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Zupanic E, Kåreholt I, Norrving B, Secnik J, von Euler M, Winblad B, Religa D, Kramberger MG, Johnell K, Eriksdotter M, Garcia-Ptacek S. Acute Stroke Care in Dementia: A Cohort Study from the Swedish Dementia and Stroke Registries. J Alzheimers Dis 2018; 66:185-194. [PMID: 30248059 PMCID: PMC6294591 DOI: 10.3233/jad-180653] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous studies have shown that patients with dementia receive less testing and treatment for stroke. OBJECTIVES Our aim was to investigate hospital management of acute ischemic stroke in patients with and without dementia. METHODS Retrospective analysis of prospectively collected data 2010-2014 from the Swedish national dementia registry (SveDem) and the Swedish national stroke registry (Riksstroke). Patients with dementia who suffered an acute ischemic stroke (AIS) (n = 1,356) were compared with matched non-dementia AIS patients (n = 6,755). Outcomes included length of stay in a stroke unit, total length of hospitalization, and utilization of diagnostic tests and assessments. RESULTS The median age at stroke onset was 83 years. While patients with dementia were equally likely to be directly admitted to a stroke unit as their non-dementia counterparts, their stroke unit and total hospitalization length were shorter (10.5 versus 11.2 days and 11.6 versus 13.5, respectively, p < 0.001). Dementia patients were less likely to receive carotid ultrasound (OR 0.36, 95% CI [0.30-0.42]) or undergo assessments by the interdisciplinary team members (physiotherapists, speech therapists, occupational therapists; p < 0.05 for all adjusted models). However, a similar proportion of patients received CT imaging (97.4% versus 98.6%, p = 0.001) and a swallowing assessment (90.7% versus 91.8%, p = 0.218). CONCLUSIONS Patients with dementia who suffer an ischemic stroke have equal access to direct stroke unit care compared to non-dementia patients; however, on average, their stay in a stroke unit and total hospitalization are shorter. Dementia patients are also less likely to receive specific diagnostic tests and assessments by the interdisciplinary stroke team.
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Affiliation(s)
- Eva Zupanic
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ingemar Kåreholt
- Jönköping University, Institute of Gerontology, School of Health and Welfare, Aging Research network - Jönköping (ARN-J), Jönköping, Sweden
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Juraj Secnik
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - Mia von Euler
- Department of Clinical Science and Education, Södersjukhuset and Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Dorota Religa
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Milica Gregoric Kramberger
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
| | - Kristina Johnell
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
- Department of Internal Medicine, Section for Neurology, Södersjukhuset, Stockholm, Sweden
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27852
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Groves SJ, Douglas KM, Porter RJ. A Systematic Review of Cognitive Predictors of Treatment Outcome in Major Depression. Front Psychiatry 2018; 9:382. [PMID: 30210368 PMCID: PMC6121150 DOI: 10.3389/fpsyt.2018.00382] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/30/2018] [Indexed: 12/28/2022] Open
Abstract
Background: Research suggests that only 50% of patients with major depression respond to psychotherapy or pharmacological treatment, and relapse is common. Therefore, there is interest in elucidating factors that help predict clinical response. Cognitive impairment is a key feature of depression, which often persists beyond remission; thus, the aim of this systematic review was to determine whether baseline cognitive functioning can predict treatment outcomes in individuals with depression. Method: Studies examining cognitive predictors of treatment response in depression were identified using Pub Med and Web of Science databases. Given the heterogeneity of outcome measures, the variety of treatment protocols, and the differing ways in which data was presented and analyzed, a narrative rather than meta-analytic review technique was used. Results: 39 studies met inclusion criteria. Findings in younger adult samples were inconclusive. There was some evidence for a predictive effect of executive function and to a lesser extent, psychomotor speed, on treatment response. There was no evidence of learning or memory being associated with treatment response. In older-aged samples, the evidence was much more consistent, suggesting that poor executive function predicts poor response to SSRIs. Conclusions: Findings from the present review suggest that certain aspects of cognitive functioning, particularly executive function, may be useful in predicting treatment response in depression. This is certainly the case in elderly samples, with evidence suggesting that poor executive functioning predicts poor response to SSRIs. With further research, baseline cognitive functioning may serve as a factor which helps guide clinical decision making. Moreover, cognitive deficits may become targets for specific pharmacological or psychological treatments, with the hope of improving overall outcome.
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Affiliation(s)
- Samantha J Groves
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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27853
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Ramezani F, Ahmadi S, Faridaalee G, Baratloo A, Yousefifard M. Value of Manchester Acute Coronary Syndromes Decision Rule in the Detection of Acute Coronary Syndrome; a Systematic Review and Meta-Analysis. EMERGENCY (TEHRAN, IRAN) 2018; 6:e61. [PMID: 30788388 PMCID: PMC6368935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION There is still no consensus on the value of Manchester Acute Coronary Syndromes (MACS) decision rule in detecting acute coronary syndrome (ACS). Therefore, the purpose of the present systematic review and meta-analyzes is to summarize the clinical evidence in the evaluation of the value of MACS in the diagnosis of ACS. METHODS A literature search was performed on the Medline, Embase, Scopus, and Web of Science databases. Outcomes included acute myocardial infarction (AMI) and major adverse cardiac event (MACE). Data were analyzed in the STATA 14.0 statistical program and the results were reported as summary receiver operating characteristics (SROC), sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio with 95% confidence interval (95% CI). RESULTS Finally, 8 articles included in the meta-analysis. The area under the SROC of MACS was excellent in rule out of AMI (AUC = 0.99, 95% CI: 0.97 to 0.99) and MACE (AUC = 0.97, 95% CI: 0.95 to 0.98). The sensitivity and specificity of the troponin-only MACS/history electrocardiogram alone MACS (HE-MACS) in the rule out of AMI were0.99 (95% CI: 0.98-0.99) and 0.22 (95% CI: 0.11-0.37), respectively, and for the original MACS were in order 0.99 (95% CI: 0.98-0.99) and 0.26 (95% CI: 0.20-0.34),. The sensitivity and specificity of the troponin-only MACS / HE-MACS in the rule out of MACE were 0.94 (95% CI: 0.92-0.96) and 0.22 (95% CI: 0.12-0.39) compared to the 0.99 (95% CI: 0.98-0.99) and 0.27 (95% CI: 0.22-0.33) for the original MACS. CONCLUSION The findings of this study showed that original MACS, troponin-only MACS, and HE-MACS are able to rule out AMI and MACE. However, further studies are needed in developing countries to confirm its external validity.
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Affiliation(s)
- Fatemeh Ramezani
- Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sajjad Ahmadi
- Emergency Medicine Department, Maragheh University of Medical Sciences; Maragheh; Iran
| | | | - Alireza Baratloo
- Emergency Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Yousefifard
- Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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27854
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Swaminathan S, Room RS, Ivers LC, Hillis G, Grais RF, Bhutta ZA, Byass P. What's coming for health science and policy in 2018? Global experts look ahead in their field. PLoS Med 2018; 15:e1002498. [PMID: 29381695 PMCID: PMC5790228 DOI: 10.1371/journal.pmed.1002498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In PLOS Medicine's first editorial of 2018, editorial board members and other leading researchers share their hopes, pleas, concerns, and expectations for this year in health research and policy.
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Affiliation(s)
- The PLOS Medicine Editors
- Public Library of Science, San Francisco, California, United States of America, and Cambridge, United Kingdom
- * E-mail:
| | | | - Robin S. Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, Australia
- Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Louise C. Ivers
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Graham Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, Australia
- University of Western Australia, Crawley, Australia
| | | | - Zulfiqar A. Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Peter Byass
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- University of Aberdeen, Aberdeen, Scotland, United Kingdom
- University of the Witwatersrand, Johannesburg, South Africa
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27855
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Burden of depressive symptoms and non-alcohol substance abuse; and their association with alcohol use and partner violence: a cross-sectional study in four sub-Saharan Africa countries. Glob Ment Health (Camb) 2018; 5:e31. [PMID: 30455966 PMCID: PMC6236214 DOI: 10.1017/gmh.2018.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/23/2018] [Accepted: 06/13/2018] [Indexed: 12/14/2022] Open
Abstract
In sub-Saharan Africa, there are limited data on burden of non-alcohol substance abuse (NAS) and depressive symptoms (DS), yet potential risk factors such as alcohol and intimate partner violence (IPV) are common and NAS abuse may be the rise. The aim of this study was to measure the burden of DS and NAS abuse, and determine whether alcohol use and IPV are associated with DS and/or NAS abuse. We conducted a cross-sectional study at five sites in four countries: Nigeria (nurses), South Africa (teachers), Tanzania (teachers) and two sites in Uganda (rural and peri-urban residents). Participants were selected by simple random sampling from a sampling frame at each of the study sites. We used a standardized tool to collect data on demographics, alcohol use and NAS use, IPV and DS and calculated prevalence ratios (PR). We enrolled 1415 respondents and of these 34.6% were male. DS occurred among 383 (32.3%) and NAS use among 52 (4.3%). In the multivariable analysis, being female (PR = 1.49, p = 0.008), NAS abuse (PR = 2.06, p = 0.02) and IPV (PR = 2.93, p < 0.001) were significantly associated with DS. Older age [odds ratio (OR) = 0.31, p < 0.001)], female (OR = 0.48, p = 0.036) were protective of NAS but current smokers (OR = 2.98, p < 0.001) and those reporting IPV (OR = 2.16, p = 0.024) were more likely to use NAS. Longitudinal studies should be done to establish temporal relationships with these risk factors to provide basis for interventions.
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27856
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Clark SR, Schubert KO, Olagunju AT, Lyrtzis EA, Baune BT. Cognitive and Functional Assessment of Psychosis Stratification Study (CoFAPSS): Rationale, Design, and Characteristics. Front Psychiatry 2018; 9:662. [PMID: 30559688 PMCID: PMC6287598 DOI: 10.3389/fpsyt.2018.00662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/19/2018] [Indexed: 11/13/2022] Open
Abstract
Prediction of treatment response and illness trajectory in psychotic disorders including schizophrenia, bipolar affective disorder, schizoaffective disorder, and psychotic depression is difficult due to heterogeneity in presentation and outcome. Consequently, patients may receive prolonged ineffective treatments leading to functional decline, illness chronicity, and iatrogenic physical illness. One approach to addressing these problems is to stratify patients based on historical, clinical, and biological signatures. Such an approach has the potential to improve categorization resulting in better understanding of underlying mechanisms and earlier evidence-based treatment with reduced side effect burden. To investigate these multimodal signatures we developed the Cognitive and Functional Assessment of Psychosis Stratification Study (CoFAPSS) employing a prospective study design and a healthy control group comparison. The main aim of this study is to investigate cognitive, and biological "genomics" markers of psychotic illnesses that can be integrated with clinical data to improve prediction of risk and define functional trajectories. We also aim to identify biological "genomic" signatures underpinning variation in treatment response and adverse medical outcomes. The study commenced in June 2016, including patients with primary diagnosis of psychotic disorders including schizophrenia, bipolar affective disorder, schizoaffective disorder, and psychotic depression according to DSM-5 criteria. The assessment covers a wide range of participant history (life stressors, trauma, and family history), cognitive dimensions (social perception, memory and learning, attention, executive function, and general cognition), measures to assess psychosocial function and quality of life, psychotic symptom severity, clinical course of illness, and parameters for adverse medical outcome. Blood is collected for comprehensive genomic discovery analyses of biological (genomic, transcriptomic, proteomic, and cell-biologic) markers. The CoFAPSS is a novel approach that integrates clinical, cognitive and biological "genomic" markers to clarify clinico-pathological basis of risk, functional trajectories, disease stratification, treatment response, and adverse medical outcome. The CoFAPSS team welcomes collaborations with both national and international investigators.
