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Ricci C, Kruger IM, Kruger HS, Breet Y, Moss SJ, van Oort A, Bester P, Pieters M. Determinants of mortality status and population attributable risk fractions of the North West Province, South African site of the international PURE study. Arch Public Health 2024; 82:102. [PMID: 38970128 PMCID: PMC11225367 DOI: 10.1186/s13690-024-01336-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/29/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Mortality data and comparative risk assessments from sub-Saharan Africa are limited. There is an urgent need for high quality population health surveys to be conducted, to improve the national health surveillance system. Our aim was to perform a comparative risk assesment and report on the mortality status and cause of death data of participants from a South African site of the international Prospective Urban Rural Epidemiology study. METHODS 1 921 Black participants were included, with a median observational time of 13 years resulting in 21 525 person-years. We performed a comparative risk assessment considering four health status domains: locality (rural vs. urban), socio-economic status (SES) (education and employment), lifestyle factors (physical activity, smoking and alcohol consumption) and prevalent diseases (human immunodeficiency virus (HIV), type 2 diabetes mellitus and hypertension). Next, population-attributable fractions (PAFs) were calculated to determine the mortality risk attributable to modifiable determinants. RESULTS 577 all-cause deaths occurred. Infectious diseases (28.1% of all deaths) were the most frequent cause of death, followed by cardiovascular disease (CVD) (22.4%), respiratory diseases (11.6%) and cancer (11.1%). The three main contributors to all-cause mortality were HIV infection, high SES and being underweight. HIV infection and underweight were the main contributors to infectious disease mortality and hypertension, the urban environment, and physical inactivity to CVD mortality. HIV had the highest PAF, followed by physical inactivity, alcohol and tobacco use and hypertension (for CVD mortality). CONCLUSION This African population suffers from a quadruple burden of disease. Urban locality, high SES, prevalent disease (HIV and hypertension) and lifestyle factors (physical inactivity, tobacco and alcohol use) all contributed in varying degrees to all-cause and cause-specific mortalities. Our data confirm the public health importance of addressing HIV and hypertension, but also highlights the importance of physical inactivity, tobacco use and alcohol consumption as focal points for public health strategies to produce the most efficient mortality reduction outcomes.
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Affiliation(s)
- Cristian Ricci
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North- West University, Potchefstroom, South Africa
| | - Iolanthe M Kruger
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North- West University, Potchefstroom, South Africa
| | - Herculina S Kruger
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Yolandi Breet
- SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- Centre of Excellence for Hypertension in Africa Research Team, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Sarah J Moss
- Physical activity, Sport and Recreation Research Focus Area, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Abie van Oort
- Physical activity, Sport and Recreation Research Focus Area, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Petra Bester
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North- West University, Potchefstroom, South Africa
| | - Marlien Pieters
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
- SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
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Pérez-Mesa D, Marrero GA, Darias-Curvo S. Child health inequality in Sub-Saharan Africa. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101176. [PMID: 36108522 DOI: 10.1016/j.ehb.2022.101176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
We investigate child height inequality and inequality of predicted height in the Sub-Saharan Africa (SSA) region by socioeconomic, demographic and geographical factors. We characterize their changes in age-cohorts (from 0-1 up to 4-5 years old) and determine the contribution of each factor to these changes. We extract data from the Demographic and Health Surveys (DHS) for 33 SSA countries covering the period from 2009 to 2016. Our measure of health is the standardized height of children below the age of five, adjusted by the age and gender distribution in each country. We show that height inequality is lower for older children than for their younger peers. However, the share of inequality caused by our set of factors rises along the age distribution in more than 80% of countries. We find that family background (reflected by maternal education and the household wealth), followed by home infrastructures related to water, toilet and cooking facilities, and the region of residence contribute to explaining the differences observed in child health inequality along the age distribution in SSA.
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Affiliation(s)
- David Pérez-Mesa
- Economic Department, CEDESOG and IUDR, University of La Laguna, Tenerife, Spain; EQUALITAS.
| | - Gustavo A Marrero
- Economic Department, CEDESOG and IUDR, University of La Laguna, Tenerife, Spain; EQUALITAS.
| | - Sara Darias-Curvo
- WHO European Office for Investment for Health and Development and CEDESOG, University of La Laguna, Tenerife, Spain.
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Cayuela A, Cayuela L, Ortega Belmonte MJ, Rodríguez-Domínguez S, Escudero-Martínez I, González A. Has stroke mortality stopped declining in Spain? Neurologia 2022; 37:550-556. [PMID: 31780318 DOI: 10.1016/j.nrl.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/06/2019] [Accepted: 06/20/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To analyse the changes in stroke mortality trends in Spain by autonomous community and by sex during the period 1980-2016, using joinpoint regression models. METHODS Mortality data were obtained from the Spanish National Statistics Institute. Crude and standardised rates were calculated for each Spanish autonomous community, and for each sex. Joinpoint analysis was used to identify the best-fitting points showing a statistically significant change in the trend. RESULTS Joinpoint analysis enabled us to differentiate between communities in which mortality rates showed a continuous decline throughout the study period in both sexes (Asturias, Cantabria, Castile and Leon, Ceuta, and Melilla) or in men only (Extremadura). In men, in all those communities in which changes in the trend were observed (all but Aragon, the Balearic Islands, and Murcia, where rates remained stable), we observed an initial period of decline (ranging from -3.4% in Catalonia and Extremadura, to -6.0% in Madrid) and a final period where the trends diverged: mortality rates continued to fall in Andalusia, Aragon, the Balearic Islands, and Madrid, but began to stabilise in Castile-La Mancha and Murcia and to increase in the Canary Islands. In women, in those communities where changes were observed (all but Aragon, Murcia, and the Basque Country, where rates remained stable), we observed an initial period of decline (ranging from -3.1% in Catalonia to -6.4% in Navarre) and a final period where divergent trends were observed: rates continued to decline in Andalusia, Aragon, Catalonia, Galicia, Madrid, and the Basque Country, but began to stabilise in Extremadura and Murcia and to increase in the Canary Islands. CONCLUSIONS Current data show that stroke mortality rates have decreased (in women in Andalusia), stabilised (in both sexes in Murcia, in men in Castile-La Mancha, and in women in Extremadura), and have even reversed (in both sexes in the Canary Islands). Further study is needed to identify the causes of these trends.
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Affiliation(s)
- A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España.
| | - L Cayuela
- Departamento de Medicina Interna, Hospital Severo Ochoa, Leganés, Madrid, España
| | - M J Ortega Belmonte
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España
| | | | - I Escudero-Martínez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A González
- Servicio de Neurorradiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, España
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4
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Ekdahl L, Crusensvärd M, Reynisson P, Lönnerfors C, Persson J. Quality of life and long-term clinical outcome following robot-assisted radical trachelectomy. Eur J Obstet Gynecol Reprod Biol 2021; 267:234-240. [PMID: 34837852 DOI: 10.1016/j.ejogrb.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/31/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
Quality of Life and long-term clinical outcome following robot-assisted radical trachelectomy. OBJECTIVES To evaluate quality of life (QoL) and long-term clinical outcome following robot-assisted radical trachelectomy (RRT). STUDY DESIGN Prospectively retrieved clinical data were rereviewed on all women planned for a fertility sparing RRT for early stage cervical cancer at Skåne University Hospital, Sweden between 2007 and 2020. QoL was assessed using the validated questionnaires EORTC QLQ-C30, QLQ-CX24 and the Swedish LYMQOL. RESULTS Data was analyzed from 49 women, 42 with a finalised RRT and seven with an aborted RRT due to nodal metastases (n = 3) or insufficient margins (n = 4). At a median follow-up time of 54 months one recurrence (2%) occurred (aborted RRT). According to QLQ-C30 the median global health status score was 75. The disease specific QLQ-C24 showed an impact on symptoms related to sexual function where sexual/vaginal functioning had a median score of 25 and 48% of patients reported worry that sex would cause physical pain. Despite this the functional items sexual activity and sexual enjoyment both had a median score of 66.7. Lymphoedema was reported in 45%, where 9% reported severe symptom with an impact on their QoL. No intraoperative complications and no postoperative complications ≥ Clavien Dindo grade III were observed. Twenty-two of 28 (79%) women who attempted to conceive were successful. A metronidazole/no intercourse regimen was applied between GW 15 + 0-21 + 6 in 26 of 28 pregnancies beyond first trimester resulting in a 92% term (≥GW 36 + 0) delivery rate. CONCLUSIONS Although robot-assisted radical trachelectomy in this cohort was associated with a low recurrence rate, a high fertility rate and an exceptionally high term delivery rate, women's quality of life was affected postoperatively, particularly with regards to their sexual well-being and lymphatic side-effects.
