the drug Mectizan (ivermectin) by Merck & Co., Inc. In 1992, the Onchocerciasis Elimination Program for the Americas (OEPA) was launched, with its headquarters in Guatemala, to act as a technical and co-ordinating body of a multinational, multi-agency coalition that includes the endemic countries, PAHO, The Carter Center, Lions Clubs, the United States Centers for Disease Control and Prevention, The Bill and Melinda Gates Foundation, Merck & Co., Inc., and other partners. This public-private partnership facilitated the establishment of programmes for the semi-annual mass administration of Mectizan in the six countries with onchocerciasis. The aims were to (1) provide sustained treatments, with coverage reaching at least 85% of those eligible to receive the drug (in the 1845 endemic communities that are distributed within the 13 regional foci); (2) eliminate new morbidity caused by Onchocerca volvulus infection by 2007; and (3) eliminate transmission of the parasite wherever feasible. Significant progress has already been made in all six countries, each of which has active programmes with treatment coverages exceeding the target of 85%. The progress is being documented in accordance with certification guidelines for onchocerciasis elimination established by the World Health Organization. No new cases of onchocercal blindness are being reported in the region, and ocular disease attributable to O. volvulus has been eliminated from nine of the 13 foci. Treatment is no longer needed in Santa Rosa, Guatemala, where transmission has been eliminated, and will be halted in at least three other foci in 2008, as they confirm the interruption of transmission. Treatment efforts should now be concentrated on the five foci where significant transmission remains: Central (Guatemala), Amazonas/Roraima (Brazil), North-central (Venezuela), North-east (Venezuela) and South (Venezuela). Based upon the experience gained, the well-established operations and the success achieved so far, it seems reasonable to estimate that onchocerciasis could be eliminated from most of the remaining foci in the Americas by 2012. The protocol, criteria and deadline for stopping all onchocerciasis treatment in the region should soon be addressed by OEPA's Program Co-ordinating Committee (PCC), in co-ordination with the PAHO.
    背景与目标: : 人类盘尾丝虫病 (河盲症) 发生在拉丁美洲六个国家 (巴西,哥伦比亚,厄瓜多尔,危地马拉,墨西哥和委内瑞拉) 的13个病灶中,约有500,000人处于危险之中。根据泛美卫生组织 (PAHO) 1991年通过的一项具体决议,发起了从该地区消除该疾病的努力: 2007年从该地区消除盘尾丝虫病,这是一个公共卫生问题。这项工作利用了默克公司 (Merck & co.,Inc.) 捐赠的药物Mectizan (伊维菌素)。1992年,美洲盘尾丝虫病消除方案 (OEPA) 启动,其总部设在危地马拉,作为一个多国、多机构联盟的技术和协调机构,该联盟包括流行国家、泛美卫生组织、卡特中心、狮子俱乐部、美国疾病控制和预防中心、比尔和梅琳达·盖茨基金会、默克公司和其他合作伙伴。这种公私伙伴关系促进了在六个盘尾丝虫病国家建立半年度大规模管理meectizan的计划。目标是 (1) 提供持续治疗,覆盖至少85% 的有资格接受该药物的人 (在13个区域疫源地分布的1845个流行社区中); (2) 消除由肠菌感染引起的新发病率2007年; (3) 在可行的情况下消除寄生虫的传播。所有六个国家都取得了重大进展,每个国家都有积极的方案,治疗覆盖面超过85% 目标。根据世界卫生组织制定的消除盘尾丝虫病认证准则,正在记录进展情况。该地区没有新的盘尾猴失明病例的报道,并且在13个病灶中的9个病灶中消除了归因于扭转的眼部疾病。危地马拉圣罗莎不再需要治疗,那里已经消除了传播,并将在至少三个其他病灶2008年停止治疗,因为它们证实了传播的中断。现在,治疗工作应集中在仍然存在大量传播的五个重点: 中部 (危地马拉),亚马孙/罗赖马 (巴西),中北部 (委内瑞拉),东北 (委内瑞拉) 和南部 (委内瑞拉)。根据所获得的经验,完善的业务和迄今为止取得的成功,似乎可以合理地估计,2012年可以从美洲大部分剩余病灶中消除盘尾丝虫病。OEPA计划协调委员会 (PCC) 与泛美卫生组织 (PAHO) 协调,应尽快解决该地区停止所有盘尾丝虫病治疗的方案,标准和截止日期。