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Affiliation(s)
- Scott R Clark
- Discipline of Psychiatry, School of Medicine, The University of Adelaide Adelaide, SA, Australia
| | - K Oliver Schubert
- Discipline of Psychiatry, School of Medicine, The University of Adelaide Adelaide, SA, Australia
| | - Andrew T Olagunju
- Discipline of Psychiatry, School of Medicine, The University of Adelaide Adelaide, SA, Australia.,Department of Psychiatry University of Lagos, Lagos, Nigeria
| | - Ellen Alexandra Lyrtzis
- Discipline of Psychiatry, School of Medicine, The University of Adelaide Adelaide, SA, Australia
| | - Bernhard T Baune
- Discipline of Psychiatry, School of Medicine, The University of Adelaide Adelaide, SA, Australia.,Department of Psychiatry, Melbourne Medical School, The University of Melbourne Melbourne, VIC, Australia
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27857
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Quintana Pacheco DA, Sookthai D, Wittenbecher C, Graf ME, Schübel R, Johnson T, Katzke V, Jakszyn P, Kaaks R, Kühn T. Red meat consumption and risk of cardiovascular diseases-is increased iron load a possible link? Am J Clin Nutr 2018; 107:113-119. [PMID: 29381787 DOI: 10.1093/ajcn/nqx014] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/15/2017] [Indexed: 12/21/2022] Open
Abstract
Background High iron load and red meat consumption could increase the risk of cardiovascular diseases (CVDs). As red meat is the main source of heme iron, which is in turn a major determinant of increased iron load, adverse cardiometabolic effects of meat consumption could be mediated by increased iron load. Objective The object of the study was to assess whether associations between red meat consumption and CVD risk are mediated by iron load in a population-based human study. Design We evaluated relations between red meat consumption, iron load (plasma ferritin), and risk of CVD in the prospective EPIC-Heidelberg Study using a case-cohort sample including a random subcohort (n = 2738) and incident cases of myocardial infarction (MI, n = 555), stroke (n = 513), and CVD mortality (n = 381). Following a 4-step mediation analysis, associations between red meat consumption and iron load, red meat consumption and CVD risk, and iron load and CVD risk were assessed by multivariable regression models before finally testing to which degree associations between red meat consumption and CVD risk were attenuated by adjustment for iron status. Results Red meat consumption was significantly positively associated with ferritin concentrations and MI risk [HR per 50 g daily intake: 1.18 (95% CI: 1.05, 1.33)], but no significant associations with stroke risk and CVD mortality were observed. While direct associations between ferritin concentrations and MI risk as well as CVD mortality were significant in age- and sex-adjusted Cox regression models, these associations were substantially attenuated and no longer significant after multivariable adjustment for classical CVD risk factors. Strikingly, ferritin concentrations were positively associated with a majority of classical CVD risk factors (age, male sex, alcohol intake, obesity, inflammation, and lower education). Conclusion Increased ferritin concentrations may be a marker of an overall unfavorable risk factor profile rather than a mediator of greater CVD risk due to meat consumption.
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Affiliation(s)
- Daniel A Quintana Pacheco
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Disorn Sookthai
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Clemens Wittenbecher
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Mirja E Graf
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Ruth Schübel
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Theron Johnson
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Verena Katzke
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Paula Jakszyn
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rudolf Kaaks
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Tilman Kühn
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
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27858
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Ford JH, Foster SA, Stauffer VL, Ruff DD, Aurora SK, Versijpt J. Patient satisfaction, health care resource utilization, and acute headache medication use with galcanezumab: results from a 12-month open-label study in patients with migraine. Patient Prefer Adherence 2018; 12:2413-2424. [PMID: 30519007 PMCID: PMC6239121 DOI: 10.2147/ppa.s182563] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Effects of galcanezumab, a monoclonal antibody against calcitonin gene-related peptide, on patient satisfaction, health care resource utilization (HCRU), and acute medication use were evaluated in a long-term, open-label study in patients with migraine. METHODS Patients with episodic (78.9%) or chronic migraine (21.1%) were evaluated in the CGAJ study, an open-label study with 12-month treatment period. Galcanezumab 120 mg (with a loading dose of 240 mg) or 240 mg was administered subcutaneously once a month during treatment period. A self-rated scale, Patient Satisfaction with Medication Questionnaire-Modified (PSMQ-M), was used to measure satisfaction levels. Participants reported HCRU for the previous 6 months at baseline and that which occurred since the patient's last study visit during treatment period. Acute headache medication use for migraine or headache for the past month was self-reported by participants at baseline and at each monthly visit during treatment period. RESULTS At Months 1, 6, and 12, at least 69% of patients treated with galcanezumab responded positively for overall satisfaction, preference over prior treatments, and less impact from side effects. There were within-group reductions from baseline in migraine-specific HCRU (per 100 person-years) with galcanezumab for health care professional visits (173.4 to 59.6), emergency room visits (20.2 to 4.7), and hospital admissions (3.7 to 0.4) during treatment period. Statistically significant reductions in HCRU were observed for some events. There were significant within-group reductions from baseline in mean number of days/month with acute headache medication use for migraine or headache at each monthly visit during treatment period (overall change: -5.1 for galcanezumab 120 mg/240 mg; p<0.001). CONCLUSION Results from this long-term, open-label study suggest that treatment with galcanezumab is likely to lead to high patient satisfaction with treatment as well as meaningful reductions in migraine-specific HCRU and acute headache medication use in people with migraine.
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Affiliation(s)
- Janet H Ford
- Eli Lilly and Company, Indianapolis, IN 46225, USA,
| | | | | | | | | | - Jan Versijpt
- Department of Neurology - Headache and Facial Pain Clinic, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium
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27859
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Malta DC, Hallal ALC, Machado ÍE, Prado RRD, Oliveira PPVD, Campos MO, Souza MDFMD. Fatores associados ao uso de narguilé e outros produtos do tabaco entre escolares, Brasil, 2015. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 21:e180006. [DOI: 10.1590/1980-549720180006.supl.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/19/2017] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Objetivo: Identificar a frequência e os fatores associados ao uso de narguilé e outros produtos do tabaco entre os escolares brasileiros. Métodos: Estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar. A amostra foi composta por alunos do 9º ano do Ensino Fundamental. Foi realizada análise descritiva do uso de produtos do tabaco em 2012 e 2015. Para explorar a relação de fatores como características sociodemográficas, familiares, saúde mental e hábitos de vida com o uso de outros produtos do tabaco, foram calculados odds ratio ajustados. Resultados: O uso de outros produtos do tabaco aumentou de 4,8% (IC95% 4,6 - 5,0), em 2012, para 6,1% (IC95% 5,7 - 6,4), em 2015, com maior proporção em meninos. O narguilé foi o produto mais usado em 2015 (71,6%; IC95% 68,8 - 74,2), sendo mais frequente em meninas. Foram positivamente associados ao uso de outros produtos do tabaco: escola privada, morar com pai/mãe, trabalhar, não ter amigos, sofrer violência familiar, faltar às aulas, fazer uso de cigarros e álcool, ter experimentado drogas, já ter tido relação sexual, ter pais ou responsáveis fumantes e presenciar pessoas fumando. Os fatores de proteção foram: sexo feminino, incremento da idade, cor da pele parda ou indígena, fazer refeições com responsável, ter supervisão familiar e praticar atividade física. Conclusão: Conclui-se que o uso de outros produtos do tabaco foi elevado, com aumento nos últimos anos, destacando-se o narguilé. Torna-se importante a conscientização dos riscos e a vigilância do uso desses produtos, bem como o avanço das políticas públicas de controle do tabagismo no país.
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27860
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Alla F, Cambon L. [Not Available]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2018; 30:5-6. [PMID: 29589690 DOI: 10.3917/spub.181.0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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27861
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Kumar P, Kumar R. Rural Health Scenario - Role of family medicine: Academy of Family Physicians of India Position Paper. J Family Med Prim Care 2018; 7:1157-1162. [PMID: 30613489 PMCID: PMC6293896 DOI: 10.4103/jfmpc.jfmpc_254_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Half the world's people currently live in rural and remote areas. About 70% of the world's 1.4 billion people who are extremely poor live in rural areas. The problem is that the majority of healthcare providers prefer to serve in urban areas. Only a comprehensive and systematic approach can address these inequities. India, the largest democratic republic in the world, possesses 2.4% of the world's land area and supports 16% of the world's population. According to census 2011, 68.84% of population resides in rural areas. Nearly 86% of all the medical visits in India are made by rural inhabitants with a majority still traveling more than 100 km to avail healthcare facility, of which 70%–80% is born out of pocket landing them in poverty. A country's approach must systematically and simultaneously address legal coverage and rights, health worker shortages, extension of healthcare protection, and quality of care. Only then can equitable access for all be fully achieved. Those living in rural areas have access to health protection and services that meet the criteria of availability, affordability, accessibility, acceptability, and quality. Family medicine as a broad specialty has its role from womb till tomb. Family medicine is defined as a specialty of medicine which is concerned with providing comprehensive care to individuals and families by integrating biomedical, behavioral, and social sciences. As an academic discipline, it includes comprehensive healthcare services, education, and research. A family doctor provides primary and continuing care to the entire family within the communities; addresses physical, psychological, and social problems; and coordinates comprehensive healthcare services with other specialists, as needed. The practitioners in family medicine can play an important role in providing healthcare services to the suffering humanity. The general practitioner's responsibility in Medicare includes management of emergencies, treatment of problems relating to various medical and surgical specialties, care of entire family in its environment, appropriate referrals, and follow-up. He or she is the first-level contact for the patients and his or her family. Family medicine is the ideal solution to growing rural healthcare challenges. This article is a formal position paper of the Academy of Family Physicians of India.
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Affiliation(s)
- Pratyush Kumar
- Department of Geriatrics, Patna Medical College Hospital, Patna, Bihar, India
| | - Raman Kumar
- Academy of Family Physicians of India, New Delhi, India
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27862
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Schmitt A, Maurus I, Rossner MJ, Röh A, Lembeck M, von Wilmsdorff M, Takahashi S, Rauchmann B, Keeser D, Hasan A, Malchow B, Falkai P. Effects of Aerobic Exercise on Metabolic Syndrome, Cardiorespiratory Fitness, and Symptoms in Schizophrenia Include Decreased Mortality. Front Psychiatry 2018; 9:690. [PMID: 30622486 PMCID: PMC6308154 DOI: 10.3389/fpsyt.2018.00690] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/27/2018] [Indexed: 12/25/2022] Open
Abstract
Schizophrenia is a severe psychiatric disorder with a lifetime prevalence of about 1%. People with schizophrenia have a 4-fold higher prevalence of metabolic syndrome than the general population, mainly because of antipsychotic treatment but perhaps also because of decreased physical activity. Metabolic syndrome is a risk factor for cardiovascular diseases, and the risk of these diseases is 2- to 3-fold higher in schizophrenia patients than in the general population. The suicide risk is also higher in schizophrenia, partly as a result of depression, positive, and cognitive symptoms of the disease. The higher suicide rate and higher rate of cardiac mortality, a consequence of the increased prevalance of cardiovascular diseases, contribute to the reduced life expectancy, which is up to 20 years lower than in the general population. Regular physical activity, especially in combination with psychosocial and dietary interventions, can improve parameters of the metabolic syndrome and cardiorespiratory fitness. Furthermore, aerobic exercise has been shown to improve cognitive deficits; total symptom severity, including positive and negative symptoms; depression; quality of life; and global functioning. High-intensity interval endurance training is a feasible and effective way to improve cardiorespiratory fitness and metabolic parameters and has been established as such in somatic disorders. It may have more beneficial effects on the metabolic state than more moderate and continuous endurance training methods, but to date it has not been investigated in schizophrenia patients in controlled, randomized trials. This review discusses physical training methods to improve cardiorespiratory fitness and reduce metabolic syndrome risk factors and symptoms in schizophrenia patients. The results of studies and future high-quality clinical trials are expected to lead to the development of an evidence-based physical training program for patients that includes practical recommendations, such as the optimal length and type of aerobic exercise programs and the ideal combination of exercise, psychoeducation, and individual weight management sessions.