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Affiliation(s)
- Linnea Ekdahl
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Malin Crusensvärd
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Petur Reynisson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Celine Lönnerfors
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden.
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Cayuela A, Cayuela L, Ortega Belmonte MJ, Rodríguez-Domínguez S, Escudero-Martínez I, González A. Has stroke mortality stopped declining in Spain? NEUROLOGÍA (ENGLISH EDITION) 2021; 37:550-556. [PMID: 34521606 DOI: 10.1016/j.nrleng.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/20/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To analyse the changes in stroke mortality trends in Spain by autonomous community and by sex during the period 1980-2016, using joinpoint regression models. METHODS Mortality data were obtained from the Spanish National Statistics Institute. Crude and standardised rates were calculated for each Spanish autonomous community, and for each sex. Joinpoint analysis was used to identify the best-fitting points showing a statistically significant change in the trend. RESULTS Joinpoint analysis enabled us to differentiate between communities in which mortality rates showed a continuous decline throughout the study period in both sexes (Asturias, Cantabria, Castile and Leon, Ceuta, and Melilla) or in men only (Extremadura). In men, in all those communities in which changes in the trend were observed (all but Aragon, the Balearic Islands, and Murcia, where rates remained stable), we observed an initial period of decline (ranging from -3.4% in Catalonia and Extremadura, to -6.0% in Madrid) and a final period where the trends diverged: mortality rates continued to fall in Andalusia, Aragon, the Balearic Islands, and Madrid, but began to stabilise in Castile-La Mancha and Murcia and to increase in the Canary Islands. In women, in those communities where changes were observed (all but Aragon, Murcia, and the Basque Country, where rates remained stable), we observed an initial period of decline (ranging from -3.1% in Catalonia to -6.4% in Navarre) and a final period where divergent trends were observed: rates continued to decline in Andalusia, Aragon, Catalonia, Galicia, Madrid, and the Basque Country, but began to stabilise in Extremadura and Murcia and to increase in the Canary Islands. CONCLUSIONS Current data show that stroke mortality rates have decreased (in women in Andalusia), stabilised (in both sexes in Murcia, in men in Castile-La Mancha, and in women in Extremadura), and have even reversed (in both sexes in the Canary Islands). Further study is needed to identify the causes of these trends.
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Affiliation(s)
- A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain.
| | - L Cayuela
- Departamento de Medicina Interna, Hospital Severo Ochoa, Leganés, Madrid, Spain
| | - M J Ortega Belmonte
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
| | | | - I Escudero-Martínez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A González
- Servicio de Neurorradiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Wang X, Zeng F, Jin WS, Zhu C, Wang QH, Bu XL, Luo HB, Zou HQ, Pu J, Zhou ZH, Cui XP, Wang QS, Shi XQ, Han W, Wu Q, Chen HS, Lin H, Zhang LL, Zhang M, Lian Y, Xu ZQ, Zhou HD, Zhang T, Wang YJ. Comorbidity burden of patients with Parkinson's disease and Parkinsonism between 2003 and 2012: A multicentre, nationwide, retrospective study in China. Sci Rep 2017; 7:1671. [PMID: 28490759 PMCID: PMC5431825 DOI: 10.1038/s41598-017-01795-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 03/31/2017] [Indexed: 01/19/2023] Open
Abstract
Parkinson’s disease (PD) and Parkinsonism are common neurodegenerative disorders with continuously increasing prevalence, causing high global burdens. However, data concerning the comorbidity burden of patients with PD or Parkinsonism in China are lacking. To investigate the health condition and comorbidity burden, a total of 3367 PD and 823 Parkinsonism patients were included from seven tertiary hospitals in seven cities across China from 2003 to 2012. Their comorbidity burden was collected and quantified by the Elixhauser Comorbidity Index (ECI) and Charlson Comorbidity Index (CCI). The comorbidity spectra differed between PD and Parkinsonism patients. Compared with PD patients, Parkinsonism patients were older (69.8 ± 11.5 vs. 67.9 ± 11.4, P < 0.001); had a higher comorbidity burden, including ECI (1.1 ± 1.2 vs. 1.0 ± 1.2, P < 0.001) and CCI (1.3 ± 1.6 vs. 1.1 ± 1.5, P < 0.001); and had higher hospitalization expenses. The ECI (1.1 ± 1.3 vs. 0.9 ± 1.1, P < 0.001) and CCI (1.3 ± 1.6 vs. 0.9 ± 1.2, P < 0.001) were higher in males than in females. The average length of stay and daily hospitalization expenses increased with age, as did ECI and CCI. This is the first study to report the disease burden of Chinese PD and Parkinsonism patients. It provides useful information to better understand their health status, and to raise the awareness of clinicians for providing better health care.
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Affiliation(s)
- Xin Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Fan Zeng
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Wang-Sheng Jin
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Chi Zhu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Qing-Hua Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Xian-Le Bu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Hong-Bo Luo
- Department of Neurology, Lanzhou General Hospital, Lanzhou, 730050, China
| | - Hai-Qiang Zou
- Department of Neurology, Guangzhou General Hospital, Guangzhou, 510010, China
| | - Jie Pu
- Department of Neurology, Wuhan General Hospital, Wuhan, 430070, China
| | - Zhong-He Zhou
- Department of Neurology, Shenyang General Hospital, Shenyang, 110016, China
| | - Xiao-Ping Cui
- Department of Neurology, Fuzhou General Hospital, Fuzhou, 350025, China
| | - Qing-Song Wang
- Department of Neurology, Chengdu General Hospital, Chengdu, 610083, China
| | - Xiang-Qun Shi
- Department of Neurology, Lanzhou General Hospital, Lanzhou, 730050, China
| | - Wei Han
- Department of Prevention Medicine, Guangzhou General Hospital, Guangzhou, 510010, China
| | - Qiang Wu
- Department of Neurology, Wuhan General Hospital, Wuhan, 430070, China
| | - Hui-Sheng Chen
- Department of Neurology, Shenyang General Hospital, Shenyang, 110016, China
| | - Hang Lin
- Department of Neurology, Fuzhou General Hospital, Fuzhou, 350025, China
| | - Li-Li Zhang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Meng Zhang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Yan Lian
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.,Department of Preventive Medicine, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Zhi-Qiang Xu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Hua-Dong Zhou
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Tao Zhang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.
| | - Yan-Jiang Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
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Arthur KC, Calvo A, Price TR, Geiger JT, Chiò A, Traynor BJ. Projected increase in amyotrophic lateral sclerosis from 2015 to 2040. Nat Commun 2016; 7:12408. [PMID: 27510634 PMCID: PMC4987527 DOI: 10.1038/ncomms12408] [Citation(s) in RCA: 246] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/29/2016] [Indexed: 12/13/2022] Open
Abstract
Although amyotrophic lateral sclerosis (ALS) is relatively rare, the socioeconomic significance of the disease is extensive. It is therefore vital to project the epidemiologic trend of ALS. To date, there have been few published studies attempting to estimate the number and distribution of ALS cases in the upcoming years. Here we show that the number of ALS cases across the globe will increase from 222,801 in 2015 to 376,674 in 2040, representing an increase of 69%. This increase is predominantly due to ageing of the population, particularly among developing nations. This projection is likely an underestimate due to improving healthcare and economic conditions. The results should be used to inform healthcare policy to more efficiently allocate healthcare resources. The socioeconomic burden of amyotrophic lateral sclerosis (ALS) is high, but the projected number of cases in the upcoming years is unclear. Here, the authors estimate the number and distribution of ALS cases to 2040, and show that cases are projected to increase, particularly in developing nations.
