Comparative effectiveness of heel-specific medical devices for the prevention of heel pressure ulcers: A systematic review

BackgroundPressure ulcers (PUs) impact on patient's quality of life and are costly for healthcare providers. Heels are a particular concern due to specific risk factors. Relative effectiveness of medical devices, e.g., dressings, off-loading devices, heel cushioning devices, to reduce PU development is unknown.MethodsSystematic review of the effectiveness of heel-specific medical devices for the prevention of heel PU (HPU)s. Database searches were performed from inception to June 2021 for RCTs. The primary outcome was incidence of new HPUs. Trials were assessed for risk of bias and data analysed with risk ratios, mean difference or hazard ratios as appropriate.ResultsFifteen RCTs (4724 participants) were identified.Dressings, as constant low pressure (CLP) devices vs standard care: eight trials (very low quality) showed no-significant difference in effectiveness (RR 0.31, 95%CI 0.10 to 1.01).Off-loading devices vs standard care: three trials (low quality), showed significant reduction in development of Category≥1 HPUs (RR 0.20, 95%CI 0.05 to 0.80) two trials (medium quality), showed significant reduction in development of Category≥2 HPUs (RR 0.08, 95%CI 0.01 to 0.67).Comparisons between off-loading devices: two trials (low quality) showed no clear difference in HPU incidence.In a paediatric post-surgical population, one trial of off-loading device and one of a dressing (CLP device), both versus standard care, showed no clear difference in HPU incidence (RR 0.19 95%CI 0.02 to 1.55 and RR 0.89 95%CI 0.56 to 1.42 respectively).ConclusionsOff-loading devices may reduce HPU incidence, from low-quality evidence. There is insufficient evidence to suggest that dressings reduce HPU incidence.     

Labor force participation at older ages in the Western Pacific: A microeconomic analysis

Retirement has become a very important stage of life for persons in developed countries. Life expectancy for those over age 60 has increased markedly. Rising real income and the institution of broad based social security systems have encouraged older workers to leave the labor force at younger ages. p]Reductions in older age mortality have also affected the less developed regions. Increases in the number of older persons, coupled with continuing high fertility, have increased the size of the working age population through both large entry cohorts and longevity of current workers. The capacity of the economy to absorb this growth is severely limited. As a result, labor force decisions by older individuals will be of increasing importance.This study provides new evidence on labor force decisions in four developing countries in the Western Pacific: Fiji, the Republic of Korea, Malaysia, and the Philippines. A uniform survey sponsored by the World Health Organization in the four countries of persons aged 60 and over is employed to estimate the determinants of work decisions.     

APEC 医院认证工作会议(CHICAGO)综述

从建立国家医疗质量评估项目的优先发展战略;APEC成员国在医疗质量评估上的经验及合作状况;如何建立与完善质量评估标准;评估对执业机构与人员的价值与影响;建立评估体系的跨地域协作等方面介绍了亚太经济合作组织医院认证工作大会的概况。     

Ultrasound in tropical pyomyositis

Tropical pyomyositis is an infection of muscles mainly presenting in black people, occurring in the trunk and limbs. At Hoima Hospital, Uganda, 58 patients (30 men and 28 women) with a mean age of 21 years have been investigated by ultrasound; a total of 81 lesions were present. Two different characteristic images were found; abscess was present in 65 cases while 16 patients showed a diffuse infiltration among the muscular fibers. These two different images correspond to the two stages of histologic and clinical progression described by other authors. Ultrasound is useful to demonstrate the progression of pyomyositis and to determine when and where to drain any abscess.     

Mercury from gold minings in the Pantanal of Pocone (Mato Grosso,Brazil)

The Pocone gold minings are situated in the Bento Gomes River Basin, at the border of the Pantanal of Mato Grosso. Gold-bearing quartz veins are removed from the subsoils, milled with water, centrifuged and the heavier fraction is subsequently mixed with mercury for gold separation. The gold mining activities caused a very intensive landscape change, threatening many environmental processes like sediment control and storage and recycling capacity of mercury. Cold Vapor Atomic Fluorescence System (CVAFS) was used to determinate total mercury in water, suspended material and sediments from Bento Gomes River, sampled monthly for 1 year. Apart from the fact that mercury concentrations are low in water and bottom sediments, they are slightly higher in relation to background levels measured in the area. The concentration in suspended material is also lower than other rivers with gold mining activities, but the floodplains of the Bento Gomes River act as mercury sinks. Therefore, the discharge of mercury into the Pantanal floodplain should be avoided, in spite of actual contamination of the system being very low.     

东南亚及西太平洋区的丝虫病

淋巴丝虫病为东南亚、西太平洋及南太平洋的重要公共卫生问题。此为慢性病，丝虫之成虫寄生于淋巴管或淋巴结，长达10－18年之久，致淋巴循环受阻塞而形成象皮病。根据微丝蚴在人体末梢血液之出现时间，分为日间和夜间之周期型与亚周期型。媒介多达40余种。防治方法主要赖药物治疗，世界卫生组织预期以现有的药物可于2020年消灭全球之淋巴丝虫病。本将班氏丝虫、马未丝虫及旁汶丝虫发现之经过，微丝蚴定期性，病媒蚊种及防治原则，作了相当完整的综述。笔曾在中所提及的多数国家实地防治丝虫病。     

Rising Ethnic Inequalities in Acute Rheumatic Fever and Rheumatic Heart Disease,New Zealand, 2000–2018

We describe trends in acute rheumatic fever (ARF), rheumatic heart disease (RHD), and RHD deaths among population groups in New Zealand. We analyzed initial primary ARF and RHD hospitalizations during 2000–2018 and RHD mortality rates during 2000–2016. We found elevated rates of initial ARF hospitalizations for persons of Māori (adjusted rate ratio [aRR] 11.8, 95% CI 10.0–14.0) and Pacific Islander (aRR 23.6, 95% CI 19.9–27.9) ethnicity compared with persons of European/other ethnicity. We also noted higher rates of initial RHD hospitalization for Māori (aRR 3.2, 95% CI 2.9–3.5) and Pacific Islander (aRR 4.6, 95% CI 4.2–5.1) groups and RHD deaths among these groups (Māori aRR 12.3, 95% CI 10.3–14.6, and Pacific Islanders aRR 11.2, 95% CI 9.1–13.8). Rates also were higher in socioeconomically disadvantaged neighborhoods. To curb high rates of ARF and RHD, New Zealand must address increasing social and ethnic inequalities.