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Affiliation(s)
- Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Moritz J Rossner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Astrid Röh
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Martina von Wilmsdorff
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Shun Takahashi
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Boris Rauchmann
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Keeser
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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27863
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Jin Y, Mankadi PM, Rigotti JI, Cha S. Cause-specific child mortality performance and contributions to all-cause child mortality, and number of child lives saved during the Millennium Development Goals era: a country-level analysis. Glob Health Action 2018; 11:1546095. [PMID: 30474513 PMCID: PMC6263110 DOI: 10.1080/16549716.2018.1546095] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/06/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND During the Millennium Development Goal (MDG) era, impressive reductions in the under-5 mortality rate (U5MR) have been observed, although the MDG 4 target was not met. So far, cause-specific progress in child mortality has been analyzed and discussed mainly at the global and regional levels. OBJECTIVES We aimed to explore annual changes in cause-specific mortality at the country level, assess which causes contributed the most to child mortality reduction in 2000-2015, and estimate how many child lives were saved. METHODS We used the cause-specific child mortality estimates published by Liu and colleagues. We derived average annual changes in cause-specific child mortality rates and cause-specific contribution to overall child mortality in 2000-2015. We estimated the number of cause-specific child deaths averted during the MDG era, assuming that cause-specific child mortality remained the same as in 2000. We targeted the 75 Countdown countries where 95% of maternal and child deaths occurred during the MDG era. RESULTS Wide disparities existed across causes within countries, both in neonatal and post-neonatal mortality reduction, except for a few countries such as China, Rwanda, and Cambodia. In 20 of the 45 sub-Saharan African countries, malaria was the main contributor to post-neonatal mortality reduction, and pneumonia was the main contributor in only six countries. A single disease often contributed to a substantial proportion of the child mortality reduction, particularly in west and central African countries. Diarrhea-specific post-neonatal child mortality reduction accounted for 7.1 million averted child deaths (24.5%), while pneumonia accounted for another 6.7 million averted child deaths (23%). CONCLUSIONS This study demonstrates country-specific characteristics with regards to cause-wise child mortality that could not be identified by global or regional analyses. These findings provide the global community with evidence for formulating national policies and strategies to achieve the Sustainable Development Goals in child mortality reduction.
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Affiliation(s)
- Yan Jin
- Department of Microbiology, Dongguk University College of Medicine, Gyeongju, Republic of Korea
| | - Paul Mansiangi Mankadi
- Environmental Health Department, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jose Irineu Rigotti
- Department of Demography, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Seungman Cha
- Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
- Takemi Program in International Health, Global Health and Population Department, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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27864
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Patra BN, Khandelwal SK, Chadda RK, Lakshmy R, Abraham RA. A controlled study of plasma fatty acids in Indian patients with depressive episode. Asian J Psychiatr 2018; 31:152-156. [PMID: 29229218 DOI: 10.1016/j.ajp.2017.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/25/2017] [Accepted: 12/03/2017] [Indexed: 12/11/2022]
Abstract
AIM To study the plasma omega 3 and omega 6 fatty acid levels in patients with depressive episode and in matched healthy controls. METHOD Thirty patients with first episode depression and thirty healthy matched control subjects were recruited from a tertiary care hospital setting. We measured plasma omega-3 and omega-6 fatty acid levels of the study and the control group. RESULT There were no significant differences in plasma omega 3 fatty acid levels between study group and control group. The plasma omega 6 fatty acid levels of study group were significantly less than that of control group. CONCLUSIONS The present study is an initial attempt to investigate the link between fatty acids and depression in a clinical setting in India. This comparative study with normal controls did not etiologically link these polyunsaturated fatty acids in this sample of depressive disorder.
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Affiliation(s)
- Bichitra Nanda Patra
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
| | - Sudhir K Khandelwal
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Rakesh K Chadda
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Ramakrishnan Lakshmy
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Ransi Ann Abraham
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
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27865
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Hotez PJ. Human Parasitology and Parasitic Diseases: Heading Towards 2050. ADVANCES IN PARASITOLOGY 2018; 100:29-38. [PMID: 29753341 DOI: 10.1016/bs.apar.2018.03.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
By 2050 our civilized planet may be comprised predominantly of networked megacities embedded in warm subtropical and tropical climates, and under stress from climate change and catastrophic weather events. Urban slum areas in these cities, including those found in wealthier middle- and high-income nations (blue marble health), will be especially vulnerable to disease. Moreover, regional conflicts fought over shifting and limited resources, including water, will collapse health systems infrastructures to further promote disease emergence and reemergence. Thus while by 2050 we might congratulate ourselves for successfully eliminating some key parasitic and neglected tropical diseases such as dracunculiasis, lymphatic filariasis, onchocerciasis, and human African trypanosomiasis, there could be a commensurate rise in other parasitic diseases based on the scenarios highlighted above. Of particular concern are urban and newly urbanized helminth infections, including schistosomiasis and some soil-transmitted helminth infections, as well zoonotic helminthiases, such as toxocariasis, food-borne trematodiases, and cysticercosis. Protozoan infections persisting in urban environments, including leishmaniasis, Chagas disease, malaria, and intestinal protozoan infections, will also remain, as will zoonotic diseases such as toxoplasmosis. Our best hope to counteract the parasitic diseases emerging in our steaming 21st century megacities is to develop new and innovative technologies through gene editing, systems biology, and immunology, and the new single-celled OMICs. However, success on this front will require our ability to contain the globalization of antiscience beliefs and sentiments.
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27866
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Dai J, Qiu YM, Ma ZW, Yan GF, Zhou J, Li SQ, Wu H, Jin YC, Zhang XH. Neuroprotective effect of baicalin on focal cerebral ischemia in rats. Neural Regen Res 2018; 13:2129-2133. [PMID: 30323141 PMCID: PMC6199937 DOI: 10.4103/1673-5374.241464] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Baicalin, a flavonoid compound from the root of the herb Scutellaria baicalensis Georgi, has been widely used to treat patients with inflammatory disease. The aim of this study was to assess the efficacy of baicalin in a rat model of focal cerebral ischemia. Adult male Sprague-Dawley rat models of cerebral artery occlusion were established and then randomly and equally divided into three groups: ischemia (cerebral ischemia and reperfusion), valproic acid (cerebral ischemia and reperfusion + three intraperitoneal injections of valproic acid; positive control), and baicalin (cerebral ischemia and reperfusion + intraperitoneal injection of baicalin for 21 days). Neurological deficits were assessed using the postural reflex test and forelimb placing test at 3, 7, 14, and 21 days after ischemia. Rat cerebral infarct volume was measured using 2,3,5-triphenyltetrazolium chloride (TTC) staining method. Pathological change of ischemic brain tissue was assessed using hematoxylin-eosin staining. In the baicalin group, rat neurological function was obviously improved, cerebral infarct volume was obviously reduced, and the pathological impairment of ischemic brain tissue was obviously alleviated compared to the ischemia group. Cerebral infarct volume was similar in the valproic acid and baicalin groups. These findings suggest that baicalin has a neuroprotective effect on cerebral ischemia.
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Affiliation(s)
- Jiong Dai
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong-Ming Qiu
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng-Wen Ma
- Department of of Laboratory Animal Science, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo-Feng Yan
- Department of of Laboratory Animal Science, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhou
- Department of of Laboratory Animal Science, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shan-Quan Li
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wu
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Chao Jin
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Hua Zhang
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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27867
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Arku RE, Ezzati M, Baumgartner J, Fink G, Zhou B, Hystad P, Brauer M. Elevated blood pressure and household solid fuel use in premenopausal women: Analysis of 12 Demographic and Health Surveys (DHS) from 10 countries. ENVIRONMENTAL RESEARCH 2018; 160:499-505. [PMID: 29107891 DOI: 10.1016/j.envres.2017.10.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Approximately three billion people are exposed to household air pollution (HAP) from solid fuel cookstoves. Studies from single settings have linked HAP with elevated blood pressure (BP), but no evidence exists from multi-country analyses. OBJECTIVES Using nationally representative and internationally comparable data, we examined the association between solid fuel use and BP in 77,605 largely premenopausal women (aged 15-49) from ten resource-poor countries. METHODS We obtained data on systolic and diastolic BP, self-reported primary cooking fuel, health and socio-demographic characteristics from 12 Demographic and Health Surveys conducted in Albania, Armenia, Azerbaijan, Bangladesh, Benin, Ghana, Kyrgyzstan, Lesotho, Namibia, and Peru. We estimated associations between history of fuel use [solid fuel (coal or biomass) versus clean fuel (electricity or gas)] with systolic and diastolic BP and hypertension using a meta-analytical approach. RESULTS Overall, the country-level mean systolic and diastolic BP were 117 (range: 111-127) and 74 (71-83) mmHg, respectively. The country-level mean age of the women was 30.8 years (range: 28.4-32.9). The prevalence of solid fuel use was 46.0% (range: 4.1-95.8). In adjusted, pooled analyses, primary use of solid fuel was associated with 0.58mmHg higher systolic BP (95% CI: 0.23, 0.93) as compared to primary use of clean fuel. The pooled estimates for diastolic BP and pulse pressure were also positive, but the confidence intervals contained zero. The pooled odds of hypertension was [OR = 1.07 (95% CI: 0.99, 1.16)], an effect that was driven by rural participants for whom solid fuel use was associated with a 16% greater odds of hypertension [OR = 1.16 (95% CI: 1.01, 1.35)]. CONCLUSIONS Cooking with solid fuels was associated with small increases in BP and odds of hypertension. Use of cleaner fuels like gas or electricity may reduce cardiovascular risk in developing countries, particularly among rural residents.
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Affiliation(s)
- Raphael E Arku
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada; Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health and WHO Collaborating Centre on NCD Surveillance and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Jill Baumgartner
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Günther Fink
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Bin Zhou
- MRC-PHE Centre for Environment and Health and WHO Collaborating Centre on NCD Surveillance and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Perry Hystad
- The School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
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27868
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Musil F, Pokladnikova J, Pavelek Z, Wang B, Guan X, Valis M. Acupuncture in migraine prophylaxis in Czech patients: an open-label randomized controlled trial. Neuropsychiatr Dis Treat 2018; 14:1221-1228. [PMID: 29785113 PMCID: PMC5955045 DOI: 10.2147/ndt.s155119] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adjuvant acupuncture for the symptomatic treatment of migraine reduces the frequency of headaches and may be at least similarly effective to treatment with prophylactic drugs. METHODS This article describes an open-label randomized controlled clinical trial with two groups: the intervention group (n=42) and the waiting-list control group (n=44). This study occurred at the Czech-Chinese Center for Traditional Chinese Medicine at the University Hospital Hradec Kralove between October 2015 and April 2017. RESULTS After 12 weeks of acupuncture, the number of migraine days was reduced by 5.5 and 2.0 days in the acupuncture and the waiting-list control groups, respectively, with a statistically significant inter-group difference of 2.0 migraine days (95% CI: -4 to -1). A significantly greater reduction in the number of migraine days per 4 weeks was reached at the end of the 6-month follow-up period in the acupuncture vs. control groups (Δ -4.0; 95% CI: -6 to -2). A statistically significant difference was observed in the number of responders to treatment (response defined as at least a 50% reduction in average monthly migraine day frequency) in the acupuncture vs waiting-list control groups (50% vs 27%; p<0.05) at the end of the intervention. A significantly greater percentage of responders to treatment was noted in the intervention vs control groups at the 6-month follow-up (81% vs 36%; p<0.001). CONCLUSION Acupuncture can reduce symptoms and medication use, both short term and long term, as an adjuvant treatment in migraine prophylaxis in Czech patients.
