Some aspects of alcohol-related mortality in Russia: Commentary on the article by P. Kuznetsova published in issue 4 (3) / 2020 of the Population and Economics Journal

The aim of this communication is to comment on certain statements and conclusions presented in the paper on alcohol-related mortality by P.O. Kuznetsova from the medical viewpoint, summarizing and updating at the same time the preceding papers. The author refers to some evidence showing positive tendencies in Russia, namely, a decline in both the heavy binge drinking and total alcohol consumption, and claims that exaggerating the alcohol consumption problem indirectly shifts the responsibility for the relatively short life expectancy onto the excessive alcohol consumption, thus camouflaging shortcomings of the healthcare and public assistance.

Competitiveness and Financial Management in SMEs Hotel Businesses in Yucatan, Mexico

Small and medium hotel enterprises in Yucatan represent an important sector for the economic development of the State. However, inadequate financial management leads to reduced profits and a short life expectancy for them. In the case of financial management in hotels, it is necessary to develop an indicator model that facilitates the reading of the results, of the financial situation of the hotels, and of the organization in general. It is necessary to obtain hard data that lead to making quick and forceful decisions in a timely manner. The objective of this study is to explain why a good financial management is a factor that greatly increases the competitiveness of organizations and that hotel financial management indicators are an instrument for measuring the different variables associated with organizational objectives, expressed in terms of some quantitative basis that defines the scope or achievement of the expected results. For this work, a bibliographical review of relevant articles from a range of authors was conducted.

Explaining rule of rescue obligations in healthcare allocation: allowing the patient to tell the right kind of story about their life

I consider various principles which might explain our intuitive obligation to rescue people from imminent death at great cost, even when the same resources could produce more benefit elsewhere. Our obligation to rescue is commonly explained in terms of the identifiability of the rescuee, but I reject this account. Instead, I offer two considerations which may come into play. Firstly, I explain the seeming importance of identifiability in terms of an intuitive obligation to prioritise life-extending interventions for people who face a high risk of an early death, and I explain this in turn with a fair innings-style principle which prioritises life-extending interventions for people expected to die young. However, this account is incomplete. It does not explain why we would devote the same resources to rescuing miners stuck down a mine even if they are elderly. We are averse to letting people die suddenly, or separated from friends and family. And so, secondly, I give a new account that explains this in terms of narrative considerations. We value life stories that follow certain patterns, classic patterns which are reflected in many popular myths and stories. We are particularly averse to depriving people of the opportunity to follow some such pattern as they approach death. This means allowing them to sort out their affairs, say goodbyes to family and friends, review their life, or come to terms with death itself. Such activities carry a lot of meaning as ways of closing our life story in the right way. So, for someone who has not been given much notice of their death, an extra month is worth much more than for other patients. Finally, I review the UK National Health Service's end of life premium, which gives priority to patients with short life expectancy. I suggest it falls short in terms of such considerations. For example, the NHS defines its timings in terms of how long the patient can expect to live as at the time of the treatment decision, whereas the timings should be specified in terms of time from diagnosis.

FÍSTULA VESICOSIGMOIDEA EN ENFERMEDAD DIVERTICULAR, REPORTE DE CASO Y REVISIÓN DE LITERATURA.

Introduction Colovesical fistulas (CVF) are pathologic communications between bowel and bladder. They represent 1 in 3000 surgical hospital admissions per year. Imaging studies play a crucial role establishing the site, course and complexity of the fistulas, and in identifying their etiology. The management of CVF depends on the underlying pathology, the site of the intestinal injury, and the preoperative state of the patient. A surgical and non-surgical approach can be performed. Case description A clinical case of an 82-year-old patient with multiple comorbidities is reported, who suddenly presented dysuria, stranguria and fecaluria. The abdominal and pelvic tomography revealed diverticulitis with the presence of a fistulous tract from the colon to the bladder. During his hospitalization, the patient presented septic shock of urinary focus due to colovesical fistula, which required management by intensive therapy. Broad-spectrum antibiotic therapy was started. Once stable, we opted for surgical resolution with partial cystectomy plus fistulectomy and Hartmann-type colostomy. After the procedure, the patient evolved favorably with resolution of the condition. Conclusion The nonsurgical approach may be a viable option in patients with poor preoperative condition, an inability to tolerate general anesthesia, or in cancer patients with a short life expectancy. Spontaneous closure of fistulas occurs in approximately 2% of patients and, since up to 75% may have septic complications, the presence of a FCV is an indication for surgery in all patients without contraindications for it. The most widely used surgical approach consists of resection of the compromised intestinal segment with primary anastomosis, without a protective stoma, and closure of the bladder defect. At present, there is no consensus on which is the best surgical strategy due to the lack of clinical trials. An updated review of the subject and its therapeutic management is carried out.

What Role, if any, Should Economic Evaluation Play in Market Access Decisions of Pharmaceutical Treatments for Cancer Patients with Short Life Expectancy?

