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INTRODUCTION: As part of the International Society of Aesthetic Plastic Surgery, we present an analysis of our global aesthetic statistics, fulfilling the role of a worldwide organization of plastic surgeons with a clear mission to disseminate aesthetic education worldwide, promote patient safety, protect high ethical standards, and communicate. MATERIAL AND METHODS: A retrospective analysis of the ISAPS Global Aesthetic Statistics was conducted annually from 2010 to 2023. The design and analysis of each survey was carefully developed and validated by Industry Insights, Inc. prior to distribution. Participants were recruited using an anonymous online questionnaire that focused primarily on the number of surgical and nonsurgical procedures performed in the previous year, as well as questions related to surgeon demographics and the prevalence of medical tourism. ISAPS invited all physicians in their data base who were board-certified plastic surgeons or equivalent and suggested National Societies to encourage their members to participate. RESULTS: The latest survey reported a global increase in 3.4%, including 34.9 million surgical and nonsurgical aesthetic procedures performed by plastic surgeons in 2023. More than 15.8 million surgical procedures and more than 19.1 million nonsurgical procedures were performed worldwide. During the past decade, a steady increase in aesthetic procedures has been observed, which has been more pronounced since 2021. In the last 4 years, the overall increase in procedures was 40%. SURGICAL PROCEDURES: The top five surgical procedures were liposuction, breast augmentation, eyelid surgery, abdominoplasty, and rhinoplasty. This trend has been stable for 14 years, with the exception of 2022, when breast lift surgery temporarily replaced rhinoplasty. FACE AND HEAD PROCEDURES: These procedures continue to be the most popular. This group included brow lift, ear surgery, eyelid surgery, facelift, facial bone contouring, facial fat grafting, lip augmentation or frontal surgery, neck lift, and rhinoplasty. BODY AND EXTREMITIES PROCEDURES: This group included abdominoplasty, buttock augmentation, buttock lift, liposuction, lower body lift, thigh lift, arm lift, upper body lift, labiaplasty, and vaginal rejuvenation. Over the past 14 years, body and extremity procedures have increased, with more than 5.1 million procedures in 2023 compared to 2.6 million in 2009. NONSURGICAL PROCEDURES: The five most popular nonsurgical procedures are botulinum toxin, hyaluronic acid, hair removal, chemical peels, and nonsurgical fat reduction. In 2022, chemical peels will replace nonsurgical skin tightening in the top five. MALE AESTHETIC SURGERY: Procedures performed on men continue to grow, with minimally invasive procedures dominating. The most recent survey reported that they represented 14.5% of the total. The top five surgical procedures were eyelid surgery, gynecomastia, liposuction, rhinoplasty, and facial fat grafting. The most popular nonsurgical procedures for men were botulinum toxin, hyaluronic acid, hair removal, nonsurgical skin tightening, and nonsurgical fat reduction. This trend has held steady for more than a decade. DISCUSSION: This study analyzes the most recent data and experience of board-certified aesthetic plastic surgeons in surgical and nonsurgical procedures worldwide over 14 years and provides insight into future trends. More than 60 years have passed since the introduction of liposuction, being one of the most performed aesthetic procedures worldwide over the past 14 years and currently number one procedure performed by plastic surgeons. New trends and technologies have evolved over the years, however, plastic surgeons must be cautious, as history has shown that risks increase when new technologies are introduced. With the popularity of liposuction, other body contouring procedures began to gain interest, and in 2015, gluteal lipoinjections were added to the ISAPS global aesthetic statistics and with them complications arise. In 2018 and 2019, the major patient safety societies, ISAPS, ASERF, ASPS, and ASAPS, began a systematic educational campaign to inform their members about the inherent risks of performing gluteal fat transfer surgery and what techniques or equipment can be used to minimize risks. Another procedure added to the ISAPS statistics in 2010 was vaginal aesthetic surgery. With the new trend of vaginal aesthetics, many believed that they were just changing the appearance of the area, but today it is clear that they are here for much more, to truly empower women with their sexuality. Breast augmentation showed a decline for the first-time last year. However, breast augmentation and liposuction have been the most performed procedures by plastic surgeons worldwide for more than a decade. On the other hand, implant removal has been the fastest growing procedure since 2015, with an overall increase in 46.3% over the past 5 years. In relation to male aesthetic surgery, the number of men undergoing aesthetic procedures has remained stable in recent years at around 14%. Male aesthetics is certainly a growing trend, and our practices should be more inclusive. Another prominent field is regenerative medicine. In relation to plastic surgery, regenerative surgery strategies often involve adipose tissue with stem cells and preadipocytes, alone or in combination with scaffolds. In terms of prevention, regenerative medicine aims to improve the quality of the skin by improving our outcomes and would make it possible to avoid the need for facelifts in the future. Finally, given the increasing popularity of medical procedures abroad ("medical tourism") and the fact that safety regulations and guidelines vary widely from place to place, we encourage patients to choose a board-certified, specialized, trained and experienced plastic surgeon for their procedure and an accredited surgical facility to ensure the procedure in done under the highest patient safety standards. CONCLUSIONS: Despite the obvious cultural and social differences from country to country that make certain procedures more desirable in some geographic areas and less so in other parts of the world, the results of this study show a significant overall increase in all surgical and nonsurgical procedures aimed at improving the aesthetic appearance of the body during14 years. As plastic surgeons, we are open to new possibilities in aesthetic procedures and are responsible for patient safety protocols and procedures. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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The decades-long agricultural use of insecticides resulted in frequent contamination of surface waters globally regularly posing high risks for the aquatic biodiversity. However, the concentration levels of individual insecticide compounds have by now not been compiled and reported using global scale data, hampering our knowledge on the insecticide exposure of aquatic ecosystems. Here, we specify measured insecticide concentrations (MICs, comprising in total 11,300 water and sediment concentrations taken from a previous publication) for 28 important insecticide compounds covering four major insecticide classes. Results show that organochlorine and organophosphate insecticides, which dominated the global insecticide market for decades, have been detected most often and at highest concentration levels in surface waters globally. In comparison, MICs of the more recent pyrethroids and neonicotinoids were less often reported and generally at lower concentrations as a result of their later market introduction and lower application rates. An online insecticide classification calculator (ICC; available at: https://static.magic.eco/icc/v1) is provided in order to enable the comparison and classification of prospective MICs with available global insecticide concentrations. Spatial analyses of existing data show that most MICs were reported for surface waters in North America, Asia and Europe, whereas highest concentration levels were detected in Africa, Asia and South America. An evaluation of water and sediment MICs showed that theoretical organic carbon-water partition coefficients (KOC) determined in the laboratory overestimated KOC values based on actual field concentrations by up to a factor of more than 20, with highest deviations found for highly sorptive pyrethroids. Overall, the comprehensive compilation of insecticide field concentrations presented here is a valuable tool for the classification of future surface water monitoring results and serves as important input data for more field relevant toxicity testing approaches and pesticide exposure and risk assessment schemes.