  • 【圣路易斯脑炎病毒在美洲的演变和传播。】 复制标题 收藏 收藏
    DOI:10.1016/j.meegid.2008.07.006 复制DOI
    作者列表:Auguste AJ,Pybus OG,Carrington CV
    BACKGROUND & AIMS: :Using a Bayesian coalescent approach on a dataset of 73 envelope gene sequences we estimated substitution rates and dates of divergence for St. Louis encephalitis virus (SLEV) in the Americas. We found significant rate heterogeneity among lineages, such that "relaxed" molecular clock models were much better supported than a strict molecular clock. The mean substitution rate estimated for all SLEV was 4.1x10(-4)substitutions/site/year (95% HPD 2.5-5.7)-higher than previous estimates that relied on the less well-suited strict clock. Mean substitution rates for individual lineages varied from 3.7x10(-4) to 7.2x10(-4)substitutions/site/year. For the first time we also assessed the magnitude and direction of viral gene flow within the Americas. The overall direction of gene flow during the period represented by the phylogeny is from South to North, and the region between 15 degrees N and 30 degrees N latitude appears to be the major source of virus for the rest of North America, which is consistent with migratory birds returning to their northern breeding grounds having acquired infection while wintering in the region of the Gulf of Mexico.
    背景与目标: : 在73个包膜基因序列的数据集上使用贝叶斯合并方法,我们估计了美洲圣路易斯脑炎病毒 (SLEV) 的替代率和差异日期。我们发现谱系之间存在显着的速率异质性,因此与严格的分子钟相比,“放松” 的分子钟模型得到了更好的支持。所有SLEV的平均替代率估计为4.1x10(-4) 替换/位点/年 (95% HPD 2.5-5.7)-高于先前依赖不太适合的严格时钟的估计。单个谱系的平均替代率从3.7x10(-4) 到7.2x10(-4) 替换/站点/年不等。我们还首次评估了美洲病毒基因流的大小和方向。在系统发育所代表的时期内,基因流的总体方向是从南到北,北纬15度至北纬30度之间的区域似乎是北美其他地区的主要病毒来源,这与在墨西哥湾地区越冬时返回北部繁殖地的候鸟获得感染是一致的。
  • 【跨大西洋溢出: 解构美洲利什曼原虫的生态适应。】 复制标题 收藏 收藏
    DOI:10.3390/genes11010004 复制DOI
    作者列表:Boité MC,Späth GF,Bussotti G,Porrozzi R,Morgado FN,Llewellyn M,Schwabl P,Cupolillo E
    BACKGROUND & AIMS: :Pathogen fitness landscapes change when transmission cycles establish in non-native environments or spill over into new vectors and hosts. The introduction of Leishmania infantum in the Americas into the Neotropics during European colonization represents a unique case study to investigate the mechanisms of ecological adaptation of this important parasite. Defining the evolutionary trajectories that drive L. infantum fitness in this new environment are of great public health importance as they will allow unique insight into pathways of host/pathogen co-evolution and their consequences for region-specific changes in disease manifestation. This review summarizes current knowledge on L. infantum genetic and phenotypic diversity in the Americas and its possible role in the unique epidemiology of visceral leishmaniasis (VL) in the New World. We highlight the importance of appreciating adaptive molecular mechanisms in L. infantum to understand the parasites' successful establishment on the continent.