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Affiliation(s)
- Frantisek Musil
- Czech-Chinese Center for Traditional Chinese Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jitka Pokladnikova
- Czech-Chinese Center for Traditional Chinese Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.,Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Zbysek Pavelek
- Department of Neurology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Bo Wang
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Xin Guan
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Martin Valis
- Department of Neurology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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27869
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Fuensalida-Novo S, Palacios-Ceña M, Fernández-Muñoz JJ, Castaldo M, Wang K, Catena A, Arendt-Nielsen L, Fernández-de-Las-Peñas C. The burden of headache is associated to pain interference, depression and headache duration in chronic tension type headache: a 1-year longitudinal study. J Headache Pain 2017; 18:119. [PMID: 29285577 PMCID: PMC5745374 DOI: 10.1186/s10194-017-0829-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/18/2017] [Indexed: 01/03/2023] Open
Abstract
Background To investigate variables associated at one year (longitudinal design) with the physical or emotional component of burden in chronic tension type headache (CTTH). Methods One hundred and thirty (n = 130) individuals with CTTH participated in this longitudinal study. Clinical features were collected with a 4-weeks headache diary at baseline and 1-year follow-up. The burden of headache was assessed at baseline and one -year follow-up with the Headache Disability Inventory (HDI), physical (HDI-P) or emotional (HDI-E) component. Sleep quality (Pittsburgh Sleep Quality Index), anxiety and depression (Hospital Anxiety and Depression Scale-HADS), and quality of life (SF-36) were also assessed at baseline. Hierarchical regression analyses were conducted to determine the associations between the baseline variables and the headache burden at 1-year. Simple mediation models were also applied to determine the potential mediation effect of any intermediary variable. Results Regression analyses revealed that baseline pain interference and depression explained 32% of the variance in the emotional burden of headache, whereas baseline emotional burden of the headache, pain interference, and headache duration explained 51% of the variance in the physical burden of headache (P < .01) at 1-year. The mediation models observed that the effect of baseline pain interference on emotional burden of headache at 1-year was mediated through baseline depression, whereas the effect of baseline pain interference on the physical burden of headache at 1-year was mediated through baseline emotional burden of headache (both P < .05). Conclusions The current study found a longitudinal interaction between pain interference and depression with the burden of headache in individuals with CTTH.
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Affiliation(s)
- Stella Fuensalida-Novo
- Department Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Facultad de Ciencias de la Salud, University Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Maria Palacios-Ceña
- Department Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Facultad de Ciencias de la Salud, University Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | - Matteo Castaldo
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Master in Sport Physiotherapy, University of Siena, Siena, Italy.,Poliambulatorio Fisiocenter, Collecchio, (Parma), Italy
| | - Kelun Wang
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - César Fernández-de-Las-Peñas
- Department Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Facultad de Ciencias de la Salud, University Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain. .,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
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27870
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Abilova V, Kurdi A, Godman B. Ongoing initiatives in Azerbaijan to improve the use of antibiotics; findings and implications. Expert Rev Anti Infect Ther 2017; 16:77-84. [DOI: 10.1080/14787210.2018.1417835] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Vafa Abilova
- Analytical Expertise Center, Ministry of Health, Baku, Azerbaijan Republic
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
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27871
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Rykhus RD, Shepard ZV, Young A, Frisby H, Calder KA, Coon CM, Falk JA, McAndrews SR, Turner A, Chang C, Michelsohn J, Petch R, Dieker SM, Markworth BH, Alamo-Perez K, Hosack AJ, Berg JM, Schmidt C, Storsberg J, Brown MA. Facilitating a More Efficient Commercial Review Process for Pediatric Drugs and Biologics. Diseases 2017; 6:E2. [PMID: 29271878 PMCID: PMC5871948 DOI: 10.3390/diseases6010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 11/23/2022] Open
Abstract
Over the past two decades, the biopharmaceutical industry has seen unprecedented expansion and innovation in concert with significant technological advancements. While the industry has experienced marked growth, the regulatory system in the United States still operates at a capacity much lower than the influx of new drug and biologic candidates. As a result, it has become standard for months or even years of waiting for commercial approval by the U.S. Food and Drug Administration. These regulatory delays have generated a system that stifles growth and innovation due to the exorbitant costs associated with awaiting approval from the nation's sole regulatory agency. The recent re-emergence of diseases that impact pediatric demographics represents one particularly acute reason for developing a regulatory system that facilitates a more efficient commercial review process. Herein, we present a range of initiatives that could represent early steps toward alleviating the delays in approving life-saving therapeutics.
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Affiliation(s)
- Ryan D Rykhus
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA.
| | - Zachary V Shepard
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
| | - Alix Young
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
| | - Hadley Frisby
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
| | - Kailee A Calder
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
| | - Collin M Coon
- Department of Biology, Colorado State University, Fort Collins, CO 80523, USA.
| | - Justin A Falk
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA.
| | - Sydney R McAndrews
- Department of Biology, Colorado State University, Fort Collins, CO 80523, USA.
| | - Aspen Turner
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
| | - Christina Chang
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA.
| | - Johanna Michelsohn
- Department of Biology, Colorado State University, Fort Collins, CO 80523, USA.
| | - Raegan Petch
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA.
| | - Sarah M Dieker
- Walter Scott College of Engineering, Colorado State University, Fort Collins, CO 80523, USA.
| | - Benjamin H Markworth
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA.
| | - Kevin Alamo-Perez
- Department of Electrical and Computer Engineering, Colorado State University, Fort Collins, CO 80523, USA.
| | - Aaron J Hosack
- Department of Biology, Colorado State University, Fort Collins, CO 80523, USA.
| | - Jacob M Berg
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
| | - Christian Schmidt
- Department of Biomaterials and Healthcare, Fraunhofer-Institute for Applied Polymer Research (IAP), Division of Life Science and Bioprocesses, 14476 Potsdam-Golm, Germany.
| | - Joachim Storsberg
- Department of Biomaterials and Healthcare, Fraunhofer-Institute for Applied Polymer Research (IAP), Division of Life Science and Bioprocesses, 14476 Potsdam-Golm, Germany.
| | - Mark A Brown
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
- Cell and Molecular Biology Program, Colorado State University, Fort Collins, CO 80523, USA.
- Epidemiology Section, Colorado School of Public Health, Fort Collins, CO 80523, USA.
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27872
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Evaluation of Behavior Change Communication Campaigns to Promote Modern Cookstove Purchase and Use in Lower Middle Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 15:ijerph15010011. [PMID: 29271949 PMCID: PMC5800111 DOI: 10.3390/ijerph15010011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 11/21/2022]
Abstract
Nearly three billion people worldwide burn solid fuels and kerosene in open fires and inefficient stoves to cook, light, and heat their homes. Cleaner-burning stoves reduce emissions and can have positive health, climate, and women’s empowerment benefits. This article reports on the protocol and baseline data from the evaluation of four behavior change communication (BCC) campaigns carried out in lower to middle income countries aimed at promoting the sale and use of cleaner-burning stoves. Interventions implemented in Bangladesh, Kenya, and Nigeria are using a range of BCC methods including mass media, digital media, outdoor advertising, and inter-personal communication. The mixed methods evaluation comprises three large-scale surveys: one pre-BCC and two follow-ups, along with smaller scale assessments of stove uptake and patterns of use. Baseline results revealed varying levels of awareness of previous promotions and positive attitudes and beliefs about modern (i.e., relatively clean-burning) cookstoves. Differences in cookstove preferences and behaviors by gender, socio-demographics, media use, and country/region were observed that may affect outcomes. Across all three countries, cost (lack of funds) a key perceived barrier to buying a cleaner-burning stove. Future multivariate analyses will examine potential dose-response effects of BCC on cookstove uptake and patterns of use. BCC campaigns have the potential to promote modern cookstoves at scale. More research on campaign effectiveness is needed, and on how to optimize messages and channels. This evaluation builds on a limited evidence base in the field.
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27873
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Barbosa I, Versfeld A, Tinasti K, Terlikbayeva A. Addressing deprivation of liberty, human mobility and tuberculosis in 2018. Public Health Action 2017; 7:309. [PMID: 29344444 DOI: 10.5588/pha.17.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Isabela Barbosa
- London School of Hygiene & Tropical Medicine, London, United Kingdom.,Underserved Populations Program, Geneva, Switzerland
| | | | - Khalid Tinasti
- Swansea University, Swansea, UK.,Global Commission on Drug Policy, Geneva, Switzerland
| | - Assel Terlikbayeva
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
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27874
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Kastien-Hilka T, Rosenkranz B, Schwenkglenks M, Bennett BM, Sinanovic E. Association between Health-Related Quality of Life and Medication Adherence in Pulmonary Tuberculosis in South Africa. Front Pharmacol 2017; 8:919. [PMID: 29326591 PMCID: PMC5741974 DOI: 10.3389/fphar.2017.00919] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/04/2017] [Indexed: 02/01/2023] Open
Abstract
Background: Health-related quality of life (HRQOL) and adherence to treatment are two often inter-related concepts that have implications for patient management and care. Tuberculosis (TB) and its treatment present a major public health concern in South Africa. The study aimed to evaluate the association between HRQOL and adherence in TB patients in South Africa. Methods: Four self-reported HRQOL and one self-reported adherence measures were used in an observational longitudinal multicentre study during 6-month standard TB treatment. These included the generic Short-Form 12 items (SF-12) and European Quality of Life 5 dimensions 5 levels (EQ-5D-5L), the disease-specific St. George's Respiratory Questionnaire (SGRQ) and the condition-specific Hospital Anxiety and Depression Scale (HADS) for HRQOL. Adherence was measured by the Morisky Medication Adherence Scale 8 items (MMAS-8). The relationship between both concepts was examined in 131 patients using Spearman's rho correlations, and linear regression models. Results: HRQOL improved over 6-month TB treatment, whereas adherence mean scores stayed constant with participants attaining a medium average level. Around 76% of patients reported to be high adherers and 24% were reporting a medium or low adherence. Associations between HRQOL and adherence were mainly weak. High adherence at treatment start was positively related to improvements in anxiety and depression after 6-month treatment. The overall improvement in pain and discomfort, and psychosocial health aspects over treatment time was positively, but weakly associated with adherence at 6 months of treatment. Conclusion: A positive relationship exists between adherence and HRQOL in TB in a South African setting, but this relationship was very weak, most likely because HRQOL is affected by a number of different factors and not limited to effects of adherence. Therefore, management of TB patients should, besides adequate drug treatment, address the specific mental and psychosocial needs.