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Affiliation(s)
- Karissa C Arthur
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892, USA.,The Commonwealth Medical College, Scranton, Pennsylvania 18509, USA
| | - Andrea Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin 10124, Italy.,Neuroscience Institute of Torino, Turin 10124, Italy
| | - T Ryan Price
- Statistical Genetics Group, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Joshua T Geiger
- Neurodegenerative Diseases Research Unit, Laboratory of Neurogenetics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Adriano Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin 10124, Italy.,Neuroscience Institute of Torino, Turin 10124, Italy
| | - Bryan J Traynor
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892, USA.,Brain Science Institute, Department of Neurology, Johns Hopkins University, Baltimore, Maryland 21205, USA
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8
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Fors A, Gyllensten H, Swedberg K, Ekman I. Effectiveness of person-centred care after acute coronary syndrome in relation to educational level: Subgroup analysis of a two-armed randomised controlled trial. Int J Cardiol 2016; 221:957-62. [PMID: 27441475 DOI: 10.1016/j.ijcard.2016.07.060] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/04/2016] [Indexed: 11/24/2022]
Abstract
AIM The aim of this study was to evaluate the effects of person-centred care (PCC) after acute coronary syndrome (ACS) in relation to educational level of participants. METHOD 199 Patients <75years with ACS were randomised to PCC plus usual care or usual care alone and followed for 6months from hospital to outpatient care and primary care. For the PCC group, patients and health care professionals co-created a PCC health plan reflecting both perspectives, which induced a continued collaboration in person-centred teams at each health care level. A composite score of changes that included general self-efficacy assessment, return to work or previous activity level, re-hospitalisation or death was used as outcome measure. RESULTS In the group of patients without postsecondary education (n=90) the composite score showed a significant improvement in favour of the PCC intervention (n=40) vs. usual care (n=50) at six months (35.0%, n=14 vs. 16.0%, n=8; odds ratio (OR)=2.8, 95% confidence interval (CI): 1.0-7.7, P=0.041). In patients with postsecondary education (n=109), a non-significant difference in favour of the PCC intervention (n=54) vs. usual care (n=55) was observed in the composite score (13.0%, n=7 vs 3.6%, n=2; OR=3.9, 95% CI: 0.8-19.9, P=0.097). CONCLUSION A PCC approach, which stresses the necessity of a patient-health care professional partnership, is beneficial in patients with low education after an ACS event. Because these patients have been identified as a vulnerable group in cardiac rehabilitation, we suggest that PCC can be integrated into conventional cardiac rehabilitation programmes to improve both equity in uptake and health outcomes. TRIAL REGISTRATION Swedish registry, Researchweb.org, ID NR 65 791.
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Affiliation(s)
- Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Närhälsan Research and Development, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. http://www.gpcc.gu.se
| | - Karl Swedberg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; National Heart and Lung Institute, Imperial College, London, United Kingdom. http://www.gpcc.gu.se
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden. http://www.gpcc.gu.se
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Choprapawon C, Porapakkham Y, Sablon O, Panjajaru R, Jhantharatat B. Thailand's National Death Registration Reform: Verifying the Causes of Death between July 1997 and December 1999. Asia Pac J Public Health 2016; 17:110-6. [PMID: 16425655 DOI: 10.1177/101053950501700209] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A fundamental aspect of public health is the accuracy of death certification. Assessing the death registration system is a step toward improving the quality of death reporting. Thailand implemented a more rigorous and informative pilot death registration system in March 2001 in 18 provinces, followed by nationwide implementation in August 2003. Since Thailand is an industrializing nation, its experiences will be of interest to other developing nations planning similar reforms. The causes of all deaths in the 15 provincial pilot projects (of Thailand's 76 provinces) and a random sampling in Bangkok were investigated between July 1997 and December 1999. Health workers interviewed close relatives and three medical doctors reviewed hospital records to verify the causes of death. We were able to interview 78% of the relatives ( i.e. 47,632 in number). Three-quarters (76%) of the deceased had sought prior medical care; 41% died in hospital and 54% at home. The overall agreement between the causes of death in our survey vs. that reported on the death certificate was 29%. The highest agreement was for: III-defined' causes (33%), 'Cancer and Tumors' (17%), 'External Causes' (16%), and 'Infectious Diseases' (10%). Considering the different patterns among age groups and sex, hypertension with stroke, cancer of the liver and bile duct, and HIV infection, were the highest ranking causes among females. Infectious diseases (especially HIV/AIDS), hypertension with stroke and accidents, were the leading causes of deaths among males. External causes were highest among children and young adults. Asia Pac J Public Health 2005; 17(2): 110-116.
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Affiliation(s)
- C Choprapawon
- National Institute for Brain-based Learning, Jasmine International Bldg. Floor 11, Chaengwattana Road, Pakkred, Nontaburi, Thailand.
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Gentry S, L'Estrade Ehrstrom B, Gauthier A, Alvarez J, Wortley D, van Rijswijk J, Car J, Lilienthal A, Tudor Car L, Nikolaou CK, Zary N. Serious Gaming and Gamification interventions for health professional education. Hippokratia 2016. [DOI: 10.1002/14651858.cd012209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sarah Gentry
- Norfolk and Norwich University Hospital; Norwich Norfolk UK NR4 7UY
- University of East Anglia; Norwich Medical School; Norwich Norfolk UK NR4 7TJ
- School of Public Health, Imperial College London; Department of Primary Care and Public Health; Charing Cross Campus Reynolds Building London UK W6 8RP
| | - Beatrice L'Estrade Ehrstrom
- Karolinska Institutet; Department of Learning, Informatics, Management and Ethics (LIME); Solna, Stockholm Sweden
| | - Andrea Gauthier
- Faculty of Medicine, University of Toronto; Institute of Medical Science; Medical Sciences Building, 1 King's College Circle Toronto Ontario Canada
| | - Julian Alvarez
- University of Lille; CIREL Laboratory of the Educational Science Department; Lille France
| | | | | | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological University; Health Services and Outcomes Research Programme; 3 Fusionopolis Link, #03-08 Nexus@one-north Singapore Singapore 138543
- Imperial College London; Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health; Reynolds Building St Dunstans Road London UK W6 8RP
- University of Ljubljana; Department of Family Medicine, Faculty of Medicine; Ljubljana Slovenia
| | - Anneliese Lilienthal
- Karolinska Institutet; Department of Learning, Informatics, Management and Ethics (LIME); Solna, Stockholm Sweden
| | - Lorainne Tudor Car
- School of Public Health, Imperial College London; Department of Primary Care and Public Health; Charing Cross Campus Reynolds Building London UK W6 8RP
| | - Charoula K Nikolaou
- Universite Catholique de Louvain; Centre de philosophie du droit (Cellule Biogov); Faculté de droit et de criminologie Collège Thomas More Place Montesquieu 2, bte L2.07.01, B-1348 Louvain-la-Neuve Belgium
| | - Nabil Zary
- Karolinska Institutet; Department of Learning, Informatics, Management and Ethics (LIME); Solna, Stockholm Sweden
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11
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Sheikh K, Schneider H, Agyepong IA, Lehmann U, Gilson L. Boundary-spanning: reflections on the practices and principles of Global Health. BMJ Glob Health 2016; 1:e000058. [PMID: 28588928 PMCID: PMC5321314 DOI: 10.1136/bmjgh-2016-000058] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 04/30/2016] [Accepted: 05/05/2016] [Indexed: 11/03/2022] Open
Abstract
As Global Health evolves, not merely as a metaphor for international collaboration, but as a distinct field of practice, it warrants greater consideration of how it is practiced, by whom, and for what goals. We believe that, to become more relevant for the health systems and communities that are their intended beneficiaries, Global Health practices must actively span and disrupt boundaries of geography, geopolitics and constituency, some of which are rooted in imbalances of power and resources. In this process, fostering cross-country learning networks and communities of practice, and building local and national institutions with a global outlook in low and middle-income countries, are critically important. Crucially, boundary-spanning practices in Global Health require a mindset of inclusiveness, awareness of and respect for different coexisting realities.
