Reducing Mortality Among Bleeding Trauma Patients with Tranexamic Acid

2018 ◽  
pp. 241-247
Author(s):  
Haytham M. A. Kaafarani
Keyword(s):  
Randomized Controlled Trial ◽  
Tranexamic Acid ◽  
Hemorrhagic Shock ◽  
Low Income ◽  
Controlled Trial ◽  
Low Income Countries ◽  
Trauma Patients ◽  
Thromboembolic Events ◽  
The World ◽  
The Impact

The CRASH-2 trial is a randomized controlled trial performed in more than 270 hospitals across the world and aimed at studying the impact of tranexamic acid (TXA), an anti-fibrinolytic agent, on mortality in trauma patients presenting with hemorrhagic shock. With more than 20,000 patients, CRASH-2 showed a small but statistically significant decrease in mortality from 16% to 14.5% (p < 0.05), without any increase in thromboembolic events, in patients who received TXA versus placebo. Subset analyses suggested that the benefit was only present if TXA was administered within 3 h from injury. Two main criticisms of the study are (1) TXA reduced mortality but not the number of blood products used or the percentage of patients who needed transfusion, raising questions regarding the mechanism by which the drug worked; (2) the conductance of the study in moderate- to low-income countries, limiting its generalizability to high-income countries with advanced trauma systems.

scholarly journals CRASH-2 Study of Tranexamic Acid to Treat Bleeding in Trauma Patients: A Controversy Fueled by Science and Social Media

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Sophia Binz ◽  
Jonathon McCollester ◽  
Scott Thomas ◽  
Joseph Miller ◽  
Timothy Pohlman ◽  
...  
Keyword(s):  
Social Media ◽  
Tranexamic Acid ◽  
Communication Technology ◽  
Low Income ◽  
Controlled Trial ◽  
Low Income Countries ◽  
Trauma Patients ◽  
Randomized Controlled ◽  
Cast Doubt ◽  
Trauma Networks

This paper reviews the application of tranexamic acid, an antifibrinolytic, to trauma. CRASH-2, a large randomized controlled trial, was the first to show a reduction in mortality and recommend tranexamic acid use in bleeding trauma patients. However, this paper was not without controversy. Its patient recruitment, methodology, and conductance in moderate-to-low income countries cast doubt on its ability to be applied to trauma protocols in countries with mature trauma networks. In addition to traditional vetting in scientific, peer-reviewed journals, CRASH-2 came about at a time when advances in communication technology allowed debate and influence to be leveraged in new forms, specifically through the use of multimedia campaigns, social media, and Internet blogs. This paper presents a comprehensive view of tranexamic acid utilization in trauma from peer-reviewed evidence to novel multimedia influences.

scholarly journals The Right to Education and ICT during COVID-19: An International Perspective

2020 ◽  
Vol 12 (21) ◽  
pp. 9091
Author(s):  
Luis Miguel Lázaro Lorente ◽  
Ana Ancheta Arrabal ◽  
Cristina Pulido-Montes
Keyword(s):  
Low Income ◽  
International Perspective ◽  
School Closure ◽  
Global Perspective ◽  
Low Income Countries ◽  
Right To Education ◽  
The World ◽  
The Government ◽  
The Right ◽  
The Impact

There is a lack of concluding evidence among epidemiologists and public health specialists about how school closures reduce the spread of COVID-19. Herein, we attend to the generalization of this action throughout the world, specifically in its quest to reduce mortality and avoid infections. Considering the impact on the right to education from a global perspective, this article discusses how COVID-19 has exacerbated inequalities and pre-existing problems in education systems around the world. Therefore, the institutional responses to guaranteeing remote continuity of the teaching–learning process during this educational crisis was compared regionally through international databases. Three categories of analysis were established: infrastructure and equipment, both basic and computer-based, as well as internet access of schools; preparation and means of teachers to develop distance learning; and implemented measures and resources to continue educational processes. The results showed an uneven capacity in terms of response and preparation to face the learning losses derived from school closure, both in low-income regions and within middle- and high-income countries. We concluded that it is essential to articulate inclusive educational policies that support strengthening the government response capacity, especially in low-income countries, to address the sustainability of education.