Short Commentary By Angel Justiz-Vaillant, Department of Para-Clinical Sciences. University of the West Indies. St. Augustine Campus. Trinidad and Tobago

The Evolution of Hemoglobin A1C Targets for Youth with Type 1 diabetes: Rationale and Supporting Evidence

The American Diabetes Association 2020 Standards of Medical Care in Diabetes (Standards of Care) recommends a hemoglobin A1C of <7% (53 mmol/ml) for many children with type 1 diabetes (T1D), with an emphasis on target personalization. A higher A1C target of <7.5% may be more suitable for youth who cannot articulate symptoms of hypoglycemia or have hypoglycemia unawareness, and for those who do not have access to analog insulins, advanced diabetes technologies, or cannot monitor blood glucoses regularly. Even less stringent A1C targets (e.g. <8%) may be warranted for children with a history of severe hypoglycemia, severe morbidities, or short life expectancy. During the “honeymoon” period and in situations where lower mean glycemia is achievable without excessive hypoglycemia or reduced quality of life, an A1C <6.5% may be safe and effective

The Evolution of Hemoglobin A1C Targets for Youth with Type 1 diabetes: Rationale and Supporting Evidence

The American Diabetes Association 2020 Standards of Medical Care in Diabetes (Standards of Care) recommends a hemoglobin A1C of <7% (53 mmol/ml) for many children with type 1 diabetes (T1D), with an emphasis on target personalization. A higher A1C target of <7.5% may be more suitable for youth who cannot articulate symptoms of hypoglycemia or have hypoglycemia unawareness, and for those who do not have access to analog insulins, advanced diabetes technologies, or cannot monitor blood glucoses regularly. Even less stringent A1C targets (e.g. <8%) may be warranted for children with a history of severe hypoglycemia, severe morbidities, or short life expectancy. During the “honeymoon” period and in situations where lower mean glycemia is achievable without excessive hypoglycemia or reduced quality of life, an A1C <6.5% may be safe and effective

Cardiovascular Diseases and Rheumatology

The prevalence of various cardiovascular diseases (CVD) in the different rheumatologic disorders is a very important topic. Each disease has a number of unique manifestations despite the fact that an overlap is present due to shared common risk factors, which may be related to the longer life expectancy of the recent therapeutic advances. A growing understanding of the role of inflammation and immune system in the initiation and progression of atherosclerosis as well as the early detection of cardiovascular manifestations is due to the availability and use of sophisticated noninvasive cardiac and vascular diagnostic technology. Such discipline results in the detection of cardiac manifestation unique to each rheumatologic disorder. This was not possible previously due to short life expectancy, limited therapeutic interventions, vague understanding of pathological process for each disease, and the limited diagnostic resources.

Slash youth in China: From precarious strugglers to successful exemplars

Slash has become a new phenomenon and practice as a growing number of youth, no longer in long-term employment with clear future security, create a contingent combination of careers. Its recent prevalence in China marks a visible consequence of the national restructuring policy of labor flexibilization over the past decades. Dismantling of the historical norm of full employment, encouragement of flexible digital economy, short-life expectancy of new businesses, and generalized insecurity due to intense competition at individual level, are the major factors contributing to the emergence and expansion of slash youth. Based on empirical and ethnographic evidences, this article identifies the complexity, diversity, and creativity embodied in individual slash experiences, suggesting that slash youth are stratified and they demonstrate differentiated ability to translate uncertainties into opportunities under the condition of individualization. This article is part of the special issue Creative Labour in East Asia.

Ureteroiliac artery fistula caused by full-length metallic ureteral stenting in a malignant ureteral obstruction: a case report

Background The metallic stent is a new device for relieving the urinary tract in patients with malignant ureteral obstruction with short life expectancy and has been used frequently worldwide for its efficacy and safety. A ureteroarterial fistula with indwelling ureteral stent is rare but highly fatal, and there are several reports of ureteroarterial fistula treated by conventional polymer stents, although there are no reports on metallic stents. To our knowledge, this paper describes the first case of a ureteroiliac artery fistula caused by a full-length metallic ureteral stent in malignant ureteral obstruction. Case presentation Our patient was a 57-year-old Asian woman with a history of locally advanced cervical cancer who underwent abdominal total hysterectomy and chemoradiotherapy. She was diagnosed with right hydronephrosis and hydroureter secondary to upper ureteral obstruction because of retroperitoneal lymph node metastasis. A urinary tract obstruction after placement of 12 months of polymer stent followed by 18 months of metallic stent was relieved, consequently resulting in intermittent gross hematuria with bladder tamponade and anemia. Contrast-enhanced computed tomography could not reveal a ureteroarterial fistula; however, retrograde pyelography emphasized the existence of a ureteroiliac artery fistula. The patient underwent successful endovascular heparin-bonded stent graft placement, and her gross hematuria disappeared thereafter. Conclusion The metallic stent is a useful device for patients with malignant ureteral obstruction with a short life expectancy, although it may impose a higher pressure on the extraureteral tissue than conventional polymer stents due to its properties and may cause a ureteroarterial fistula. The narrowing of the external iliac artery diameter visualized by computed tomography may be helpful for predicting ureteroarterial fistulas.