Surgery and global health: a view from beyond the OR.
Surgery and global health: a view from beyond the OR.
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外科和全球健康：OR超越的观点。
DOI：
10.1007/s00268-008-9525-9
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发表时间：
2008-04
影响因子：
2.6
通讯作者：
Kim, Jim Y.
中科院分区：
文献类型：
--
作者：
Farmer, Paul E.;Kim, Jim Y.
在非洲，手术可能被认为是全球公共卫生中被忽视的继子。在这个大陆上，每一个人口拥有的医生比其他任何一个都少;外科医生更是罕见，而且几乎所有的外科医生都在仍然是农村地区的城市飞地工作。在亚洲和拉丁美洲的贫困地区，情况也是如此（除了古巴等少数例外）。虽然可以通过手术治疗的疾病仍然是世界穷人的头号杀手，但公共卫生的主要资助者表明，他们并不认为手术疾病是一个优先事项，即使每年有50多万妇女死于分娩;这些死亡主要是由于缺乏手术服务和其他阻止产后出血的手段[1]。在非常贫困的人群中，同样无人关注的还有机动车和农场事故、腹膜炎、长骨骨折，甚至失明[2-4]。心脏病，先天性或感染后遗症，是对大多数人的死刑判决-其中许多是儿童-在世界上最贫穷的地区深受其害[5，6]。在某些情况下，调查显示，外科疾病是导致残疾的15大原因之一[7]，而外科疾病占全世界总残疾调整生命年（DIFs）损失的15%[8]。如果外科手术确实是全球健康中被忽视的继子，那么是否可以推断出贫穷国家没有外科服务？事实甚至更令人不快：在贫穷国家，外科服务几乎全部集中在城市，而且大部分保留给那些能够支付的人。例如，在海地，1980年代进行的一项以社区为基础的调查表明，海地南部大部分地区的剖腹产率接近于零;产妇死亡率为每10万活产1，400人[9]。然而，在同一个国家的富裕人群中，剖腹产的比例与美国登记的比例相差不大。对当地风险和获得护理机会不平等的仔细审查表明，在贫穷国家，即使是轻微的手术病理也往往会因时间和疏忽而变成致命的情况。先天性畸形，如腭裂仍然是终身的痛苦，而不是儿科外科疾病。除了手术创伤外，严重创伤（交通事故造成的创伤多于蓄意暴力造成的创伤）和其他可能致命的病症仍然是未经治疗的疾病的巨大负担，影响着世界最底层10亿人的生活和生产力。
In Africa, surgery may be thought of as the neglected stepchild of global public health. There are fewer physicians per population on this continent than on any other; surgeons are rarer still, and almost all of them work in the urban enclaves of what remains a rural region. The story is the same in the poorer parts of Asia and Latin America (with a few exceptions, such as Cuba). Although disease treatable by surgery remains a ranking killer of the world’s poor, major financers of public health have shown that they do not regard surgical disease as a priority even though, for example, more than 500,000 women die each year in childbirth; these deaths are largely attributable to an absence of surgical services and other means of stopping post-partum hemorrhage [1]. Equally unattended, among the very poor, are motor-vehicle and farm accidents, peritonitis, long-bone fractures, and even blindness [2-4]. Cardiac disease, congenital or the sequela of infection, is a death sentence for most people—many of them children—so afflicted in the poorest parts of the world [5, 6]. In some settings, surveys reveal that surgical disease is among the top 15 causes of disability [7], and surgical conditions account for up to 15% of total disability adjusted life years (DALYs) lost worldwide [8].If it is true that surgery is the neglected stepchild of global health, does it follow that there are no surgical services available in the poor world? The truth is even more unpleasant: within poor countries, surgical services are concentrated almost wholly in cities and reserved largely for those who can pay for them. In Haiti, for example, a community-based survey conducted in the 1980s suggested that rates of caesarian section in a large area of southern Haiti were close to zero; maternal mortality was pegged at 1,400 per 100,000 live births [9]. Yet among the affluent of that same country, rates of caesarian section do not vary much from those registered in the United States. Careful scrutiny of local inequalities of risk and access to care reveals that in poor countries, even minor surgical pathologies are often transformed through time and inattention into lethal conditions. Congenital abnormalities such as cleft palate remain life-long afflictions rather than pediatric surgical disease. In addition to surgical abdomens, severe trauma (from road accidents more often than from intentional violence) and other potentially fatal pathologies remain a massive burden of untreated disease that weighs on the lives, and productivity, of the world’s bottom billion.
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DOI：
10.2106/00004623-200408000-00029
发表时间：
2004-08-01
影响因子：
5.3
作者：
Beveridge, M;Howard, A
通讯作者：
Howard, A
影响因子：
1.6
作者：
Rao, Suresh G.
通讯作者：
Rao, Suresh G.
影响因子：
3.8
作者：
Walton, DA;Farmer, PE;Mukherjee, JS
通讯作者：
Mukherjee, JS
影响因子：
3.9
作者：
Yorston, D
通讯作者：
Yorston, D
影响因子：
10.7
作者：
Wright, I. G.;Walker, I. A.;Yacoub, M. H.
通讯作者：
Yacoub, M. H.