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Affiliation(s)
- Tanja Kastien-Hilka
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bernd Rosenkranz
- Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Fundisa African Academy of Medicines Development, Cape Town, South Africa
| | - Matthias Schwenkglenks
- Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
| | - Bryan M. Bennett
- Patient Centered Outcomes, Adelphi Values, Bollington, United Kingdom
| | - Edina Sinanovic
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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27875
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Lee F, Lawrence DA. From Infections to Anthropogenic Inflicted Pathologies: Involvement of Immune Balance. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2017; 21:24-46. [PMID: 29252129 DOI: 10.1080/10937404.2017.1412212] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A temporal trend can be seen in recent human history where the dominant causes of death have shifted from infectious to chronic diseases in industrialized societies. Human influences in the current "Anthropocene" epoch are exponentially impacting the environment and consequentially health. Changing ecological niches are suggested to have created health transitions expressed as modifications of immune balance from infections inflicting pathologies in the Holocene epoch (12,000 years ago) to human behaviors inflicting pathologies beginning in the Anthropocene epoch (300 years ago). A review of human immune health and adaptations responding to environmental (biological, chemical, physical, and psychological) stresses, which are influenced by social conditions, emphasize the involvement of fluctuations in immune cell subsets affecting influential gene-environment interactions. The literature from a variety of fields (anthropological, immunological, and environmental) is incorporated to present an expanded perspective on shifts in diseases within the context of immune balance and function and environmental immunology. The influences between historical and contemporary human ecology are examined in relation to human immunity. Several examples of shifts in human physiology and immunity support the premise that increased incidences of chronic diseases are a consequence of human modification of environment and lifestyle. Although the development of better health care and a broader understanding of human health have helped with better life quality and expectancy, the transition of morbidity and mortality rates from infections to chronic diseases is a cause for concern. Combinations of environmental stressors/pollutants and human behaviors and conditions are modulating the immune-neuroendocrine network, which compromises health benefits.
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Affiliation(s)
- Florence Lee
- a Department of Anthropology , University at Albany , Albany , NY , USA
| | - David A Lawrence
- b Wadsworth Center/New York State Department of Health , Albany , NY , USA
- c Biomedical Sciences and Environmental Health Sciences , University at Albany, School of Public Health , Albany , NY , USA
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27876
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Edvinsson L. Headache advances in 2017: a new horizon in migraine therapy. Lancet Neurol 2017; 17:5-6. [PMID: 29263007 DOI: 10.1016/s1474-4422(17)30415-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/03/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Lars Edvinsson
- Experimental Vascular Research, Division of Medicine, Lund University, Lund 22184, Sweden.
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27877
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Fullman N, Lozano R. Towards a meaningful measure of universal health coverage for the next billion. LANCET GLOBAL HEALTH 2017; 6:e122-e123. [PMID: 29248368 DOI: 10.1016/s2214-109x(17)30487-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA.
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27878
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Hogan DR, Stevens GA, Hosseinpoor AR, Boerma T. Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services. LANCET GLOBAL HEALTH 2017; 6:e152-e168. [PMID: 29248365 DOI: 10.1016/s2214-109x(17)30472-2] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Achieving universal health coverage, including quality essential service coverage and financial protection for all, is target 3.8 of the Sustainable Development Goals (SDG). As a result, an index of essential health service coverage indicators was selected by the UN as SDG indicator 3.8.1. We have developed an index for measuring SDG 3.8.1, describe methods for compiling the index, and report baseline results for 2015. METHODS 16 tracer indicators were selected for the index, which included four from within each of the categories of reproductive, maternal, newborn, and child health; infectious disease; non-communicable diseases; and service capacity and access. Indicator data for 183 countries were taken from UN agency estimates or databases, supplemented with submissions from national focal points during a WHO country consultation. The index was computed using geometric means, and a subset of tracer indicators were used to summarise inequalities. FINDINGS On average, countries had primary data since 2010 for 72% of the final set of indicators. The median national value for the service coverage index was 65 out of 100 (range 22-86). The index was highly correlated with other summary measures of health, and after controlling for gross national income and mean years of adult education, was associated with 21 additional years of life expectancy over the observed range of country values. Across 52 countries with sufficient data, coverage was 1% to 66% lower among the poorest quintile as compared with the national population. Sensitivity analyses suggested ranks implied by the index are fairly stable across alternative calculation methods. INTERPRETATION Service coverage within universal health coverage can be measured with an index of tracer indicators. Our universal health coverage service coverage index is simple to compute by use of available country data and can be refined to incorporate relevant indicators as they become available through SDG monitoring. FUNDING Ministry of Health, Japan, and the Rockefeller Foundation.
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Affiliation(s)
| | | | | | - Ties Boerma
- Department of Community and Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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27879
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Eneroth H, Wallin S, Leander K, Nilsson Sommar J, Åkesson A. Risks and Benefits of Increased Nut Consumption: Cardiovascular Health Benefits Outweigh the Burden of Carcinogenic Effects Attributed to Aflatoxin B₁ Exposure. Nutrients 2017; 9:E1355. [PMID: 29236075 PMCID: PMC5748805 DOI: 10.3390/nu9121355] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/24/2017] [Accepted: 12/04/2017] [Indexed: 01/24/2023] Open
Abstract
Nuts are rich in nutrients and mounting evidence shows that consumption reduces cardiovascular disease (CVD) incidence. Nuts may also be a major source of aflatoxin B₁, a potent liver carcinogen and the risk/benefit balance is unknown. Based on national statistics and data from the PREDIMED intervention trial, we estimated the potential CVD-reduction if Swedes aged 55-79 consumed 30 g nuts/day, instead of the current national average of five grams per day. We also assessed the reduction in disability-adjusted life years (DALYs) due to myocardial infarction (MI) and stroke. We estimated the aflatoxin B₁ exposure from nuts and calculated the margin of exposure. The approximation that one nanogram aflatoxin B₁/kg body weight/day results in one additional liver cancer case/10 million person-years was used to estimate the number of liver cancer cases. The increased nut consumption scenario prevented more than 7000 CVDs in 2013 (306/100,000 person-years) and contributed to about 55,000 saved DALYs for stroke and 22,000 for MI. The concomitant increase in aflatoxin B₁ exposure caused an estimated zero to three additional cases of liver cancer, corresponding to 159 DALYs spent, emphasizing the associated risks. Increased nut consumption, as part of a varied healthy diet, is warranted even when aflatoxin B₁ exposure is taken into account. However, efforts to reduce aflatoxin exposure from food are essential.
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Affiliation(s)
- Hanna Eneroth
- National Food Agency, Box 622, 751 26 Uppsala, Sweden;
| | - Stina Wallin
- National Food Agency, Box 622, 751 26 Uppsala, Sweden;
| | - Karin Leander
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden; (K.L.), (A.Å.)
| | - Johan Nilsson Sommar
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
| | - Agneta Åkesson
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden; (K.L.), (A.Å.)
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27880
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Zupan Z, Evans A, Couturier DL, Marteau TM. Wine glass size in England from 1700 to 2017: a measure of our time. BMJ 2017; 359:j5623. [PMID: 29237588 PMCID: PMC5728305 DOI: 10.1136/bmj.j5623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Wine glass capacity in England has increased sevenfold in 300 years. Can downsizing reduce wine consumption? Theresa Marteau and colleagues investigate
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Affiliation(s)
- Zorana Zupan
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, England
| | - Alexandra Evans
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, England
| | | | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, England
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27881
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Saha L, Kaur S, Khosla P, Kumari S, Rani A. Pharmacoeconomic Analysis of Drugs Used in the Treatment of Pneumonia in Paediatric Population in a Tertiary Care Hospital in India-A Cost-of-Illness Study. Med Sci (Basel) 2017; 5:E33. [PMID: 29232913 PMCID: PMC5753662 DOI: 10.3390/medsci5040033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/04/2017] [Accepted: 12/04/2017] [Indexed: 12/28/2022] Open
Abstract
AIMS AND OBJECTIVES The cost of antibiotic therapy for the treatment of pneumonia in the inpatient paediatric population can have a major impact on the healthcare expenditure. We planned to assess the direct and indirect costs of diagnosis and medical treatment of paediatric patients with community acquired pneumonia who are hospitalized in a tertiary care hospital in India. METHODS 125 children with a diagnosis of pneumonia who were admitted to the inpatient department of a paediatric hospital receiving antibiotic treatment were observed. Data on clinical presentation and resources consumed were collected and the costs of pneumonia treatment were calculated. Descriptive statistics (mean ± standard deviation (SD)) were used to evaluate data regarding demographics, drugs prescribed and cost (direct and indirect cost). Multivariate regression analysis was used to find out predictors of direct and indirect cost. RESULTS Among all pneumonia admissions, mild-to-moderate pneumonia constitutes 76.8%, and 23.2% children were admitted with severe pneumonia; 105 children out of 125 (84%) were suffering from associated disorders along with pneumonia. The majority of antibiotics prescribed belonged to beta lactams (52%) followed by aminoglycosides (19%), macrolides (13%) and peptides (11%). Parenteral routes of administration were used in a majority of patients as compared to oral. The average cost per patient in management of pneumonia was 12245 ± 593 INR ($187.34 ± 9.07).
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Affiliation(s)
- Lekha Saha
- Department of Pharmacology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh 160012, India.
| | - Sharonjeet Kaur
- Department of Pharmacology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh 160012, India.
| | - Pratibha Khosla
- Department of Pharmacology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh 160012, India.
| | - Sweta Kumari
- Department of Pharmacology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh 160012, India.
| | - Alka Rani
- Department of Pediatric Medicine, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh 160012, India.
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27882
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Gianella C, de Assis Machado MR, Gloppen S. Political determinants of Sustainable Development Goals. Lancet 2017; 390:2545-2546. [PMID: 29231829 DOI: 10.1016/s0140-6736(17)33082-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 10/25/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Siri Gloppen
- Chr. Michelson Institute, Bergen 5892, Norway; Department of Comparative Politics, University of Bergen, Bergen, Norway
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27883
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Diverging patterns of cardiovascular diseases across immigrant groups in Northern Italy. Int J Cardiol 2017; 254:362-367. [PMID: 29246427 DOI: 10.1016/j.ijcard.2017.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/15/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Only fragmentary data are available on the burden of non-communicable diseases among immigrants in Europe, mostly limited to mortality by cause. Aim of the study is to investigate the prevalence of cardiovascular diseases across different immigrant groups in the Veneto Region (North-Eastern Italy). METHODS The resident population aged 20-59 was classified according to country of citizenship. The Adjusted Clinical Groups System was adopted to identify selected cardiovascular conditions by linkage of Hospital Discharge Records, Emergency Room visits, Chronic disease registry for copayment exemptions, the Home care database, and drugs reimbursed by the Regional Health Service. Age standardized prevalence rates were compared across population groups, and rate ratios (RR) with 95% confidence intervals (CI) were computed taking the Italian population as reference. RESULTS The prevalence of diabetes was higher across all immigrant groups compared to Italians. Specific risk patterns could be identified associated to different ethnicities: South Asian immigrants were at very high risk of diabetes, dyslipidemia, and ischemic heart disease (males RR 2.3, CI 1.9-2.8; females RR 2.0, CI 1.2-3.5). Immigrants from Africa were affected by high rates of hypertension, cerebrovascular diseases, and heart failure, with a more pronounced unfavorable profile among females (hypertension RR 3.0, CI 2.6-3.3; cerebrovascular diseases RR 1.7, CI 1.1-2.7). CONCLUSIONS Wide differences in the prevalence of cardiovascular diseases could be detected across immigrant groups. These findings represent a first step towards systematic chronic disease surveillance by ethnicity, a fundamental tool for shaping culturally-tailored prevention strategies.