The Effect of Mobile Instant Messaging versus Face-to-Face Counseling on the Primiparous Mothers’ Breastfeeding Self-efficacy: A Pilot Randomized Controlled Trial

2020 ◽  
Author(s):  
Manoosh Mehrabi ◽  
Shoale Zarei ◽  
Leila Bazrafkan ◽  
Ali Reza Safarpour
Keyword(s):  
Randomized Controlled Trial ◽  
Self Efficacy ◽  
Instant Messaging ◽  
Controlled Trial ◽  
World Health ◽  
Face To Face ◽  
Randomized Controlled ◽  
The World ◽  
The Impact ◽  
Pilot Randomized Controlled Trial

Abstract Background Increasing breastfeeding rates around the world is one of the most important goals of the World Health Organization. Self-efficacy is a modifying and predictive factor for initiation and continuation of breastfeeding. This study was conducted to investigate the impact of mobile-based education and regular delivery of designed messages on breastfeeding self-efficacy in primiparous mothers. Methods This study was a double blind pilot randomized controlled trial, in which a hundred and twenty primiparous breastfeeding mothers were randomly allocated into two groups using permuted block randomization. The standard method conseling arm received routine counseling interventions and the intervention arm received a mobile instant messaging program in addition to the usual counseling. The main objective of this study was to compare self-efficacy in face-to-face counseling group and mobile instant messaging group. Self-efficacy levels were compared in the two groups before and after the study procedures. Results In this study, 60 mothers were studied in each group, and then the collected data were analyzed. The mean post-test scores in the intervention group (60.40 ± 4.92) and the control group (50.10 ± 7.60) were compared in the main analysis. The results indicated a statistically significant difference (p <0.001). Given the amount of effect size ( d= 0.99; 95% CI=1.19-2.02 ) it appears that there is a high level correlation between the applied intervention and level of self-efficacy among the study participants, especially those with higher levels of education. Secondary findings of the study involved evaluating the effects of education, occupation, family income, lactation duration and spouse support for breastfeeding self-efficacy. Except for the maternal education level, which had a significant relationship with the level of breastfeeding self-efficacy (p= 0.02), the other factors did not show any correlation with self-efficacy in breastfeeding. Conclusion The pilot study provided valuable information for feasibility assessment of randomized controlled trials in future studies with larger sample sizes and more participant diversity.

scholarly journals Impact of improved small-scale livestock farming on human nutrition

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Md. Emran Hossain ◽  
Md. Ahasanul Hoque ◽  
Emanuele Giorgi ◽  
Guillaume Fournié ◽  
Goutam Buddha Das ◽  
...  
Keyword(s):  
Low Income ◽  
Dietary Diversity ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Low Income Countries ◽  
Small Scale ◽  
Micronutrient Deficiencies ◽  
Livestock Farming ◽  
Randomised Controlled ◽  
The Impact

AbstractMicronutrient deficiencies and stunting rates are high in many low-income countries. Increasing and diversifying food intake are often challenging for small-scale farmers in lowland areas as flooding often results in crop losses and drowning of livestock. A cluster-randomised controlled trial was conducted over 12-months in Bangladesh, involving 150 small-scale duck rearing households, including 50 control, and 50 households each in two intervention arms. Interventions focussing on improving duck health and duck nutrition were applied on a village level. Data analysis focussed on assessing the impact of interventions on duck mortality, sales and consumption, and on dietary diversity of household members. Improved duck rearing increased the consumption and the sales of ducks. Household selling more ducks were more likely to purchase and consume milk products, contributing to an improved households’ dietary diversity. Our results suggest that improving duck rearing can provide a suitable and sustainable alternative to maintain and improve dietary diversity of households in flood-prone areas.

scholarly journals Entrepreneurship facilitators and their role in poverty alleviation

2021 ◽  
Author(s):  
Osama Aziz
Keyword(s):  
Human Development ◽  
Low Income ◽  
Human Development Index ◽  
Poverty Alleviation ◽  
Business Environment ◽  
Entrepreneurial Activity ◽  
Low Income Countries ◽  
The World ◽  
Entrepreneurial Activities ◽  
The Impact

Poverty is one of the main issues faced by countries across the world. Over the last three decades, governments and international organizations such as the World Bank, the IMF, etc. have been trying to reduce poverty. Despite this, today almost 2.5 billion people are still living in poverty. Entrepreneurship is often seen as a way to reduce poverty. Moreover, the role of entrepreneurship facilitators is very important in creating a suitable business environment for entrepreneurs which increases the capacity of entrepreneurial activities. The purpose of this thesis is to provide an insight into how entrepreneurial activity and entrepreneurship facilitators (Government, Incubators, and Financial Institutions) help in improving the business environment in all countries and hence in poverty alleviation, examining the impact in case of high-income, high medium-income, medium-income, low-income countries and, as a result, reduce poverty. To investigate this, the Human Development Index (HDI) has been used to measure poverty. Secondary data for Entrepreneurship (Entrepreneurial Facilitators, Entrepreneurial Activities, and Economic Factors) and Poverty (HDI)) from the period of 2005 to 2016 are used for high-income countries, high medium-income countries, medium-income countries and low-income countries. The study has found that there is a positive and significant relationship between entrepreneurial activity and the changes in Human Development Index (HDI) in all countries studied over the 12 years period. It also finds that the presence of good entrepreneurial facilitators improves the capacity of entrepreneurial activity which reduces poverty as measured by the HDI. It adds to the body of knowledge by using HDI as a new tool to analyze the impact of entrepreneurial activity country wise. It also suggests that governments need to make better business related regulations which will motivate entrepreneurs and create ease of business doing. Finally it suggests that trade openness bring foreign investments in a country which create employment for people.

