Book
Здравоохранение: современное состояние и возможные сценарии развития: докл. к XVIII Апр. междунар. науч. конф. по проблемам развития экономики и общества, Москва, 11–14 апр. 2017 г.
In the internal medicine wide spectrum the gastroenterology is one of the chapters, less enlightened by the scientific evidence. It does not mean that the practice of the grasntroenterology may ot be improved by the systematic use of the approaches of the evidence based medicine
Background
Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.
Methods
Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.
Findings
Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.
Interpretation
Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.
This article analyses the interrelation between human resource policies and educational policies in the system of healthcare provision to solve the problem of the structural imbalance in the supply of physicians. International experience reveals a growing emphasis on policies which help maintain the optimal structure of medical workers, i.e. the structure that corresponds to the needs of the healthcare system and society as a whole. Such policies include new regulatory and planning mechanisms for medical schools, the regulation of admission plans and the specialization structure in postgraduate medical education, specific post-education employment practices, and measures to overcome the shortage of supply of some categories of physicians and their geographic misbalance. In Russia, the structural component of human resource policies and educational policies has clearly weakened. The current regulatory and planning methods tend to reproduce the accumulated structural imbalances. Regulatory measures to improve the quality of the training of physicians are still ineffective. No prospective planning exists. Postgraduate training is poorly oriented towards the specializations currently in short supply. Medical schools are interested in training physicians capable of paying for their education and the government does not have the instruments to manipulate the structure of the student body. Recent attempts to improve the situation have not resulted in any positive outcomes yet. The decision to accredit graduates for practicing in primary care without postgraduate training will most likely deteriorate the quality of healthcare. Based on international experience, the authors suggest new regulatory mechanisms.
Plus d'un quart de siècle après la fin de l'URSS, la libéralisation des prix en Russie et l'adoption de différents modèles pour les républiques d'Asie centrale ont des répercussions majeures sur le bilan de ces pays. La perte brutale des acquis socio-économiques au sein d'une population encore largement marquée par un mode de fonctionnement soviétique a vulnérabilisé des pans entiers de ces sociétés, exacerbant les inégalités. La reconfiguration des mobilités (exil, déplacements forcés, migrations économiques et environnementales) implique un jeu d'échelles nouveau qui nécessite de s'intéresser aux conditions d'origine des migrants, aux stratégies migratoires et à la recomposition de sociétés d'origine. Ces derniers sont en effet dépendants des contextes, politique et économique notamment, du pays d'accueil : la Russie. Ils sont également liés par différentes formes d'allégeance aux réseaux et aux systèmes de loyauté. Dans ces sociétés post-soviétiques, l'assurance de la survie de la communauté, de la famille, de la parentèle est à rechercher dans le retissage de normes et de réseaux encastrés qui ont préexisté à la fin de l'URSS et se sont remodelés face à de nouvelles contingences. Mais la circulation des migrants les expose à des risques sanitaires et épidémiologiques. Les enjeux de l'accès aux soins se posent de manière aiguë. Les politiques préventives concernant notamment l'infection par VIH/SIDA, les hépatites, la tuberculose sont confrontées à une disqualification du système de santé publique et s'accompagnent de situations très anxiogènes lors des migrations pour de nombreux ressortissants d'Asie centrale. Les vulnérabilités sont donc multidimensionnelles et les représentations du corps et de la maladie jouent un rôle non négligeable dans les mentalités. Aussi la santé des migrants représente-t-elle un enjeu majeur dans les républiques post-soviétiques mais aussi universel dans le monde globalisé qui les façonne.
Data management and analysis is one of the fastest growing and most challenging areas of research and development in both academia and industry. Numerous types of applications and services have been studied and re-examined in this field resulting in this edited volume which includes chapters on effective approaches for dealing with the inherent complexity within data management and analysis. This edited volume contains practical case studies, and will appeal to students, researchers and professionals working in data management and analysis in the business, education, healthcare, and bioinformatics areas.
This prototype development explains the challenges encountered during the ISO/IEEE 11073 standard implementation process. The complexity of the standard and the consequent heavy requirements, which have not encouraged software engineers to adopt the standard. The developing complexity evaluation drives us to propose two possible implementation strategies that cover almost all possible use cases and eases handling the standard by non-expert users. The first one is focused on medical devices (MD) and proposes a low-memory and low-processor usage technique. It is based on message patterns that allow simple functions to generate ISO/IEEE 11073 messages and to process them easily. MD act as X73 agent. Second one is focused on more powerful device X73 manager, which do not have the MDs' memory and processor usage constraints. The protocol between Agent and Manager is point-to-point and we can distribute the functionality between devices.
Developed both implementation X73 Agent and Manager will cut developing time for applications based on ISO/EEE 11073.