    背景与目标: : 当传播周期在非本地环境中建立或溢出到新的媒介和宿主中时,病原体适应性景观会发生变化。在欧洲殖民期间,将美洲的利什曼原虫引入新热带地区代表了一个独特的案例研究,以研究这种重要寄生虫的生态适应机制。定义在这种新环境中驱动婴儿适应性的进化轨迹具有重要的公共卫生重要性,因为它们将使人们能够独特地了解宿主/病原体共同进化的途径及其对疾病表现中特定区域变化的影响。这篇综述总结了美洲婴儿L.Infandum遗传和表型多样性的最新知识,以及其在新世界内脏利什曼病 (VL) 独特流行病学中的可能作用。我们强调了在婴儿中欣赏适应性分子机制以了解寄生虫在非洲大陆成功建立的重要性。
  • 【在美洲,Ustilago maydis种群通过驯化和种植来追踪玉米。】 复制标题 收藏 收藏
    DOI:10.1098/rspb.2007.1636 复制DOI
    作者列表:Munkacsi AB,Stoxen S,May G
    BACKGROUND & AIMS: :The domestication of crops and the development of agricultural societies not only brought about major changes in human interactions with the environment but also in plants' interactions with the diseases that challenge them. We evaluated the impact of the domestication of maize from teosinte and the widespread cultivation of maize on the historical demography of Ustilago maydis, a fungal pathogen of maize. To determine the evolutionary response of the pathogen's populations, we obtained multilocus genotypes for 1088 U. maydis diploid individuals from two teosinte subspecies in Mexico and from maize in Mexico and throughout the Americas. Results identified five major U. maydis populations: two in Mexico; two in South America; and one in the United States. The two populations in Mexico diverged from the other populations at times comparable to those for the domestication of maize at 6000-10000 years before present. Maize domestication and agriculture enforced sweeping changes in U. maydis populations such that the standing variation in extant pathogen populations reflects evolution only since the time of the crop's domestication.
    背景与目标: : 农作物的驯化和农业社会的发展不仅带来了人类与环境相互作用的重大变化,而且还带来了植物与挑战它们的疾病相互作用的重大变化。我们评估了从teosinte驯化玉米和玉米广泛种植对玉米真菌病原体Ustilago maydis历史人口统计学的影响。为了确定病原体种群的进化反应,我们从墨西哥的两个teosinte亚种以及墨西哥和整个美洲的玉米获得了1088个U. maydis二倍体个体的多基因座基因型。结果确定了五个主要的U. maydis人群: 两个在墨西哥; 两个在南美; 一个在美国。墨西哥的两个种群与其他种群的差异有时与目前6000-10000年前玉米驯化的种群相当。玉米驯化和农业强制了U. maydis种群的全面变化,因此现存病原体种群的长期变化仅反映了自作物驯化以来的进化。
  • 【[关于美洲初级保健的创新]。】 复制标题 收藏 收藏
    DOI:10.1590/s1020-49892007000900015 复制DOI
    作者列表:Morales LG,Blanco JH
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【美洲孕产妇和新生儿免疫综合办法的进展。】 复制标题 收藏 收藏
    DOI:10.26633/RPSP.2017.159 复制DOI
    作者列表:Ropero Alvarez AM,Jauregui B,El Omeiri N
    BACKGROUND & AIMS: :Maternal and neonatal immunization (MNI) is a core component of the new immunization model in the Americas, which transitioned from immunization of children to that of the entire family. Immunization during pregnancy protects the mother and the fetus by providing the neonate with maternal antibodies against disease. It has the potential to impact early childhood morbidity and mortality, and thus MNI has gained visibility and priority on the global health agenda. The Region of the Americas is a leader in MNI, as seen by its elimination of congenital rubella syndrome in 2015 and the progress made toward neonatal tetanus elimination. In the Americas, 31 countries currently target pregnant women for influenza vaccination; and 21 countries-over 90% of the Region's birth cohort-have nationwide newborn hepatitis B vaccination. This paper describes the status of MNI in the Americas and identifies gaps in the evidence, obstacles to optimal implementation, and opportunities for future improvements. Catalysts for MNI in the Region have been political commitment, endorsement by scientific societies, an established "culture of vaccination," widespread access to antenatal care, and context-specific communications; however, universal and equitable access for pregnant women and their newborns continues to be a formidable challenge, and additional vaccine safety and effectiveness evidence is needed. Continued efforts to integrate MNI with maternal and child health services will be critical to furthering the MNI platform as well. :La