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27884
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27885
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Hoare E, Dash SR, Varsamis P, Jennings GL, Kingwell BA. Fasting Plasma Glucose, Self-Appraised Diet Quality and Depressive Symptoms: A US-Representative Cross-Sectional Study. Nutrients 2017; 9:nu9121330. [PMID: 29215576 PMCID: PMC5748780 DOI: 10.3390/nu9121330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/10/2017] [Accepted: 12/05/2017] [Indexed: 11/25/2022] Open
Abstract
Depression and type 2 diabetes (T2D) contribute significantly to global burden of disease and often co-occur. Underpinning type 2 diabetes is poor glycaemic control and glucose is also an obligatory substrate for brain metabolism, with potential implications for cognition, motivation and mood. This research aimed to examine the relationships between fasting plasma glucose and depressive symptoms in a large, population representative sample of US adults, controlling for other demographic and lifestyle behavioural risk factors. Using the 2013–2014 National Health and Nutrition Examination Survey (NHANES) data, this study first investigated the relationship between fasting plasma glucose and mental disorders at a population-level, accounting for demographic, health behavioural and weight-related factors known to co-occur with both type 2 diabetes and mental disorders. Depressive symptoms were derived from the 9-item Patient Health Questionnaire. Fasting plasma glucose was obtained through medical examination and demographic (age, household income, sex) and health characteristics (perceived diet quality, daily time sedentary) were self-reported. Body mass index was calculated from objectively measured height and weight. In the univariate model, higher fasting plasma glucose was associated with greater depressive symptoms among females (b = 0.24, 95% CI = 0.05, 0.43, p < 0.05), but not males. In the final fully adjusted model, the relationship between fasting plasma glucose and depressive symptoms was non-significant for both males and females. Of all independent variables, self-appraised diet quality was strongly and significantly associated with depressive symptoms and this remained significant when individuals with diabetes were excluded. Although diet quality was self-reported based on individuals’ perceptions, these findings are consistent with a role for poor diet in the relationship between fasting plasma glucose and depressive symptoms.
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Affiliation(s)
- Erin Hoare
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
| | - Sarah R Dash
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
| | - Pia Varsamis
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
| | - Garry L Jennings
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
| | - Bronwyn A Kingwell
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
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27886
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Willcox M, Harrison H, Asiedu A, Nelson A, Gomez P, LeFevre A. Incremental cost and cost-effectiveness of low-dose, high-frequency training in basic emergency obstetric and newborn care as compared to status quo: part of a cluster-randomized training intervention evaluation in Ghana. Global Health 2017; 13:88. [PMID: 29212509 PMCID: PMC5719574 DOI: 10.1186/s12992-017-0313-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/19/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Low-dose, high-frequency (LDHF) training is a new approach best practices to improve clinical knowledge, build and retain competency, and transfer skills into practice after training. LDHF training in Ghana is an opportunity to build health workforce capacity in critical areas of maternal and newborn health and translate improved capacity into better health outcomes. METHODS This study examined the costs of an LDHF training approach for basic emergency obstetric and newborn care and calculates the incremental cost-effectiveness of the LDHF training program for health outcomes of newborn survival, compared to the status quo alternative of no training. The costs of LDHF were compared to costs of traditional workshop-based training per provider trained. Retrospective program cost analysis with activity-based costing was used to measure all resources of the LDHF training program over a 3-year analytic time horizon. Economic costs were estimated from financial records, informant interviews, and regional market prices. Health effects from the program's impact evaluation were used to model lives saved and disability-adjusted life years (DALYs) averted. Uncertainty analysis included one-way and probabilistic sensitivity analysis to explore incremental cost-effectiveness results when fluctuating key parameters. RESULTS For the 40 health facilities included in the evaluation, the total LDHF training cost was $823,134. During the follow-up period after the first LDHF training-1 year at each participating facility-approximately 544 lives were saved. With deterministic calculation, these findings translate to $1497.77 per life saved or $53.07 per DALY averted. Probabilistic sensitivity analysis, with mean incremental cost-effectiveness ratio of $54.79 per DALY averted ($24.42-$107.01), suggests the LDHF training program as compared to no training has 100% probability of being cost-effective above a willingness to pay threshold of $1480, Ghana's gross national income per capita in 2015. CONCLUSION This study provides insight into the investment of LDHF training and value for money of this approach to training in-service providers on basic emergency obstetric and newborn care. The LDHF training approach should be considered for expansion in Ghana and integrated into existing in-service training programs and health system organizational structures for lower cost and more efficiency at scale.
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Affiliation(s)
- Michelle Willcox
- Jhpiego, an affiliate of Johns Hopkins University, 1615 Thames St, Baltimore, MD #200 USA
| | - Heather Harrison
- Jhpiego, an affiliate of Johns Hopkins University, 1615 Thames St, Baltimore, MD #200 USA
| | | | | | - Patricia Gomez
- Jhpiego, an affiliate of Johns Hopkins University, 1615 Thames St, Baltimore, MD #200 USA
| | - Amnesty LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University Global mHealth Initiative, 615 N. Wolfe St, Baltimore, MD USA
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27887
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Nations within a nation: variations in epidemiological transition across the states of India, 1990-2016 in the Global Burden of Disease Study. Lancet 2017; 390:2437-2460. [PMID: 29150201 PMCID: PMC5720596 DOI: 10.1016/s0140-6736(17)32804-0] [Citation(s) in RCA: 509] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/08/2017] [Accepted: 10/11/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND 18% of the world's population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates have not been available so far for all major diseases and risk factors. Thus, we aimed to estimate the disease burden and risk factors in every state of India as part of the Global Burden of Disease (GBD) Study 2016. METHODS Using all available data sources, the India State-Level Disease Burden Initiative estimated burden (metrics were deaths, disability-adjusted life-years [DALYs], prevalence, incidence, and life expectancy) from 333 disease conditions and injuries and 84 risk factors for each state of India from 1990 to 2016 as part of GBD 2016. We divided the states of India into four epidemiological transition level (ETL) groups on the basis of the ratio of DALYs from communicable, maternal, neonatal, and nutritional diseases (CMNNDs) to those from non-communicable diseases (NCDs) and injuries combined in 2016. We assessed variations in the burden of diseases and risk factors between ETL state groups and between states to inform a more specific health-system response in the states and for India as a whole. FINDINGS DALYs due to NCDs and injuries exceeded those due to CMNNDs in 2003 for India, but this transition had a range of 24 years for the four ETL state groups. The age-standardised DALY rate dropped by 36·2% in India from 1990 to 2016. The numbers of DALYs and DALY rates dropped substantially for most CMNNDs between 1990 and 2016 across all ETL groups, but rates of reduction for CMNNDs were slowest in the low ETL state group. By contrast, numbers of DALYs increased substantially for NCDs in all ETL state groups, and increased significantly for injuries in all ETL state groups except the highest. The all-age prevalence of most leading NCDs increased substantially in India from 1990 to 2016, and a modest decrease was recorded in the age-standardised NCD DALY rates. The major risk factors for NCDs, including high systolic blood pressure, high fasting plasma glucose, high total cholesterol, and high body-mass index, increased from 1990 to 2016, with generally higher levels in higher ETL states; ambient air pollution also increased and was highest in the low ETL group. The incidence rate of the leading causes of injuries also increased from 1990 to 2016. The five leading individual causes of DALYs in India in 2016 were ischaemic heart disease, chronic obstructive pulmonary disease, diarrhoeal diseases, lower respiratory infections, and cerebrovascular disease; and the five leading risk factors for DALYs in 2016 were child and maternal malnutrition, air pollution, dietary risks, high systolic blood pressure, and high fasting plasma glucose. Behind these broad trends many variations existed between the ETL state groups and between states within the ETL groups. Of the ten leading causes of disease burden in India in 2016, five causes had at least a five-times difference between the highest and lowest state-specific DALY rates for individual causes. INTERPRETATION Per capita disease burden measured as DALY rate has dropped by about a third in India over the past 26 years. However, the magnitude and causes of disease burden and the risk factors vary greatly between the states. The change to dominance of NCDs and injuries over CMNNDs occurred about a quarter century apart in the four ETL state groups. Nevertheless, the burden of some of the leading CMNNDs continues to be very high, especially in the lowest ETL states. This comprehensive mapping of inequalities in disease burden and its causes across the states of India can be a crucial input for more specific health planning for each state as is envisioned by the Government of India's premier think tank, the National Institution for Transforming India, and the National Health Policy 2017. FUNDING Bill & Melinda Gates Foundation; Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India; and World Bank.
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27888
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Leslie HH, Sun Z, Kruk ME. Association between infrastructure and observed quality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8 countries. PLoS Med 2017; 14:e1002464. [PMID: 29232377 PMCID: PMC5726617 DOI: 10.1371/journal.pmed.1002464] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/25/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs)-the structural inputs to care-predicts the clinical quality of care provided to patients. METHODS AND FINDINGS Service Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development. These surveys assess health system capacity in LMICs. We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys included an audit of facility infrastructure and direct observation of family planning, antenatal care (ANC), sick-child care, and (in 2 countries) labor and delivery. To measure structural inputs, we constructed indices that measured World Health Organization-recommended amenities, equipment, and medications in each service. For clinical quality, we used data from direct observations of care to calculate providers' adherence to evidence-based care guidelines. We assessed the correlation between these metrics and used spline models to test for the presence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for family planning on average. Adherence to evidence-based guidelines was low, with an average of 37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and 61% in ANC. Correlation between infrastructure and evidence-based care was low (median 0.20, range from -0.03 for family planning in Senegal to 0.40 for ANC in Tanzania). Facilities with similar infrastructure scores delivered care of widely varying quality in each service. We did not detect a minimum level of infrastructure that was reliably associated with higher quality of care delivered in any service. These findings rely on cross-sectional data, preventing assessment of relationships between structural inputs and clinical quality over time; measurement error may attenuate the estimated associations. CONCLUSION Inputs to care are poorly correlated with provision of evidence-based care in these 4 clinical services. Healthcare workers in well-equipped facilities often provided poor care and vice versa. While it is important to have strong infrastructure, it should not be used as a measure of quality. Insight into health system quality requires measurement of processes and outcomes of care.
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Affiliation(s)
- Hannah H. Leslie
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Zeye Sun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR. Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Glob Health 2017; 5:e1221-e1234. [PMID: 29032195 DOI: 10.1016/s2214-109x(17)30393-5] [Citation(s) in RCA: 1755] [Impact Index Per Article: 250.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/11/2017] [Accepted: 09/20/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Contemporary data for causes of vision impairment and blindness form an important basis of recommendations in public health policies. Refreshment of the Global Vision Database with recently published data sources permitted modelling of cause of vision loss data from 1990 to 2015, further disaggregation by cause, and forecasts to 2020. METHODS In this systematic review and meta-analysis, we analysed published and unpublished population-based data for the causes of vision impairment and blindness from 1980 to 2014. We identified population-based studies published before July 8, 2014, by searching online databases with no language restrictions (MEDLINE from Jan 1, 1946, and Embase from Jan 1, 1974, and the WHO Library Database). We fitted a series of regression models to estimate the proportion of moderate or severe vision impairment (defined as presenting visual acuity of <6/18 but ≥3/60 in the better eye) and blindness (presenting visual acuity of <3/60 in the better eye) by cause, age, region, and year. FINDINGS We identified 288 studies of 3 983 541 participants contributing data from 98 countries. Among the global population with moderate or severe vision impairment in 2015 (216·6 million [80% uncertainty interval 98·5 million to 359·1 million]), the leading causes were uncorrected refractive error (116·3 million [49·4 million to 202·1 million]), cataract (52·6 million [18·2 million to 109·6 million]), age-related macular degeneration (8·4 million [0·9 million to 29·5 million]), glaucoma (4·0 million [0·6 million to 13·3 million]), and diabetic retinopathy (2·6 million [0·2 million to 9·9 million]). Among the global population who were blind in 2015 (36·0 million [12·9 million to 65·4 million]), the leading causes were cataract (12·6 million [3·4 million to 28·7 million]), uncorrected refractive error (7·4 million [2·4 million to 14·8 million]), and glaucoma (2·9 million [0·4 million to 9·9 million]). By 2020, among the global population with moderate or severe vision impairment (237·1 million [101·5 million to 399·0 million]), the number of people affected by uncorrected refractive error is anticipated to rise to 127·7 million (51·0 million to 225·3 million), by cataract to 57·1 million (17·9 million to 124·1 million), by age-related macular degeneration to 8·8 million (0·8 million to 32·1 million), by glaucoma to 4·5 million (0·5 million to 15·4 million), and by diabetic retinopathy to 3·2 million (0·2 million to 12·9 million). By 2020, among the global population who are blind (38·5 million [13·2 million to 70·9 million]), the number of patients blind because of cataract is anticipated to rise to 13·4 million (3·3 million to 31·6 million), because of uncorrected refractive error to 8·0 million (2·5 million to 16·3 million), and because of glaucoma to 3·2 million (0·4 million to 11·0 million). Cataract and uncorrected refractive error combined contributed to 55% of blindness and 77% of vision impairment in adults aged 50 years and older in 2015. World regions varied markedly in the causes of blindness and vision impairment in this age group, with a low prevalence of cataract (<22% for blindness and 14·1-15·9% for vision impairment) and a high prevalence of age-related macular degeneration (>14% of blindness) as causes in the high-income subregions. Blindness and vision impairment at all ages in 2015 due to diabetic retinopathy (odds ratio 2·52 [1·48-3·73]) and cataract (1·21 [1·17-1·25]) were more common among women than among men, whereas blindness and vision impairment due to glaucoma (0·71 [0·57-0·86]) and corneal opacity (0·54 [0·43-0·66]) were more common among men than among women, with no sex difference related to age-related macular degeneration (0·91 [0·70-1·14]). INTERPRETATION The number of people affected by the common causes of vision loss has increased substantially as the population increases and ages. Preventable vision loss due to cataract (reversible with surgery) and refractive error (reversible with spectacle correction) continue to cause most cases of blindness and moderate or severe vision impairment in adults aged 50 years and older. A large scale-up of eye care provision to cope with the increasing numbers is needed to address avoidable vision loss. FUNDING Brien Holden Vision Institute.