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Affiliation(s)
- Kabir Sheikh
- Public Health Foundation of India, New Delhi, India
| | - Helen Schneider
- University of the Western Cape, Cape Town, South Africa
- SAMRC/UWC Health Services to Systems Research Unit, Cape Town, South Africa
| | - Irene Akua Agyepong
- Greater Accra Regional Health Directorate, Ghana Health Service, Accra, Greater Accra Region, Ghana
| | - Uta Lehmann
- University of the Western Cape, Cape Town, South Africa
| | - Lucy Gilson
- University of Cape Town, Cape Town, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
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Theodoros DG, Hill AJ, Russell TG. Clinical and Quality of Life Outcomes of Speech Treatment for Parkinson's Disease Delivered to the Home Via Telerehabilitation: A Noninferiority Randomized Controlled Trial. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:214-232. [PMID: 27145396 DOI: 10.1044/2015_ajslp-15-0005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 11/30/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE This study investigated the noninferiority and validity of an intensive speech treatment for people with Parkinson's disease (PD) delivered via telerehabilitation to the home. The effect of location on online delivery was also investigated. METHOD In this single-blinded, randomized controlled noninferiority trial, 31 participants with dysarthria associated with PD from a metropolitan area were randomly assigned to either face-to-face or online Lee Silverman Voice Treatment (LSVT LOUD). A cohort of 21 participants from nonmetropolitan areas was also recruited and treated online. Outcomes were assessed using acoustic, perceptual, and quality of life measures. RESULTS Noninferiority of online treatment was confirmed through comparable clinical and quality of life outcomes for the metropolitan online and face-to-face treatment groups. Significant improvements posttreatment were achieved for several acoustic, perceptual, and quality of life measures across the groups. No significant effect of online treatment location was identified. CONCLUSIONS Clinical and quality of life outcomes supported the noninferiority and validity of online delivery of intensive speech treatment to people with PD in the home. Future research should address the implementation of online treatment in a clinical service, cost analyses, and potentially technology-enabled clinical pathways for people with PD in order to maintain optimal communication and quality of life.
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Spirituality as a Determinant of Health for those with Disabilities. AUSTRALIAN JOURNAL OF REHABILITATION COUNSELLING 2015. [DOI: 10.1017/s1323892200000843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Disability is commonly viewed as permanent loss of physical, cognitive and social aspects of self. Rehabilitation interventions are aimed to return the individual to full health by either restoration of past physical, cognitive or social capabilities or strengthening aspects of self to counter such loss. However, rehabilitation interventions do not result in a complete return to past physical, mental or social health. Does this mean that people with disability can never be healthy? Or does it indicate that our perception and definition of health does not reflect the essence of health? We argue that when people with disability redefine themselves in terms other than levels of physical, social and cognitive functioning, good health is an attainable goal. We discuss evidence that suggests why spirituality could be a primary determinant of health.
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Abstract
Heart failure (HF) is an epidemic in healthcare worldwide, including Asia. It appears that HF will become more serious in the near future, with the epidemiological transition and ageing of the population. However, in contrast to Western countries, information on HF epidemiology is still limited in Asia, particularly in South Asia. In this review, we will briefly summarize available information regarding the current and future burden of HF in Asia, which indicates the importance of both primary prevention of underlying diseases of HF and secondary prevention, including management of ischaemic HF, HF with preserved EF, and HF in the elderly.
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Affiliation(s)
- Hiroaki Shimokawa
- Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masanobu Miura
- Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kotaro Nochioka
- Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Yeates K, Lohfeld L, Sleeth J, Morales F, Rajkotia Y, Ogedegbe O. A Global Perspective on Cardiovascular Disease in Vulnerable Populations. Can J Cardiol 2015; 31:1081-93. [PMID: 26321432 DOI: 10.1016/j.cjca.2015.06.035] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/29/2015] [Accepted: 06/29/2015] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular disease (CVD) is a major contributor to the growing public health epidemic in chronic diseases. Much of the disease and disability burden from CVDs are in people younger than the age of 70 years in low- and middle-income countries, formerly "the developing world." The risk of CVD is heavily influenced by environmental conditions and lifestyle variables. In this article we review the scope of the CVD problem in low- and middle-income countries, including economic factors, risk factors, at-risk groups, and explanatory frameworks that hypothesize the multifactorial drivers. Finally, we discuss current and potential interventions to reduce the burden of CVD in vulnerable populations including research needed to evaluate and implement promising solutions for those most at risk.
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Affiliation(s)
- Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Lynne Lohfeld
- McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada
| | - Jessica Sleeth
- Office of Global Health, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Fernando Morales
- ICAP at Columbia University, Mailman School of Public Health, New York, New York
| | | | - Olugbenga Ogedegbe
- Division of Health an Behavior, Center for Healthful Behavior Change, College of Global Public Health, Center for Healthful Behavior Change, New York University, Langone Medical Center, New York, New York
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Awodele O, Osuolale JA. Medication adherence in type 2 diabetes patients: study of patients in Alimosho General Hospital, Igando, Lagos, Nigeria. Afr Health Sci 2015; 15:513-22. [PMID: 26124798 DOI: 10.4314/ahs.v15i2.26] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Poor adherence is an obstacle in therapeutic control of diabetes. Despite the advances in the treatment of diabetes mellitus over the years, diabetes places an immense burden on the individuals living with the condition, their families and the overall health care system. OBJECTIVE Evaluation of the impact of medication adherence on the clinical outcomes of type 2 diabetes patients at Alimosho general hospital, Igando Lagos state. METHOD The medication adherence study was both descriptive (retrospective) and prospective. The retrospective study assessed the prevalence of medication non-adherence leading to poor glycemic control. This involved the review of case notes of one-hundred and fifty two randomly selected patients. Prospective study was done by counselling and educating the patients on medication adherence and assessing their medication adherence and the impact of medication adherence on glycemic control. RESULTS The proportions of females/males with type 2 DM was found to be 69% and 31% respectively. 51.32% of these patients viewed their medications to be unaffordable. 56.6% of the patient population were 61 years and above in age. There was a significant relationship between patient age, gender and adherence to medication. There was however no significant P ≥ 0.05 association between educational level and adherence. Health education and counselling resulted in adherence rate and clinical parameters improvements. CONCLUSION Non-adherence is a major factor that could lead to morbidity and mortality in diabetic patients. The overall improvement in adherence rate of 86.8% was observed with a decline in non- adherence rate after interventions.