scholarly journals Entrepreneurship facilitators and their role in poverty alleviation

2021 ◽  
Author(s):  
Osama Aziz
Keyword(s):  
Human Development ◽  
Low Income ◽  
Human Development Index ◽  
Poverty Alleviation ◽  
Business Environment ◽  
Entrepreneurial Activity ◽  
Low Income Countries ◽  
The World ◽  
Entrepreneurial Activities ◽  
The Impact

Poverty is one of the main issues faced by countries across the world. Over the last three decades, governments and international organizations such as the World Bank, the IMF, etc. have been trying to reduce poverty. Despite this, today almost 2.5 billion people are still living in poverty. Entrepreneurship is often seen as a way to reduce poverty. Moreover, the role of entrepreneurship facilitators is very important in creating a suitable business environment for entrepreneurs which increases the capacity of entrepreneurial activities. The purpose of this thesis is to provide an insight into how entrepreneurial activity and entrepreneurship facilitators (Government, Incubators, and Financial Institutions) help in improving the business environment in all countries and hence in poverty alleviation, examining the impact in case of high-income, high medium-income, medium-income, low-income countries and, as a result, reduce poverty. To investigate this, the Human Development Index (HDI) has been used to measure poverty. Secondary data for Entrepreneurship (Entrepreneurial Facilitators, Entrepreneurial Activities, and Economic Factors) and Poverty (HDI)) from the period of 2005 to 2016 are used for high-income countries, high medium-income countries, medium-income countries and low-income countries. The study has found that there is a positive and significant relationship between entrepreneurial activity and the changes in Human Development Index (HDI) in all countries studied over the 12 years period. It also finds that the presence of good entrepreneurial facilitators improves the capacity of entrepreneurial activity which reduces poverty as measured by the HDI. It adds to the body of knowledge by using HDI as a new tool to analyze the impact of entrepreneurial activity country wise. It also suggests that governments need to make better business related regulations which will motivate entrepreneurs and create ease of business doing. Finally it suggests that trade openness bring foreign investments in a country which create employment for people.

scholarly journals Effects of an urban sanitation intervention on childhood enteric infection and diarrhoea in Mozambique

2020 ◽  
Author(s):  
Jackie Knee ◽  
Trent Sumner ◽  
Zaida Adriano ◽  
Claire Anderson ◽  
Farran Bush ◽  
...  
Keyword(s):  
Low Income ◽  
Urban Areas ◽  
Critical Infrastructure ◽  
Controlled Trial ◽  
Prevalence Ratio ◽  
Low Income Countries ◽  
Enteric Infection ◽  
Urban Sanitation ◽  
Protozoan Infection ◽  
The Impact

Background. Onsite sanitation serves more than 740 million people in urban areas, primarily in low-income countries. Although this critical infrastructure may play an important role in controlling enteric infections in high-burden settings, its health impacts have never been evaluated in a controlled trial. Methods. We conducted a controlled before and after trial to evaluate the impact an onsite urban sanitation intervention on the prevalence of bacterial and protozoan infection (primary outcome), soil transmitted helminth (STH) re-infection, and seven-day period prevalence of diarrhoea among children living in informal neighborhoods of Maputo, Mozambique. A non-governmental organization replaced existing shared latrines in poor condition with engineered pour-flush toilets with septic tanks serving household clusters. We enrolled children aged 1-48 months at baseline and measured outcomes before the intervention and at 12 and 24 months following intervention. We measured outcomes concurrently among children served by the sanitation improvements and those in a comparable control arm served by existing poor sanitation. The trial was registered at ClinicalTrials.gov, number NCT02362932. Findings. At baseline, we enrolled 454 children from 208 intervention clusters and 533 children from 287 control clusters. We enrolled or re-visited 462 intervention and 477 control children 12 months 60 after intervention and 502 intervention and 499 control children 24 months after intervention. Despite nearly exclusive use of the intervention, we found no evidence that engineered onsite sanitation affected the overall prevalence of any measured bacterial or protozoan infection (12-month adjusted prevalence ratio 1.05, 95% CI [0.95-1.16]; 24-month adjusted prevalence ratio 0.99, 95% CI [0.91-1.09]), any STH re-infection (1.11 [0.89-1.38]; 0.95 [0.77-1.17]), or diarrhoea (1.69 [0.89-3.21]; 0.84 [0.47-1.51]) after 12 or 24 months of exposure. Among children born into study sites after the intervention and measured at the 24-month visit, we observed a reduced prevalence of any STH re-infection of 49% (adjusted prevalence ratio 0.51 [95% confidence interval 0.27 - 0.95]), Trichuris of 76% (0.24 [0.10 - 0.60]), and Shigella infection by 51% (0.49 [0.28-0.85]) relative to the same age group at baseline. Interpretation. The intervention did not reduce the overall prevalence of enteric infection and diarrhoea among all enrolled children but may have substantially reduced the prevalence of STHs and Shigella among children born into clusters with sanitary improvements.