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Affiliation(s)
- Seth R Flaxman
- Department of Mathematics and Data Science Institute, Imperial College London, London, UK
| | - Rupert R A Bourne
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK.
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, NSW, Australia; School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
| | - Peter Ackland
- International Agency for the Prevention of Blindness, London, UK
| | | | | | | | - Jost B Jonas
- Department of Ophthalmology, Universitätsmedizin, Mannheim, Germany; Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA; Discovery Eye Center, Addis Ababa, Ethiopia; MyungSung Christian Medical Center, Addis Ababa, Ethiopia
| | - Janet Leasher
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Hans Limburg
- Health Information Services, Grootebroek, Netherlands
| | - Kovin Naidoo
- Brien Holden Vision Institute, Sydney, NSW, Australia; African Vision Research Institute, University of Kwazulu-Natal, Glenwood, Durban, South Africa
| | - Konrad Pesudovs
- National Health and Medical Research Council Centre for Clinical Eye Research, Flinders University, Adelaide, SA, Australia
| | | | - Gretchen A Stevens
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Nina Tahhan
- Brien Holden Vision Institute, Sydney, NSW, Australia; School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
| | - Tien Y Wong
- Singapore Eye Research Institute, Duke-National University of Singapore Graduate Medical School, National University of Singapore, Singapore
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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27890
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Kermanizadeh A, Jacobsen NR, Roursgaard M, Loft S, Møller P. Hepatic toxicity assessment of cationic liposome exposure in healthy and chronic alcohol fed mice. Heliyon 2017; 3:e00458. [PMID: 29234737 PMCID: PMC5717320 DOI: 10.1016/j.heliyon.2017.e00458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/02/2017] [Accepted: 11/15/2017] [Indexed: 02/01/2023] Open
Abstract
The utilisation of nanoparticles as the means of targeted delivery of therapeutics and/or imaging agents could greatly enhance the specific transport of biologically active payloads to target tissues while avoiding or reducing undesired side-effects. To allow for this to become a reality, the question of potential toxicological effects needs to be addressed. In the present investigation, a cationic liposome with prospective for medical applications was constructed and thoroughly assessed for any material-induced hepatic adverse effects in vivo − in healthy and alcoholic hepatic disease models and in vitro − (HepG2 cells). The data demonstrated that intravenous injection of liposomes did not cause any significant in vivo hepatic toxicity (inflammation, alterations in blood parameters, anti-oxidant depletion, acute phase response and histopathology) at doses of 200 μg per mouse in either healthy or chronically alcohol fed mice. Additionally, the in vitro material-induced adverse effects (cytotoxicity, inflammation or albumin secretion) were all also minimal. The data from this study demonstrated that the intravenous injection of cationic liposomes does not cause hepatic toxicity. This investigation is important as it investigates the toxicity of a nano-sized material in a model of alcoholic hepatic disease in vitro and in vivo. This is an area of research in the field of nanotoxicology that is currently almost entirely overlooked.
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Affiliation(s)
- Ali Kermanizadeh
- University of Copenhagen, Department of Public Health, Section of Environmental Health, Copenhagen, Denmark
| | - Nicklas R Jacobsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Martin Roursgaard
- University of Copenhagen, Department of Public Health, Section of Environmental Health, Copenhagen, Denmark
| | - Steffen Loft
- University of Copenhagen, Department of Public Health, Section of Environmental Health, Copenhagen, Denmark
| | - Peter Møller
- University of Copenhagen, Department of Public Health, Section of Environmental Health, Copenhagen, Denmark
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27891
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Goodson JL, Alexander JP, Linkins RW, Orenstein WA. Measles and rubella elimination: learning from polio eradication and moving forward with a diagonal approach. Expert Rev Vaccines 2017; 16:1203-1216. [PMID: 29037086 PMCID: PMC6477920 DOI: 10.1080/14760584.2017.1393337] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION In 1988, an estimated 350,000 children were paralyzed by polio and 125 countries reported polio cases, the World Health Assembly passed a resolution to achieve polio eradication by 2000, and the Global Polio Eradication Initiative (GPEI) was established as a partnership focused on eradication. Today, following eradication efforts, polio cases have decreased >99% and eradication of all three types of wild polioviruses is approaching. However, since polio resources substantially support disease surveillance and other health programs, losing polio assets could reverse progress toward achieving Global Vaccine Action Plan goals. Areas covered: As the end of polio approaches and GPEI funds and capacity decrease, we document knowledge, experience, and lessons learned from 30 years of polio eradication. Expert commentary: Transitioning polio assets to measles and rubella (MR) elimination efforts would accelerate progress toward global vaccination coverage and equity. MR elimination feasibility and benefits have long been established. Focusing efforts on MR elimination after achieving polio eradication would make a permanent impact on reducing child mortality but should be done through a 'diagonal approach' of using measles disease transmission to identify areas possibly susceptible to other vaccine-preventable diseases and to strengthen the overall immunization and health systems to achieve disease-specific goals.
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Affiliation(s)
- James L. Goodson
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James P. Alexander
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert W. Linkins
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Walter A. Orenstein
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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27892
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Bland JS. Cardiology Meets Personalized Lifestyle Medicine. Integr Med (Encinitas) 2017; 16:12-16. [PMID: 30936810 PMCID: PMC6438082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This is a very exciting time for medicine. We are witnessing the creation of a new approach to the prevention and treatment of cardiovascular disease. It is an omnigenic approach-powered by systems biology-to assembling patient-specific information about how genes and lifestyle interact. When combined with other new technologies such as artificial intelligence and machine learning informatics, the result will be the development of a precision form of personalized lifestyle medicine applied to cardiovascular disease. This advancement will be a gateway for change throughout the entire segment of the health care system that is focused on the many complex chronic conditions affecting our world population.
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27893
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Undurraga EA, Carias C, Meltzer MI, Kahn EB. Potential for broad-scale transmission of Ebola virus disease during the West Africa crisis: lessons for the Global Health security agenda. Infect Dis Poverty 2017; 6:159. [PMID: 29191243 PMCID: PMC5710062 DOI: 10.1186/s40249-017-0373-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 10/27/2017] [Indexed: 01/19/2023] Open
Abstract
Background The 2014–2016 Ebola crisis in West Africa had approximately eight times as many reported deaths as the sum of all previous Ebola outbreaks. The outbreak magnitude and occurrence of multiple Ebola cases in at least seven countries beyond Liberia, Sierra Leone, and Guinea, hinted at the possibility of broad-scale transmission of Ebola. Main text Using a modeling tool developed by the US Centers for Disease Control and Prevention during the Ebola outbreak, we estimated the number of Ebola cases that might have occurred had the disease spread beyond the three countries in West Africa to cities in other countries at high risk for disease transmission (based on late 2014 air travel patterns). We estimated Ebola cases in three scenarios: a delayed response, a Liberia-like response, and a fast response scenario. Based on our estimates of the number of Ebola cases that could have occurred had Ebola spread to other countries beyond the West African foci, we emphasize the need for improved levels of preparedness and response to public health threats, which is the goal of the Global Health Security Agenda. Our estimates suggest that Ebola could have potentially spread widely beyond the West Africa foci, had local and international health workers and organizations not committed to a major response effort. Our results underscore the importance of rapid detection and initiation of an effective, organized response, and the challenges faced by countries with limited public health systems. Actionable lessons for strengthening local public health systems in countries at high risk of disease transmission include increasing health personnel, bolstering primary and critical healthcare facilities, developing public health infrastructure (e.g. laboratory capacity), and improving disease surveillance. With stronger local public health systems infectious disease outbreaks would still occur, but their rapid escalation would be considerably less likely, minimizing the impact of public health threats such as Ebola. Conclusions The Ebola outbreak could have potentially spread to other countries, where limited public health surveillance and response capabilities may have resulted in additional foci. Health security requires robust local health systems that can rapidly detect and effectively respond to an infectious disease outbreak. Electronic supplementary material The online version of this article (10.1186/s40249-017-0373-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eduardo A Undurraga
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. .,Present address: School of Government, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile.
| | - Cristina Carias
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Martin I Meltzer
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily B Kahn
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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27894
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Ibrahim N, Ramke J, Pozo-Martin F, Gilbert CE. Willingness to pay for cataract surgery is much lower than actual costs in Zamfara state, northern Nigeria. Ophthalmic Epidemiol 2017; 25:227-233. [PMID: 29182463 DOI: 10.1080/09286586.2017.1408845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Direct medical and non-medical costs incurred by those undergoing subsidised cataract surgery at Gusau eye clinic, Zamfara state, were recently determined. The aim of this study was to assess the willingness to pay for cataract surgery among adults with severe visual impairment or blindness from cataract in rural Zamfara and to compare this to actual costs. METHODS In three rural villages served by Gusau eye clinic, key informants helped identify 80 adults with bilateral severe visual impairment or blindness (<6/60), with cataract being the cause in at least one eye. The median amount participants were willing to pay for cataract surgery was determined. The proportion willing to pay actual costs of the (i) subsidised surgical fee (US$18.5), (ii) average non-medical expenses (US$25.2), and (iii) average total expenses (US$51.2) at Gusau eye clinic were calculated. Where participants would seek funds for surgery was determined. RESULTS Among 80 participants (38% women), most (n = 73, 91%) were willing to pay something, ranging from <US$1 to US$186 (median US$18.5, interquartile range 6.2-31.1). Approximately half of the participants (n = 41) were willing to pay US$18.5 (78% men), one-third (n = 26) were willing to pay US$25.2 (77% men); and 11% (n = 9) were willing to pay US$51.2 (all men). Only six participants (8%) already had the money to pay; one quarter (n = 20) would need to sell possessions to raise the funds. CONCLUSION Willingness to pay for cataract surgery among adults with operable cataract in rural Zamfara state is far lower than current costs of undergoing surgery. People who were widowed-most of whom were women-were willing to pay least. Further financial support is required for cataract surgery to be universally accessible.