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Affiliation(s)
- Olufunsho Awodele
- Department of Pharmacology, Therapeutics & Toxicology, College of Medicine, PMB 12003, Idi Araba, University of Lagos, Lagos-Nigeria
| | - Jemeela A Osuolale
- Department of Pharmacy, Alimosho General Hospital, Igando, Lagos-Nigeria
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Awotidebe TO, Adedoyin RA, Yusuf AO, Mbada CE, Opiyo R, Maseko FC. Comparative functional exercise capacity of patients with type 2-diabetes and healthy controls: a case control study. Pan Afr Med J 2014; 19:257. [PMID: 25852800 PMCID: PMC4382056 DOI: 10.11604/pamj.2014.19.257.4798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 10/21/2014] [Indexed: 11/28/2022] Open
Abstract
Introduction Functional Exercise Capacity (FEC) is a valid measure of physical fitness in health and disease. However, there is paucity of studies on FEC in African patients with Type-2 Diabetes (T2D). This study compared FEC between patients with T2D and healthy controls. Methods Thirty five patients with T2D (18 men, 17 women) and 35 (16 men, 19 women) age-sex matched healthy controls participated in this case-control study. Anthropometric and demographic characteristics and cardiovascular parameters were measured following standard procedures. A glucometer was used to determine the Fasting Blood Glucose (FBG) level following at least 8 hours of overnight fasting. FEC was assessed using the Six-Minute Walk Test (6MWT) while Hand Grip Strength (HGS) test was measured with an electronic dynamometer. Data were analyzed using descriptive and inferential statistics. Alpha level was set at p< 0.05. Results Patients with T2D and controls were similar in age (p > 0.05). There were significant differences in the distance covered during 6MWT between patients and controls (t= 0.329; p =0.03), exercise capacity (t = 0.329; p = 0.03), FBG (t = 7.403; p = 0.001), systolic and diastolic blood pressure (t = 12.56; p = 0.001 and t = 27.23; p = 0.001) respectively. There were significant inverse relationships between 6MWD and Body mass index (r = -0.39; p = 0.02) and FBS(r = -0.51; p = 0.02) in patients with type-2 respectively. No significant association was found between exercise capacity and HGS (p > 0.05). Conclusion Patients with type-2 diabetes demonstrated lower functional exercise capacity than healthy controls. High body mass index and fasting blood glucose were significantly associated with lower functional exercise capacity.
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Affiliation(s)
- Taofeek Oluwole Awotidebe
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile - Ife, Nigeria
| | - Rufus Adesoji Adedoyin
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile - Ife, Nigeria
| | - Abraar Olalakan Yusuf
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile - Ife, Nigeria
| | - Chidozie Emmanuel Mbada
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile - Ife, Nigeria
| | - Rose Opiyo
- Department of Nutrition, School of Public Health, University of Nairobi, Nairobi, Kenya
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Bhargava S, Srivastava L. Hyperhomocysteinemia and its clinical implications – A short review. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.cmrp.2014.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang Y, Wang Y, Qain Y, Zhang J, Tang X, Sun J, Zhu D. Association of body mass index with cause specific deaths in Chinese elderly hypertensive patients: Minhang community study. PLoS One 2013; 8:e71223. [PMID: 23967168 PMCID: PMC3742783 DOI: 10.1371/journal.pone.0071223] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 06/27/2013] [Indexed: 11/19/2022] Open
Abstract
Background Most studies have suggested that elevated body mass index (BMI) was associated with the risk of death from all cause and from specific causes. However, there was little evidence illustrating the effect of BMI on the mortality in elderly hypertensive patients in Chinese population. Methods The information of 10,957 hypertensive patients at baseline not less than 60 years were from Xinzhuang, a town in Minhang district of Shanghai, was extracted from the Electronic Health Record (EHR) system. All study participants were divided into eight categories of baseline BMI (with cut-points at 18, 20, 22, 24, 26, 28 and 30 kg/m2). Relative hazard ratio of death from all cause, cardiovascular and non-cardiovascular cause by baseline BMI groups were calculated, standardized for sex, age, smoking, drinking, physical activity, systolic blood pressure, history of cardiovascular disorders, serum lipid disturbance, diabetes mellitus and antihypertensive drug treatment. Results During follow up (median: 3.7 years), 561 deaths occurred. Underweight (BMI<18 kg/m2) was associated with significantly increased mortality from all cause mortality (OR: 2.00; 95% CI: 1.43–2.79) and non cardiovascular mortality (OR: 2.76; 95% CI: 1.87–4.07), but not with cardiovascular mortality. For the cause specific analysis, the underweight was associated significantly with neoplasms (OR: 2.15; 95% CI: 1.16–4.00) and respiratory disorders (OR: 3.41; 95% CI: 1.64–7.06). The results for total mortality and specific cause mortality were not influenced by sex, age and smoking status. Conclusion Our study revealed an association between underweight and increased mortality from non-cardiovascular disorders in elderly hypertensive patients in Chinese community. Overweight and obesity were not associated with all cause or cause specific death.
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Affiliation(s)
- Yan Wang
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yajuan Wang
- Xinzhuang Community Health Service Center, Shanghai, China
| | - Yuesheng Qain
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jin Zhang
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaofeng Tang
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Junlei Sun
- Xinzhuang Community Health Service Center, Shanghai, China
- * E-mail: (DZ); (JS)
| | - Dingliang Zhu
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China
- * E-mail: (DZ); (JS)
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Prabhakaran D, Jeemon P, Reddy KS. Commentary: Poverty and cardiovascular disease in India: do we need more evidence for action? Int J Epidemiol 2013; 42:1431-5. [PMID: 23920139 DOI: 10.1093/ije/dyt119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India, Centre of Excellence in Cardio-metabolic Risk Reduction in South Asia, Public Health Foundation of India, New Delhi, India and Public Health Foundation of India, New Delhi, India
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Li X, Chen Y, Liu J, Yang G, Zhao J, Liao G, Shi M, Yuan Y, He S, Lu Y, Cheng J. Serum metabolic variables associated with impaired glucose tolerance induced by high-fat-high-cholesterol diet in Macaca mulatta. Exp Biol Med (Maywood) 2013; 237:1310-21. [PMID: 23239442 DOI: 10.1258/ebm.2012.012157] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Dyslipidemia caused by 'Western-diet pattern' is a strong risk factor for the onset of diabetes. This study aimed to disclose the relationship between the serum metabolite changes induced by habitual intake of high-fat and high-cholesterol (HFHC) diet and the development of impaired glucose tolerance (IGT) and insulin resistance through animal models of Macaca mulatta. Sixteen M. mulatta (six months old) were fed a control diet or a HFHC diet for 18 months. The diet effect on serum metabolic profiles was investigated by longitudinal research. Islet function was assessed by intravenous glucose tolerance and hyperinsulinemic-euglycemic clamp test. Metabonomics were determined by (1)H proton nuclear magnetic resonance spectroscopy. Prolonged diet-dependent hyperlipidemia facilitated visceral fat accumulation in liver and skeletal muscle and disorder of glucose homeostasis in juvenile monkeys. Glucose disappearance rate (K(Glu)) and insulin response to the glucose challenge effects in HFHC monkeys were significantly lower than in control monkeys. Otherwise, serum trimethylamine-N-oxide (TMAO), lactate and leucine/isoleucine were significantly higher in HFHC monkeys. Sphingomyelin and choline were the most positively correlated with K(Glu) (R(2) = 0.778), as well as negative correlation (R(2) = 0.64) with total cholesterol. The HFHC diet induced visceral fat, abnormal lipid metabolism and IGT prior to weight gain and body fat content increase in juvenile monkeys. We suggest that increased serum metabolites, such as TMAO, lactate, branched-chain amino acids and decreased sphingomyelin and choline, may serve as possible predictors for the evaluation of IGT and insulin resistance risks in the prediabetic state.