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Monitoramento Ambiental , Inseticidas/análise , Poluentes Químicos da Água/análise , África , Ásia , Europa (Continente) , América do Norte , Estudos Prospectivos , América do Sul , Poluição Química da Água/estatística & dados numéricosRESUMO
Perchlorate is a widespread environmental contaminant and potent thyroid hormone disrupting compound. Despite this, very little is known with regard to the occurrence of this compound in indoor dust and the exposure of humans to perchlorate through dust ingestion. In this study, 366 indoor dust samples were collected from 12 countries, the USA, Colombia, Greece, Romania, Japan, Korea, Pakistan, Kuwait, Saudi Arabia, India, Vietnam, and China, during 2010-2014. Dust samples were extracted by 1% (v/v) methylamine in water. Analyte separation was achieved by an ion exchange (AS-21) column and analysis was performed by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The overall concentrations of perchlorate in dust were in the range of 0.02-104µg/g (geometric mean: 0.41µg/g). The indoor dust samples from China contained the highest concentrations (geometric mean: 5.38µg/g). No remarkable differences in perchlorate concentrations in dust were found among various microenvironments (i.e., car, home, office, and laboratory). The estimated median daily intake (EDI) of perchlorate for toddlers through dust ingestion in the USA, Colombia, Greece, Romania, Japan, Korea, Pakistan, Kuwait, Saudi Arabia, India, Vietnam, and China was 1.89, 0.37, 1.71, 0.74, 4.90, 7.20, 0.60, 0.80, 1.55, 0.70, 2.15, and 21.3ng/kgbodyweight (bw)/day, respectively. Although high concentrations of perchlorate were measured in some dust samples, the contribution of dust to total perchlorate intake was <5% of the total perchlorate intake in humans. This is the first multinational survey on the occurrence of perchlorate in indoor dust.
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Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Poeira/análise , Percloratos/análise , Adolescente , Adulto , Criança , Pré-Escolar , China , Cromatografia Líquida de Alta Pressão , Colômbia , Ingestão de Alimentos , Exposição Ambiental/análise , Grécia , Humanos , Índia , Lactente , Japão , Kuweit , Paquistão , República da Coreia , Romênia , Arábia Saudita , Espectrometria de Massas em Tandem , Estados Unidos , Vietnã , Adulto JovemRESUMO
This paper focuses on the links between the WHO atlas on global resources for persons with intellectual disabilities (Atlas-ID) project and the right to health in international human rights law. The WHO Atlas-ID project initiated by the Department of Mental Health and Substance Abuse of the WHO was designed to collect, compile and disseminate data on intellectual disabilities services and resources throughout the world. The right to health, as linked to all other human rights, brings a set of globally agreed upon norms and standards, and out of these norms arise governmental obligations. Even in countries which have a relatively high standard of living, persons with intellectual disabilities are very often denied the opportunity to enjoy the full range of economic, social and cultural rights. This paper aims at establishing the WHO Atlas-ID and the international human rights instruments as two parts of a holistic approach in regards to State provided services to persons with intellectual disabilities and their families.
Este artículo se centra en la relación entre el proyecto Atlas-DI de la OMS y el derecho a la salud en la normativa internacional de derechos humanos. El proyecto Atlas-DI de la OMS, puesto en marcha por el Departamento de Salud Mental y Abuso de Sustancias de la OMS, se diseñó para recolectar, compilar y divulgar datos sobre servicios y recursos para la discapacidad intelectual alrededor del mundo. El derecho a la salud, en su relación con todos los demás derechos humanos, engloba un conjunto de normas y estándares aprobados internacionalmente, y de éstos emanan obligaciones gubernamentales. Incluso en países con estándares relativamente altos de vida, a las personas con discapacidades intelectuales se les niega frecuentemente la oportunidad de disfrutar el espectro total de derechos económicos, sociales y culturales. El objetivo de este artículo es el de establecer el Atlas-DI de la OMS y los instrumentos internacionales en derechos humanos como partes integrantes de un enfoque holístico sobre los servicios provistos por el Estado para las personas con discapacidades intelectuales y sus familias.