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Affiliation(s)
- Nazaradden Ibrahim
- a Zamfara State Eye Care Programme, Ministry of Health , Gusau , Nigeria
| | - Jacqueline Ramke
- b Department of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences , University of Auckland , Auckland , New Zealand
| | - Francisco Pozo-Martin
- c Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , UK
| | - Clare E Gilbert
- d International Centre for Eye Health, Clinical Research Unit, Department of Infectious & Tropical Diseases , London School of Hygiene and Tropical Medicine , London , UK
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27895
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Abstract
Supplemental Digital Content is available in the text Objective: The global fight against HIV/AIDS in Africa has long been a focus of US foreign policy, but this could change if the federal budget for 2018 proposed by the US Office of Management and Budget is adopted. We aim to inform public and Congressional debate around this issue by evaluating the historical and potential future impact of US investment in the African HIV response. Design/methods: We use a previously published mathematical model of HIV transmission to characterize the possible impact of a series of financial scenarios for the historical and future AIDS response across Sub-Saharan Africa. Results: We find that US funding has saved nearly five million adults in Sub-Saharan Africa from AIDS-related deaths. In the coming 15 years, if current numbers on antiretroviral treatment are maintained without further expansion of programs (the proposed US strategy), nearly 26 million new HIV infections and 4.4 million AIDS deaths may occur. A 10% increase in US funding, together with ambitious domestic spending and focused attention on optimizing resources, can avert up to 22 million HIV infections and save 2.3 million lives in Sub-Saharan Africa compared with the proposed strategy. Conclusion: Our synthesis of available evidence shows that the United States has played, and could continue to play, a vital role in the global HIV response. Reduced investment could allow more than two million avoidable AIDS deaths by 2032, whereas continued leadership by the United States and other countries could bring UNAIDS targets for ending the epidemic into reach.
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27896
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Himmelstein DU, Woolhandler S, Almberg M, Fauke C. The U.S. Health Care Crisis Continues: A Data Snapshot. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2017; 48:28-41. [PMID: 29182038 DOI: 10.1177/0020731417741779] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite implementation of the Affordable Care Act in 2014, the U.S. health care crisis continues. While coverage has been expanded, 28 million people remain uninsured, and tens of millions who have coverage are unable to afford care because of high cost-sharing requirements. Moreover, many with coverage have a sharply restricted choice of physicians and hospitals, and the corporate takeover of medical care in the United States is proceeding rapidly. This article provides a brief précis of recent data on U.S. health policy.
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Affiliation(s)
- David U Himmelstein
- 1 Hunter College, City University of New York, New York, NY, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Steffie Woolhandler
- 1 Hunter College, City University of New York, New York, NY, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Mark Almberg
- 3 Physicians for a National Health Program, Chicago, Illinois, USA
| | - Clare Fauke
- 3 Physicians for a National Health Program, Chicago, Illinois, USA
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27897
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Friedman JF, Olveda RM, Mirochnick MH, Bustinduy AL, Elliott AM. Praziquantel for the treatment of schistosomiasis during human pregnancy. Bull World Health Organ 2017; 96:59-65. [PMID: 29403101 PMCID: PMC5791873 DOI: 10.2471/blt.17.198879] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/31/2017] [Accepted: 11/15/2017] [Indexed: 02/08/2023] Open
Abstract
In 2014, an estimated 40 million women of reproductive age were infected with Schistosoma haematobium, S. japonicum and/or S. mansoni. In both 2003 and 2006, the World Health Organization (WHO) recommended that all schistosome-infected pregnant and breastfeeding women be offered treatment, with praziquantel, either individually or during treatment campaigns. In 2006, WHO also stated the need for randomized controlled trials to assess the safety and efficacy of such treatment. Some countries have yet to follow the recommendation on treatment and many programme managers and pregnant women in other countries remain reluctant to follow the recommended approach. Since 2006, two randomized controlled trials on the use of praziquantel during pregnancy have been conducted: one against S. mansoni in Uganda and the other against S. japonicum in the Philippines. In these trials, praziquantel treatment of pregnant women had no significant effect on birth weight, appeared safe and caused minimal side-effects that were similar to those seen in treated non-pregnant subjects. Having summarized the encouraging data, on efficacy, pharmacokinetics and safety, from these two trials and reviewed the safety data from non-interventional human studies, we recommend that all countries include pregnant women in praziquantel treatment campaigns. We identify the barriers to the treatment of pregnant women, in countries that already include such women in individual treatments and mass drug administration campaigns, and discuss ways to address these barriers.
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Affiliation(s)
- Jennifer F Friedman
- Center for International Health Research at Rhode Island Hospital, 55 Claverick Street, Suite 101, Providence, RI 02903, United States of America (USA)
| | - Remigio M Olveda
- Department of Immunology, Research Institute for Tropical Medicine, Manila, Philippines
| | - Mark H Mirochnick
- Division of Neonatology, Department of Pediatrics, Boston University School of Medicine, Boston, USA
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, England
| | - Alison M Elliott
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, England
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27898
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Kuruvilla S, Sadana R, Montesinos EV, Beard J, Vasdeki JF, Araujo de Carvalho I, Thomas RB, Drisse MNB, Daelmans B, Goodman T, Koller T, Officer A, Vogel J, Valentine N, Wootton E, Banerjee A, Magar V, Neira M, Bele JMO, Worning AM, Bustreo F. A life-course approach to health: synergy with sustainable development goals. Bull World Health Organ 2017; 96:42-50. [PMID: 29403099 PMCID: PMC5791871 DOI: 10.2471/blt.17.198358] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 12/03/2022] Open
Abstract
A life-course approach to health encompasses strategies across individuals’ lives that optimize their functional ability (taking into account the interdependence of individual, social, environmental, temporal and intergenerational factors), thereby enabling well-being and the realization of rights. The approach is a perfect fit with efforts to achieve universal health coverage and meet the sustainable development goals (SDGs). Properly applied, a life-course approach can increase the effectiveness of the former and help realize the vision of the latter, especially in ensuring health and well-being for all at all ages. Its implementation requires a shared understanding by individuals and societies of how health is shaped by multiple factors throughout life and across generations. Most studies have focused on noncommunicable disease and ageing populations in high-income countries and on epidemiological, theoretical and clinical issues. The aim of this article is to show how the life-course approach to health can be extended to all age groups, health topics and countries by building on a synthesis of existing scientific evidence, experience in different countries and advances in health strategies and programmes. A conceptual framework for the approach is presented along with implications for implementation in the areas of: (i) policy and investment; (ii) health services and systems; (iii) local, multisectoral and multistakeholder action; and (iv) measurement, monitoring and research. The SDGs provide a unique context for applying a holistic, multisectoral approach to achieving transformative outcomes for people, prosperity and the environment. A life-course approach can reinforce these efforts, particularly given its emphasis on rights and equity.
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Affiliation(s)
- Shyama Kuruvilla
- Office of the Assistant Director-General, Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ritu Sadana
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Eugenio Villar Montesinos
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - John Beard
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Jennifer Franz Vasdeki
- Office of the Assistant Director-General, Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Rebekah Bosco Thomas
- Department of Gender, Equity and Human Rights, World Health Organization, Geneva, Switzerland
| | - Marie-Noel Brunne Drisse
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Tracey Goodman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Theadora Koller
- Department of Gender, Equity and Human Rights, World Health Organization, Geneva, Switzerland
| | - Alana Officer
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Joanna Vogel
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Nicole Valentine
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Emily Wootton
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Office of the Assistant Director-General, Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Veronica Magar
- Department of Gender, Equity and Human Rights, World Health Organization, Geneva, Switzerland
| | - Maria Neira
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Jean Marie Okwo Bele
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Anne Marie Worning
- Office of the Director-General, World Health Organization, Geneva, Switzerland
| | - Flavia Bustreo
- Office of the Assistant Director-General, Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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27899
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Akhtar S, Al-Abkal J, Al-Hashel JY, Alroughani R. Age-Period-Cohort Modeling of Multiple Sclerosis Incidence Rates in Kuwait: 1980-2014. Neuroepidemiology 2017; 49:152-159. [PMID: 29161697 DOI: 10.1159/000484318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/16/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a complex immune-mediated disorder of the central nervous system with undefined etiology. Genetic predisposition and environmental factors play an imperative role in MS causation and its sustained increasing burden worldwide. This study examined the age, period, and cohort effects on MS incidence rates in Kuwait. METHODS In this retrospective cohort study, data on MS cases diagnosed between January 1, 1980 and December 31, 2014 and registered in National MS Registry and reference population were obtained. Age-period-cohort (APC) analysis was conducted using a loglinear Poisson regression model to supplement the descriptive and graphical presentation. Descriptive statistics were complemented with APC parameters' estimates including net drift, local drift, age at onset curve, and longitudinal age trend. Age effect was presented as incidence rates (per 105 person-years), whereas period and cohort effects were presented as adjusted relative rates. RESULTS A total of 1,131 cases were diagnosed in 1,385,923 person-years. Overall age-standardized MS incidence rate was 64.5 (95% CI 52.4-79.8). An estimated annual percentage change revealed 7.4% annual increase in MS incidence rate during the study period (Net drift = 7.4%; 95% CI 4.1-10.8%). APC "fitted" age-at-onset curve showed a bimodal pattern with peaked incidence rates at 20-24 years and 45-49 years of age. Compared with the referent period (1980-1984) and cohort (1970-1974), MS incidence rates progressively and significantly (p < 0.001) increased during subsequent time periods and in successive cohorts. Results of APC analysis are descriptive in nature and specific etiological hypotheses were not evaluated. However, the findings of this study substantiated the notion of multiplicity of genetic and/or environmental risk factors' contributions. CONCLUSION A substantial increase in MS incidence rates was recorded, which significantly varied in all 3 temporal dimensions during the study period. Future studies may contemplate biological basis for recorded temporal increase in MS risk.
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Affiliation(s)
- Saeed Akhtar
- Department of Community Medicine and Behavioural Sciences, Jabriya, Kuwait
| | | | - Jasem Y Al-Hashel
- Department of Medicine, Faculty of Medicine, University of Kuwait, Jabriya, Kuwait.,Department of Neurology, Ibn Sina Hospital, Safat, Kuwait
| | - Raed Alroughani
- Division of Neurology, Amiri Hospital, Sharq, Kuwait.,Neurology Clinic, Dasman Diabetes Institute, Dasman, Kuwait
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27900
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Schwendicke F, Dörfer CE, Meier T. Global smoking-attributable burden of periodontal disease in 186 countries in the year 2015. J Clin Periodontol 2017; 45:2-14. [PMID: 28965352 DOI: 10.1111/jcpe.12823] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/22/2022]
Abstract
AIM We aimed to quantify the smoking-attributable burden of periodontal disease (PD). METHODS The association between smoking and PD was evaluated. Population, smoking and PD data from the Global Burden of Disease Study were used, and the burden in different sex and age groups in 186 countries in 2015 calculated, adjusted for PD prevalence and numbers of cigarettes smoked. No adjustment was performed in a sensitivity analysis. RESULTS The global smoking-attributable burden was 251,160 disability-adjusted life years (DALYs; 95% uncertainty interval: 190,721-324,241; sensitivity analysis: 344,041 DALYs) or 38.5 million cases. The burden was lower in females than males, and highest in the age group of the 50- to 69-year-olds. On super-regional level, the burden was highest in South-East Asia, East Asia and Oceania (83,052 DALYs), and high-income North America and Asia Pacific (55,362 DALYs). On regional level, it was highest in East Asia (70,845 DALYs), South Asia (30,808 DALYs) and North Africa and the Middle East (24,095 DALYs). On national level, it was highest in China (69,148 DALYs), India (29,362 DALYs) and the United States (12,714 DALYs). The relative smoking-attributable burden ranged between >25% in Suriname and <1% in Chad. CONCLUSIONS There is great need to monitor and tackle the smoking-attributable burden of PD.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christof E Dörfer
- Clinic for Conservative Dentistry and Periodontology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Toni Meier
- Institute for Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Germany
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