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Affiliation(s)
- Xinli Li
- Key Laboratory of Transplant Engineering and Immunology, Ministry of Health, Regenerative Medicine Research Center, Sichuan, PR China
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Blair JEA, Huffman M, Shah SJ. Heart failure in North America. Curr Cardiol Rev 2013; 9:128-46. [PMID: 23597296 PMCID: PMC3682397 DOI: 10.2174/1573403x11309020006] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 11/13/2012] [Accepted: 12/03/2012] [Indexed: 01/08/2023] Open
Abstract
Heart failure is a major health problem that affects patients and healthcare systems worldwide. Within the continent of North America, differences in economic development, genetic susceptibility, cultural practices, and trends in risk factors and treatment all contribute to both inter-continental and within-continent differences in heart failure. The United States and Canada represent industrialized countries with similar culture, geography, and advanced economies and infrastructure. During the epidemiologic transition from rural to industrial in countries such as the United States and Canada, nutritional deficiencies and infectious diseases made way for degenerative diseases such as cardiovascular diseases, cancer, overweight/obesity, and diabetes. This in turn has resulted in an increase in heart failure incidence in these countries, especially as overall life expectancy increases. Mexico, on the other hand, has a less developed economy and infrastructure, and has a wide distribution in the level of urbanization as it becomes more industrialized. Mexico is under a period of epidemiologic transition and the etiology and incidence of heart failure is rapidly changing. Ethnic differences within the populations of the United States and Canada highlight the changing demographics of each country as well as potential disparities in heart failure care. Heart failure with preserved ejection fraction makes up approximately half of all hospital admissions throughout North America; however, important differences in demographics and etiology exist between countries. Similarly, acute heart failure etiology, severity, and management differ between countries in North America. The overall economic burden of heart failure continues to be large and growing worldwide, with each country managing this burden differently. Understanding the inter-and within-continental differences may help improve understanding of the heart failure epidemic, and may aid healthcare systems in delivering better heart failure prevention and treatment.
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Affiliation(s)
- John E A Blair
- San Antonio Military Medical Center, San Antonio, TX, USA.
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Sartorius B. Modelling determinants, impact, and space-time risk of age-specific mortality in rural South Africa: integrating methods to enhance policy relevance. Glob Health Action 2013; 6:19239. [PMID: 23364094 PMCID: PMC3556703 DOI: 10.3402/gha.v6i0.19239] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 10/19/2012] [Accepted: 10/20/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There is a lack of reliable data in developing countries to inform policy and optimise resource allocation. Health and socio-demographic surveillance sites (HDSS) have the potential to address this gap. Mortality levels and trends have previously been documented in rural South Africa. However, complex space-time clustering of mortality, determinants, and their impact has not been fully examined. OBJECTIVES To integrate advanced methods enhance the understanding of the dynamics of mortality in space-time, to identify mortality risk factors and population attributable impact, to relate disparities in risk factor distributions to spatial mortality risk, and thus, to improve policy planning and resource allocation. METHODS Agincourt HDSS supplied data for the period 1992-2008. Advanced spatial techniques were used to identify significant age-specific mortality 'hotspots' in space-time. Multivariable Bayesian models were used to assess the effects of the most significant covariates on mortality. Disparities in risk factor profiles in identified hotspots were assessed. RESULTS Increasing HIV-related mortality and a subsequent decrease possibly attributable to antiretroviral therapy introduction are evident in this rural population. Distinct space-time clustering and variation (even in a small geographic area) of mortality were observed. Several known and novel risk factors were identified, and population impact was quantified. Significant differences in the risk factor profiles of the identified 'hotspots' included ethnicity; maternal, partner, and household deaths; household head demographics; migrancy; education; and poverty. CONCLUSIONS A complex interaction of highly attributable multilevel factors continues to demonstrate differential space-time influences on mortality risk (especially for HIV). High-risk households and villages displayed differential risk factor profiles. This integrated approach could prove valuable to decision makers. Tailored interventions for specific child and adult high-risk mortality areas are needed, such as preventing vertical transmission, ensuring maternal survival, and improving water and sanitation infrastructure. This framework can be applied in other settings within the region.
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Affiliation(s)
- Benn Sartorius
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Misganaw A, Mariam DH, Araya T, Ayele K. Patterns of mortality in public and private hospitals of Addis Ababa, Ethiopia. BMC Public Health 2012; 12:1007. [PMID: 23167315 PMCID: PMC3520706 DOI: 10.1186/1471-2458-12-1007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 11/14/2012] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Ethiopia is encountering a growing burden of non-communicable diseases along with infectious diseases, perinatal and nutritional problems that have long been considered major problems of public health importance. This retrospective analysis was carried out to examine the mortality patterns from communicable diseases and non communicable diseases in public and private hospitals of Addis Ababa. METHODS Approximately 47,153 deaths were captured over eight years (2002-2010) in forty three public and private hospitals of Addis Ababa, Ethiopia. Data collectors (43 hospital clerks) and coordinators (3 nurses) had been extensively trained on how to review hospital death records. Information obtained included: dates of admission and death, age, sex, address, and principal cause of death. Only the diseases responsible for deaths are taken as the cause of death. Cause of death was coded using International Classification of Diseases (ICD-10) and data were double entered. Diseases were classified into: Group I (communicable diseases, maternal conditions and nutritional deficiencies); Group II (non-communicable causes); and Group III (injuries). Percentages, proportional mortality ratios, 95% confidence intervals (CI) and Adjusted odd ratios (OR) were calculated. RESULTS Overall, 59% of the deaths were attributed to Group I diseases, and 31% to Group II diseases and 12% to injuries. Nearly 56% of the males and 68% of the females deaths were due to five leading causes (conditions arising during perinatal period, HIV/AIDS, tuberculosis, cardiovascular diseases and respiratory infections). Significantly larger proportions of females died from Group I (67%) and Group II diseases (32%) compared with males (where the respective proportions were 52% and 30%). Significantly higher proportion of males (17%) than females (6%) were dying from Group III diseases. Deaths due to Group I diseases decreased while those due to Group II diseases increased with age. Overall Group I diseases and HIV/AIDS, tuberculosis and still birth mortality in particular have showed decreasing trend while Group II and III increasing over time. Double burden in mortality was highly observed in the age groups of 15-64 years. Those aged >45 years were dying more likely with non-communicable diseases compared with children. Children aged below 15 years were 16 times more likely to die from communicable, perinatal and nutritional conditions compared with elders. Mortality variation with age has been identified between public and private hospitals. CONCLUSIONS The results of the present study shows that, in addition to the common Group I causes of death, emerging group II diseases are contributing to high proportions of mortality in the public and private hospitals of Addis Ababa, Ethiopia. Thus, priority should be given to the prevention and management of conditions arising during perinatal period such as low birth weight and still birth, HIV/AIDS; tuberculosis, respiratory infections, cardiovascular diseases, malignant neoplasm, chronic respiratory diseases and road traffic accident. The planning of health resources and activities should take into account the double burden in mortality due to Group I and Group II diseases. This calls for strengthening approaches towards the control and prevention of non-communicable diseases such as cardiovascular and malignant neoplasm.
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Affiliation(s)
- Awoke Misganaw
- Addis Ababa Mortality Surveillance Program, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Damen Haile Mariam
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tekebash Araya
- Addis Ababa Mortality Surveillance Program, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kidane Ayele
- Addis Ababa Mortality Surveillance Program, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Fu C, Chen Y, Wang F, Wang X, Song J, Jiang Q. High prevalence of hyperglycaemia and the impact of high household income in transforming rural China. BMC Public Health 2011; 11:862. [PMID: 22078718 PMCID: PMC3256241 DOI: 10.1186/1471-2458-11-862] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 11/12/2011] [Indexed: 11/21/2022] Open
Abstract
Background The prevalence of hyperglycaemia and its association with socioeconomic factors have been well studied in developed countries, however, little is known about them in transforming rural China. Methods A cross-sectional study was carried out in 4 rural communities of Deqing County located in East China in 2006-07, including 4,506 subjects aged 18 to 64 years. Fasting plasma glucose (FPG) was measured. Subjects were considered to have impaired fasting glucose (IFG) if FPG was in the range from 5.6 to 6.9 mmol/L and to have diabetes mellitus (DM) if FG was 7.0 mmol/L or above. Results The crude prevalences of IFG and DM were 5.4% and 2.2%, respectively. The average ratio of IFG/DM was 2.5, and tended to be higher for those under the age of 35 years than older subjects. After adjustment for covariates including age (continuous), sex, BMI (continuous), smoking, alcohol drinking, and regular leisure physical activity, subjects in the high household income group had a significantly higher risk of IFG compared with the medium household income group (OR: 1.74, 95% CI: 1.11-2.72) and no significant difference in IFG was observed between the low and medium household income groups. Education and farmer occupation were not significantly associated with IFG. Conclusions High household income was significantly associated with an increased risk of IFG. A high ratio of IFG/DM suggests a high risk of diabetes in foreseeable future in the Chinese transforming rural communities.