inmunización materna y neonatal es un componente central del nuevo modelo de inmunización en la Región de las Américas, que pasó de la inmunización infantil a la de toda la familia. La inmunización durante el embarazo protege a la madre y el feto dando al recién nacido los anticuerpos maternos contra las enfermedades. Tiene el potencial de repercutir en la morbilidad y la mortalidad en la primera infancia, por lo que la inmunización materna y neonatal ha adquirido visibilidad y prioridad en la agenda mundial de salud.La Región de las Américas ocupa una posición de liderazgo en materia de inmunización materna y neonatal, como lo demuestra la eliminación del síndrome de rubéola congénita en el 2015 y los avances logrados para la eliminación del tétanos neonatal. Actualmente en 31 países de la Región se da prioridad a las embarazadas para que reciban vacunación antigripal y en 21 países —más de 90% de la cohorte de nacimiento de la Región— se incluye la vacunación de los recién nacidos contra la hepatitis B a nivel nacional.En este documento se describe la situación de la inmunización materna y neonatal en la Región de las Américas y se señalan las lagunas en la evidencia, los obstáculos a la implementación óptima y las oportunidades para las mejoras futuras. Los catalizadores de la inmunización materna y neonatal en la Región han sido el compromiso político, el aval de las sociedades científicas, una “cultura de vacunación” establecida, el acceso generalizado a la atención prenatal y las comunicaciones específicas para cada contexto; sin embargo, el acceso universal y equitativo de las embarazadas y los recién nacidos sigue siendo un reto enorme y se necesitan más datos científicos sobre la seguridad y efectividad de las vacunas. La continuación de los esfuerzos para integrar la inmunización materna y neonatal en los servicios de salud maternoinfantil será fundamental para promover también la plataforma a favor de esta inmunización. :A imunização materna e neonatal é peça fundamental do novo modelo de imunização nas Américas, com a transição da vacinação de crianças à vacinação de toda a família. A vacinação da gestante protege a mãe e o feto ao proporcionar ao recém-nascido anticorpos maternos contra doenças. A imunização materna e neonatal possivelmente repercute na primeira infância reduzindo a morbidade e a mortalidade e, portanto, ganhou visibilidade sendo considerada prioritária na agenda global de saúde.A Região das Américas é líder em imunização materna e neonatal, tendo alcançado a eliminação da síndrome da rubéola congênita em 2015 e avançado para a eliminação do tétano neonatal. Existem atualmente programas de vacinação contra influenza para gestantes em 31 países e programas nacionais de vacinação contra hepatite B para recém-nascidos em 21 países (com uma cobertura superior a 90% da coorte de nascidos vivos na Região).Este artigo apresenta um panorama da imunização materna e neonatal nas Américas, destaca as lacunas nas evidências científicas e os obstáculos à implementação ideal dos programas de vacinação e aponta oportunidades futuras para melhorias. Entre os fatores responsáveis pelo incentivo à imunização materna e neonatal na Região estão o compromisso político, o endosso das sociedades científicas, uma “cultura de vacinação” estabelecida, o amplo acesso à assistência pré-natal e a comunicação contextualizada. Porém, o acesso universal e equitativo das gestantes e seus recémnascidos à vacinação é ainda um grande desafio e se fazem necessárias mais evidências sobre a segurança e a efetividade das vacinas. Além disso, é imprescindível o empenho contínuo para integrar a imunização materna e neonatal aos serviços de saúde materno-infantil e seguir promovendo a plataforma de imunização materna e neonatal.