scholarly journals International Migration in the World: Current Development Trends and the Global Problems Management

2021 ◽  
Vol 26 (1) ◽  
pp. 64-73
Author(s):  
Nataliya Kuznetsova ◽  
Keyword(s):  
Climate Change ◽  
International Migration ◽  
Low Income ◽  
Low Income Countries ◽  
Modern World ◽  
Host Countries ◽  
Economic Relations ◽  
The World ◽  
Migration Flows ◽  
The Impact

Abstract. Introduction. International migration is an important socio-economic indicator of the development of states and a regulator of socio-economic relations in the international economy. Under the modern conditions of development of the world society migration processes are characterized by dynamic development and scale of distribution. Today, international migration is becoming an important factor influencing the formation of international reality, causing social changes and cultural interaction of countries involved in migration process. Purpose. The modern world is diverse in its development and progress. Existing asymmetries and inequalities in most countries, conflicts, poverty, climate change encourage people from the low-income countries to migrate to the economically developed countries in searching of a safer and better life. In addition, the COVID-19 pandemic carries great threats to the lives and health of migrants, negatively affects their spatial mobility, and creates the new societal challenges and dangers. That is why the author of the article aims to explore the main trends in the formation of modern migration flows and changes in international migration; to identify global factors influencing the dynamics of international migration and to identify key issues that need to be corrected in the management system of international migration at the global level. Results. The author has analyzed the current trends in the development of international migration in the global space, assesses the formation of the main migration flows in terms of individual sub-regions and countries. According to the results of the analysis, the growing influence of exogenous factors (interstate conflicts, economic and political instability in the world, climate change, etc.) and endogenous factors (low level of social protection of the low-income countries, limited access to vital public resources), high levels of corruption in some countries that cause poverty, carry threat and danger to the lives and health of their citizens) to increase the dynamics of migration flows in the world. During the studying the author has formed the main group of countries (USA, Canada, Luxembourg, Norway, Switzerland, Germany, France, Czech Republic, others), which (according to the long-term UN forecasts) will increase net migration rates and net numbers of migrants; this information is the important indicators for governments of these countries in order to respond in a timely manner and put changes into their existing migration policies. The tools of integration of international migrants into the national societies of the host countries of Europe in terms of employment, education, social inclusion have been considered. The benefits of the host countries from successful integration have been determined. The impact of the COVID-19 pandemic on the change in the dynamics of international migration has been studied and the key problems of international migration development that need to be corrected at the global international level due to the intensification of crisis situations have been identified. Conclusions. Thus, the acceleration of migration processes and the scale of their spread in the world have a great impact on significant changes in foreign economic relations between countries; the macroeconomic dynamics of their development is gaining new momentum. The mechanical movement of the population causes changes in the structure of human capital, affects the quality of its formation and development. Due to the unevenness and the existing asymmetry in the socio-economic development of the world, the migration factor can become a major tool for the destruction of economic stability of many countries, the intensification of crises in the social sphere. Therefore, the existing problems of global cooperation and coordination of international migration, the lack of effective mechanisms for interaction between national and global levels of migration management need to be solved in time. The international regulatory framework for the protection of migrants' rights in the global dimension needs to be improved.

scholarly journals Cell, Time and Knowledge: Some Conjectures

2021 ◽  
Vol 2 (5) ◽  
pp. 408-411
Author(s):  
Diosey Ramon Lugo-Morin
Keyword(s):  
Low Income ◽  
Vaccine Development ◽  
Low Income Countries ◽  
Poor Countries ◽  
Global Institutions ◽  
Health Measures ◽  
The World ◽  
The Impact ◽  
Single Path ◽  
Over Time

The impact that the COVID-19 pandemic has had on global institutions and populations has been unprecedented. The health measures (e.g., confinement and social distancing) recommended by WHO and adopted by most nations in the world have not contained the spread of COVID-19. Vaccine development is expected to be a decisive element in controlling the pandemic, however, poor countries do not have immediate access to developed vaccines, which means that the COVID-19 pandemic will be present for some time among low-income countries. Against this daunting backdrop, it is necessary to explore more universal and inclusive ways of combating the COVID-19 pandemic and all future pandemics. Three conjectures are proposed that lead to a single path, unlocking the knowledge that cells have been able to accumulate over time. Although it may seem impossible in practice, the theory shows that knowledge exists to reach the frontiers of DNA.

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