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Affiliation(s)
- Chaowei Fu
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China
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Browne JL, Grobbee DE. Cardiovascular prevention and international health: time for action. ACTA ACUST UNITED AC 2011; 18:547-9. [DOI: 10.1177/1741826711414116] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joyce L Browne
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Friel S, Marmot MG. Action on the social determinants of health and health inequities goes global. Annu Rev Public Health 2011; 32:225-36. [PMID: 21219162 DOI: 10.1146/annurev-publhealth-031210-101220] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Marked health inequities exist between regions, between countries, and within countries. Reducing these inequities in health requires attention to the unfair distribution of power, money, and resources and the conditions of everyday life. These are the social determinants of health. The World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) brought together a global evidence base of what could be done to reduce these health inequities, demonstrating that economic and social policy, if done well, can improve health and health equity. A global movement for health equity was reignited by the WHO Commission on Social Determinants of Health when it made a call to action upon delivering its final report.
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Affiliation(s)
- Sharon Friel
- International Institute for Society and Health, Department of Epidemiology and Public Health, University College London, United Kingdom.
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Sadeghi-Bazargani H, Jafarzadeh H, Fallah M, Hekmat S, Bashiri J, Hosseingolizadeh GH, Soltanmohammadzadeh MS, Mortezazadeh A, Shaker A, Danehzan M, Zohouri A, Khosravi O, Nasimidoust R, Malekpour N, Kharazmi E, Babaei M, Nadirmohammadi M, Mashhadi-Abdollahi H. Risk factor investigation for cardiovascular health through WHO STEPS approach in Ardabil, Iran. Vasc Health Risk Manag 2011; 7:417-24. [PMID: 21796256 PMCID: PMC3141914 DOI: 10.2147/vhrm.s22727] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Indexed: 12/21/2022] Open
Abstract
Objectives: Reliable evidence is the keystone for any noncommunicable disease (NCD) prevention plan to be initiated. In this study we carried out a risk factor investigation based on the WHO Stepwise approach to Surveillance (STEPS). Methods: The study was conducted on 1000 adults between 15 and 64 years of age living in Ardabil province, north-west Iran during 2006, based on the WHO STEPS approach to surveillance of risk factors for NCD. At this stage only the first and second steps were carried out. Data were collected through standard questionnaires and methods analyzed using STATA version 8 statistical software package. Results: 29.0% of men and 2.6% of women were current daily tobacco smokers. The mean number of manufactured cigarettes smoked per day was 18.9 among current daily smokers. Smoking was most prevalent among men of low-income families and those of lower education. The mean body mass index (BMI) was 26.6 kg/m2, and was significantly correlated with systolic blood pressure. 58.9% were overweight or obese; 18.0% had raised blood pressure and 3.7% had isolated systolic hypertension. The mean number of servings of fruit consumed per day was 1.1; 33.1% had low levels of activity. Combined risk factor analysis showed that 4.1% of participants were in the low-risk group (up to 5.1% among men and 3.2% among women). Those in the high-risk group comprised 25.6% in the 25- to 44-year age group and 49.7% in the 45- to 64-year age group. Mean BMI increased by age in both sexes at least at the first three decades of adult life. Conclusion: Based on observed status of risk for cardiovascular health, burden of cardiovascular diseases is expected to increase if an effective prevention strategy is not undertaken.
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Affiliation(s)
- H Sadeghi-Bazargani
- Neuroscience Research Center, Faculty of Health and Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
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Reniers G, Masquelier B, Gerland P. Adult Mortality in Africa. INTERNATIONAL HANDBOOK OF ADULT MORTALITY 2011. [DOI: 10.1007/978-90-481-9996-9_7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Fujiura GT, Rutkowski-Kmitta V, Owen R. Make measurable what is not so: national monitoring of the status of persons with intellectual disability. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2010; 35:244-258. [PMID: 21117882 DOI: 10.3109/13668250.2010.519330] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Statistics are critical in holding governments accountable for the well-being of citizens with disability. International initiatives are underway to improve the quality of disability statistics, but meaningful ID data is exceptionally rare. METHOD The status of ID data was evaluated in a review of 12 national statistical systems. Recurring data collection by national ministries was identified and the availability of measures of poverty, exclusion, and disadvantage was assessed. RESULTS A total of 131 recurring systems coordinated by 50 different ministries were identified. The majority included general disability but less than 25% of the systems screened ID. Of these, few provided policy-relevant data. CONCLUSIONS The scope of ID data was dismal at best, though a significant statistical infrastructure exists for the integration of ID data. Advocacy will be necessary. There is no optimal form of data monitoring, and decisions regarding priorities in purpose, targeted audiences, and the goals for surveillance must be resolved.
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Affiliation(s)
- Glenn T Fujiura
- Institute on Disability and Human Development, Department on Disability and Human Development (M/C 626), University of Illinois at Chicago, 1640 W. Roosevelt Road, Chicago, IL 60608, USA.
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Olsen OE. The impact of global health initiatives on trust in health care provision under extreme resource scarcity: presenting an agenda for debate from a case study of emergency obstetric care in Northern Tanzania. Health Res Policy Syst 2010; 8:14. [PMID: 20500857 PMCID: PMC2891741 DOI: 10.1186/1478-4505-8-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 05/25/2010] [Indexed: 11/29/2022] Open
Abstract
Background Through the nearly three decades that have passed since the Alma Ata conference on Primary Health Care, a wide range of global health initiatives and ideas have been advocated to improve the health of people living in developing countries. The issues raised in the Primary Health Care concept, the Structural Adjustment Programmes and the Health Sector Reforms have all influenced health service delivery. Increasingly however, health systems in developing countries are being described as having collapsed Do the advocated frameworks contribute to this collapse through not adequately including population trust as a determinant of the revival of health services, or are they primarily designed to satisfy the values of other actors within the health care system? This article argues there is an urgent need to challenge common thinking on health care provision under extreme resource scarcity. Methods This article sets out to discuss and analyze the described collapse of health services through a brief case study on provision of Emergency Obstetric Care in Northern Tanzania. Results The article argues that post the Alma Ata conference on Primary Health Care developments in global health initiatives have not been successful in incorporating population trust into the frameworks, instead focusing narrowly on expert-driven solutions through concepts such as prevention and interventions. The need for quantifiable results has pushed international policy makers and donors towards vertical programmes, intervention approaches, preventive services and quantity as the coverage parameter. Health systems have consequently been pushed away from generalized horizontal care, curative services and quality assurance, all important determinants of trust. Conclusions Trust can be restored, and to further this objective a new framework is proposed placing generalized services and individual curative care in the centre of the health sector policy domain. Preventive services are important, but should increasingly be handled by other sectors in a service focused health care system. To facilitate such a shift in focus we should acknowledge that limited resources are available and accept the conflict between population demand and expert opinion, with the aim of providing legitimate, accountable and trustworthy services through fair, deliberative, dynamic and incremental processes. A discussion of the acceptable level of quality, given the available resources, can then be conducted. The article presents for debate that an increased focus on quality and accountability to secure trust is an important precondition for enabling the political commitment to mobilize necessary resources to the health sector.