    背景与目标:
  • 【美洲的酒精消费和疾病负担2012年: 对酒精政策的影响。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Shield KD,Monteiro M,Roerecke M,Smith B,Rehm J
    BACKGROUND & AIMS: OBJECTIVE:To describe the volume and patterns of alcohol consumption up to and including 2012, and to estimate the burden of disease attributable to alcohol consumption as measured in deaths and disability-adjusted life years (DALYs) lost in the Americas in 2012. METHODS:Measures of alcohol consumption were obtained from the World Health Organization (WHO) Global Information System on Alcohol and Health (GISAH). The burden of alcohol consumption was estimated in both deaths and DALYs lost based on mortality data obtained from WHO, using alcohol-attributable fractions. Regional groupings for the Americas were based on the WHO classifications for 2004 (according to child and adult mortality). RESULTS:Regional variations were observed in the overall volume of alcohol consumed, the proportion of the alcohol market attributable to unrecorded alcohol consumption, drinking patterns, prevalence of drinking, and prevalence of heavy episodic drinking, with inhabitants of the Americas consuming more alcohol (8.4 L of pure alcohol per adult in 2012) compared to the world average. The Americas also experienced a high burden of disease attributable to alcohol consumption (4.7% of all deaths and 6.7% of all DALYs lost), especially in terms of injuries attributable to alcohol consumption. CONCLUSIONS:Alcohol is consumed in a harmful manner in the Americas, leading to a high burden of disease, especially in terms of injuries. New cost-effective alcohol policies, such as increasing alcohol taxation, increasing the minimum legal age to purchase alcohol, and decreasing the maximum legal blood alcohol content while driving, should be implemented to decrease the harmful consumption of alcohol and the resulting burden of disease.
    背景与目标:
  • 11 Depressive symptomatology across the Americas. 复制标题 收藏 收藏

    【整个美洲的抑郁症状学。】 复制标题 收藏 收藏
    DOI:10.1001/archpsyc.1980.01780200096012 复制DOI
    作者列表:Mezzich JE,Raab ES
    BACKGROUND & AIMS: We compared depressive symptomatology and its sociocultural context across a Peruvian sample of 93 and a US sample of 64 adult depressive patients. The design involved the interview and evaluation of both groups by a bilingual investigator using Spanish- and English-language versions of the same assessment instruments. A basic commonality of core depressive symptoms and signs was found across samples, which also had similar levels of overall depressive severity. However, more complaints and higher scores on somatic symptoms and daily fluctuation of depression were seen in the Peruvian group, while the US group had higher scores on suicidal manifestations.

    背景与目标: 我们在秘鲁93个样本和美国64个成年抑郁症患者样本中比较了抑郁症状及其社会文化背景。该设计涉及双语研究者使用相同评估工具的西班牙语和英语版本对两组进行访谈和评估。在样本中发现了核心抑郁症状和体征的基本共性,其总体抑郁严重程度也相似。然而,在秘鲁组中,出现了更多的抱怨和更高的躯体症状和抑郁的日常波动,而美国组在自杀表现方面的得分更高。
  • 【欧洲药品监管网络五十年: 加强美洲区域内合作的思考。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Allchurch MH,Barbano DB,Pinheiro MH,Lazdin-Helds J
    BACKGROUND & AIMS: :This report considers how the experience of the European regulatory system might be applied to help strengthen the regulatory systems for medicines in the Region of the Americas. The work of the European Medicines Agencies (EMA) is carried out through its scientific committees, composed of members from European Economic Area countries. A robust legal framework allows EMA to coordinate resources from Member States' competent authorities, including, for example, assisting candidate countries as they prepare to join the European Union (EU). Capacity-building programs help countries adjust their regulatory systems ahead of full participation in the European medicines regulatory network. These programs facilitate adoption of common technical requirements, identify areas where action might be needed to ensure the smooth transposition of EU pharmaceutical law into national legislation, and prepare candidate countries for participation in EMA committees and the European regulatory network. The methodology of these programs could be of potential interest to the Pan American Health Organization (PAHO), the Regional Office of the World Health Organization for the Americas. Given resolutions adopted by the World Health Assembly and the PAHO Directing Council, there is a strong indication that the countries of the Region of the Americas wish to assemble a system that uses the existing regulatory capacity of some countries to strengthen local regulatory capacities in others.
