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<<   作成日時 : 2010/07/16 20:24   >>

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 世界で毎年行われる手術のうち、裕福な20億人がその75%を受け、貧しい20億人は4%しか受けていないという。多くの国で、難産、腫瘍、交通事故などよくある死因となる病気の治療を行う外科医が足りない。さらに、白内障や先天異常の手術や骨疾患など生活を改善する手術も不可能である。外科医がいたとしても使用可能な手術室がない場合も多い。
 92カ国の769病院にたいして手術室数や酸素飽和度モニターなどの装備を問い合わせた。モニターを装備していない手術室では必要十分な設備が備わっていないものと判断した。
 アフリカのほとんどの国では人口10万人あたりの手術室数は1しかなかった。アジアと南米の貧困国では4〜10、西ヨーロッパ・北米・豪州では約15、東ヨーロッパと裕福なアジア諸国で約25だった。
 南アジアやアフリカでは多くで半数以上の手術室が酸素飽和度モニターを備えていなかった。

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Surgery: Poorest 2 Billion Remain in Dire Need of Fully Functioning Operating Rooms
Dwi Oblo/Reuters
By DONALD G. McNEIL Jr.
Published: July 12, 2010
http://www.nytimes.com/2010/07/13/health/13glob.html

画像The world’s wealthiest two billion people get 75 percent of all the surgery done each year, while the poorest two billion get only 4 percent and often die or live in misery as a result, according to a new study published in the medical journal Lancet.

Many countries lack enough surgeons to handle difficult childbirths, tumors, car accidents and other common causes of death, the study found. They often cannot remove cataracts, fix birth defects and skeletal problems or do other operations that improve lives.

Even where surgeons were available, usable operating rooms often were not.

The study asked 769 hospitals in 92 countries how many operating rooms each had and how many were equipped with pulse oximeters ― the finger clips that measure how much oxygen is in a patient’s blood. The study assumed that operating theaters without that could also lack other essentials like suction pumps, instrument sterilizers, gloves, oxygen and blood banks.

In most of Africa, there was only 1 operating room per 100,000 people. In the poorer parts of Asia and Latin America, there were 4 to 10 per 100,000. In Western Europe, North America, Australia and New Zealand, there were about 15. In Eastern Europe and the wealthiest Asian countries, there were about 25.

In South Asia and most of Africa, half or more of all operating rooms lacked pulse oximetry.

The study was done by a team from the Harvard School of Public Health along with researchers from New Zealand, Canada and the World Health Organization.

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The Lancet, Early Online Publication, 1 July 2010
doi:10.1016/S0140-6736(10)60392-3Cite or Link Using DOI
Global operating theatre distribution and pulse oximetry supply: an estimation from reported data
Original Text

Dr Luke M Funk MD a b Corresponding AuthorEmail Address, Thomas G Weiser MD a b, William R Berry MD a b, Stuart R Lipsitz ScD b, Prof Alan F Merry FANZCA c, Prof Angela C Enright FRCPC d, Iain H Wilson FRCA e, Gerald Dziekan MD f, Atul A Gawande MD a b
Summary
Background
Surgery is an essential part of health care, but resources to ensure the availability of surgical services are often inadequate. We estimated the global distribution of operating theatres and quantified the availability of pulse oximetry, which is an essential monitoring device during surgery and a potential measure of operating theatre resources.
Methods
We calculated ratios of the number of operating theatres to hospital beds in seven geographical regions worldwide on the basis of profiles from 769 hospitals in 92 countries that participated in WHO's safe surgery saves lives initiative. We used hospital bed figures from 190 WHO member states to estimate the number of operating theatres per 100 000 people in 21 subregions throughout the world. To estimate availability of pulse oximetry, we sent surveys to anaesthesia providers in 72 countries selected to ensure a geographically and demographically diverse sample. A predictive regression model was used to estimate the pulse oximetry need for countries that did not provide data.
Findings
The estimated number of operating theatres ranged from 1?0 (95% CI 0?9―1?2) per 100 000 people in west sub-Saharan Africa to 25?1 (20?9―30?1) per 100 000 in eastern Europe. High-income subregions all averaged more than 14 per 100 000 people, whereas all low-income subregions, representing 2?2 billion people, had fewer than two theatres per 100 000. Pulse oximetry data from 54 countries suggested that around 77 700 (63 195―95 533) theatres worldwide (19?2% [15?2―23?9]) were not equipped with pulse oximeters.
Interpretation
Improvements in public-health strategies and monitoring are needed to reduce disparities for more than 2 billion people without adequate access to surgical care.
Funding
WHO.

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