    背景与目标: : 本报告考虑了如何应用欧洲监管体系的经验来帮助加强美洲地区的药品监管体系。欧洲药品机构 (EMA) 的工作是通过其科学委员会进行的,该委员会由来自欧洲经济区国家的成员组成。健全的法律框架使EMA可以协调成员国主管当局的资源,例如,在准备加入欧盟 (EU) 时协助候选国。能力建设计划帮助各国在全面参与欧洲药品监管网络之前调整其监管体系。这些计划有助于采用共同的技术要求,确定可能需要采取行动以确保将欧盟制药法顺利转换为国家立法的领域,并为参与EMA委员会和欧洲监管网络的候选国家做准备。这些计划的方法可能会引起世界卫生组织美洲区域办事处泛美卫生组织 (PAHO) 的潜在兴趣。鉴于世界卫生大会和泛美卫生组织指导理事会通过的决议,有强烈迹象表明,美洲区域各国希望建立一个利用一些国家现有监管能力加强其他国家地方监管能力的系统。
  • 【使用美国疝气协会质量合作进行造口旁疝修补术的患者: 一项前瞻性队列研究。】 复制标题 收藏 收藏
    DOI:10.1016/j.jamcollsurg.2018.07.658 复制DOI
    作者列表:Gavigan T,Stewart T,Matthews B,Reinke C
    BACKGROUND & AIMS: BACKGROUND:Parastomal hernia is the most common complication after stoma creation. It can create significant morbidity and is associated with a lower quality of life. Current parastomal hernia repair techniques and outcomes are not well characterized. We aimed to describe patient characteristics, operative techniques, and outcomes of patients undergoing parastomal hernia repair. STUDY DESIGN:Patients in the Americas Hernia Society Quality Collaborative (AHSQC) ≥18 years old, who underwent parastomal hernia repair were identified. Descriptive statistics were performed for patient demographics, preoperative characteristics, operative details, 30-day follow-up, and patient-reported outcomes. The surgical techniques used in parastomal hernia repair and postoperative outcomes were described, and predictors of open vs minimally invasive surgery (MIS) and type of mesh used were analyzed. RESULTS:We identified 672 patients in the AHSQC who underwent parastomal hernia repair between 2013 and Nov 2017. Almost all operations were elective, 22% of patents had their stoma reversed, and 94% of repairs used mesh. Elective status and surgeon practice type were associated with use of synthetic mesh. A surgeon's preference for MIS, defect size, and age were associated with use of an MIS approach. Quality of life scores improved for patients who completed a postoperative questionnaire. CONCLUSIONS:This is the first multi-institutional report of parastomal hernia repair using prospective data complete with operative details. Parastomal hernia repair remains a difficult operation without a clear best practice. Multiple factors appear to influence operative approach. Surgical treatment may improve quality of life at 6 to 12 months postoperatively.
    背景与目标:
  • 14 The health situation in the Americas. 复制标题 收藏 收藏

    【美洲的健康状况。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Terris M
    BACKGROUND & AIMS: :This paper considers the elements that determine the health situation in any country: the specific hazards to health, the health services, and the general determinants which influence both the hazards and the services. The expectation of life--the best single measure of the health situation--is presented for each country of the Americas as representing the resultant of these determinants. The changing pattern of disease in the Americas--the emergence of noninfectious diseases as the major problems--is documented, and the need for epidemiologically oriented health planning is stressed. Data are presented to indicate that medical care is the least significant of the basic triad of public health, and that primary attention must be paid to both disease prevention and living standards.
    背景与目标: : 本文考虑了决定任何国家健康状况的要素: 对健康的具体危害,卫生服务以及影响危害和服务的一般决定因素。对生命的期望-衡量健康状况的最佳单一指标-为美洲每个国家/地区提供了这些决定因素的结果。记录了美洲疾病模式的变化-非传染病的出现是主要问题-并强调了以流行病学为导向的健康计划的必要性。提供的数据表明,医疗保健是公共卫生基本三合会中最不重要的,必须首先注意疾病预防和生活水平。
  • 【生活方式的迅速变化使增加体育锻炼成为美洲的优先事项。】 复制标题 收藏 收藏
    DOI:10.1590/s1020-49892003000900002 复制DOI
    作者列表:Jacoby E,Bull F,Neiman A
    BACKGROUND & AIMS: -2
    背景与目标: -2

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