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Affiliation(s)
- Oystein E Olsen
- Center for International Health, P,O, Box 7024, N-5020, University of Bergen, Norway.
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Teo K, Chow CK, Vaz M, Rangarajan S, Yusuf S. The Prospective Urban Rural Epidemiology (PURE) study: examining the impact of societal influences on chronic noncommunicable diseases in low-, middle-, and high-income countries. Am Heart J 2009; 158:1-7.e1. [PMID: 19540385 DOI: 10.1016/j.ahj.2009.04.019] [Citation(s) in RCA: 383] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 04/21/2009] [Indexed: 12/29/2022]
Abstract
BACKGROUND Marked changes in the prevalence of noncommunicable diseases such as obesity, diabetes, and cardiovascular disease have occurred in developed and developing countries in recent decades. The overarching aim of the study is to examine the relationship of societal influences on human lifestyle behaviors, cardiovascular risk factors, and incidence of chronic noncommunicable diseases. METHODS The Prospective Urban Rural Epidemiology (PURE) study is a large-scale epidemiological study that plans to recruit approximately 140,000 individuals residing in >600 communities in 17 low-, middle-, and high-income countries around the world. Individual data collection includes medical history, lifestyle behaviors (physical activity and dietary profile), blood collection and storage for biochemistry and future genetic analysis, electrocardiogram, and anthropometric measures. In addition, detailed information is being collected with respect to 4 environmental domains of interest-the built environment, nutrition and associated food policy, psychosocial/socioeconomic factors, and tobacco environment. A minimum follow-up of 10 years is currently planned. RESULTS This report describes the design, justification, and methodology of the PURE study. The PURE study has been recruiting since 2002 and has enrolled 139,506 individuals by March 31, 2009. CONCLUSIONS The PURE study builds on the work and experience gained through conduct of the INTERHEART study. Its design and extensive data collection are geared toward addressing major questions on causation and development of the underlying determinants of cardiovascular disease in populations at varying stages of epidemiologic transition.
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Rubinstein A, Alcocer L, Chagas A. High blood pressure in Latin America: a call to action. Ther Adv Cardiovasc Dis 2009; 3:259-85. [PMID: 19561117 DOI: 10.1177/1753944709338084] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
High blood pressure (BP) is an enormous global problem, and is especially challenging for low- and middle-income countries such as those of Latin America. Although developed countries have benefited from significant reductions in cardiovascular and cerebrovascular disease in recent decades, comparable reductions have not been achieved in Latin America. In fact, the prevalence of high BP is increasing in many Latin American countries, and the situation will worsen without definitive efforts to correct it. The growing preponderance of hypertension and chronic diseases, coupled with expected increases in population growth, present a mounting threat to Latin American economies. This report provides a comprehensive overview of the burden of high BP throughout Latin America, and presents recommendations for change. The dismal observations warrant a call to action for improved control of high BP and other cardiovascular risk factors across Latin America. Achieving these ambitious goals will require collaborative efforts by many groups, including policymakers, international organizations, healthcare providers, schools and society as a whole.
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Primordial prevention, developing countries and the epidemiological transition: thirty years later. Wien Klin Wochenschr 2009; 121:168-72. [PMID: 19412745 DOI: 10.1007/s00508-008-1110-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cambios recientes en la mortalidad por cáncer de próstata en España: estudio de tendencias en el período 1991-2005. Actas Urol Esp 2008; 32:184-9. [DOI: 10.1016/s0210-4806(08)73811-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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London L. 'Issues of equity are also issues of rights': lessons from experiences in Southern Africa. BMC Public Health 2007; 7:14. [PMID: 17257421 PMCID: PMC1797007 DOI: 10.1186/1471-2458-7-14] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 01/26/2007] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Human rights approaches to health have been criticized as antithetical to equity, principally because they are seen to prioritise rights of individuals at the expense of the interests of groups, a core tenet of public health. The objective of this study was to identify how human rights approaches can promote health equity. METHODS The Network on Equity in Health in Southern Africa undertook an exploration of three regional case studies - antiretroviral access, patient rights charters and civic organization for health. A combination of archival reviews and stakeholder interviews were complemented with a literature review to provide a theoretical framework for the empirical evidence. RESULTS Critical success factors for equity are the importance of rights approaches addressing the full spectrum from civil and political, through to socio-economic rights, as well as the need to locate rights in a group context. Human rights approaches succeed in achieving health equity when coupled with community engagement in ways that reinforce community capacity, particularly when strengthening the collective agency of its most vulnerable groups. Additionally, human rights approaches provide opportunities for mobilising resources outside the health sector, and must aim to address the public-private divide at local, national and international levels. CONCLUSION Where it is clear that rights approaches are predicated upon understanding the need to prioritize vulnerable groups and where the way rights are operationalised recognizes the role of agency on the part of those most affected in realising their socio-economic rights, human rights approaches appear to offer powerful tools to support social justice and health equity.
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Affiliation(s)
- Leslie London
- Health and Human Rights Division, School of Public Health and Family Medicine, University of Cape Town Health Sciences Faculty, Anzio Rd, Observatory, 7925, South Africa.
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He J, Gu D, Wu X, Reynolds K, Duan X, Yao C, Wang J, Chen CS, Chen J, Wildman RP, Klag MJ, Whelton PK. Major causes of death among men and women in China. N Engl J Med 2005; 353:1124-34. [PMID: 16162883 DOI: 10.1056/nejmsa050467] [Citation(s) in RCA: 901] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND With China's rapid economic development, the disease burden may have changed in the country. We studied the major causes of death and modifiable risk factors in a nationally representative cohort of 169,871 men and women 40 years of age and older in China. METHODS Baseline data on the participants' demographic characteristics, medical history, lifestyle-related risk factors, blood pressure, and body weight were obtained in 1991 with the use of a standard protocol. The follow-up evaluation was conducted in 1999 and 2000, with a follow-up rate of 93.4 percent. RESULTS We documented 20,033 deaths in 1,239,191 person-years of follow-up. The mortality from all causes was 1480.1 per 100,000 person-years among men and 1190.2 per 100,000 person-years among women. The five leading causes of death were malignant neoplasms (mortality, 374.1 per 100,000 person-years), diseases of the heart (319.1), cerebrovascular disease (310.5), accidents (54.0), and infectious diseases (50.5) among men and diseases of the heart (268.5), cerebrovascular disease (242.3), malignant neoplasms (214.1), pneumonia and influenza (45.9), and infectious diseases (35.3) among women. The multivariate-adjusted relative risk of death and the population attributable risk for preventable risk factors were as follows: hypertension, 1.48 (95 percent confidence interval, 1.44 to 1.53) and 11.7 percent, respectively; cigarette smoking, 1.23 (95 percent confidence interval, 1.18 to 1.27) and 7.9 percent; physical inactivity, 1.20 (95 percent confidence interval, 1.16 to 1.24) and 6.8 percent; and underweight (body-mass index [the weight in kilograms divided by the square of the height in meters] below 18.5), 1.47 (95 percent confidence interval, 1.42 to 1.53) and 5.2 percent. CONCLUSIONS Vascular disease and cancer have become the leading causes of death among Chinese adults. Our findings suggest that control of hypertension, smoking cessation, increased physical activity, and improved nutrition should be important strategies for reducing the burden of premature death among adults in China.
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Affiliation(s)
- Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
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Abstract
As the global culture moves forward into the 21st century with increasing interaction of populations through direct contact and electronic interchange, those citizens of our planet who have not benefited from the material gains that have been realized in the "mature economy" countries will increasingly seek equity on all levels, beginning with the most fundamental aspect of health care. There is a need to develop a capacity for treatment of urgent and emergent health conditions globally, a need that will only increase with advancing global economic development.
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Affiliation(s)
- L Kristian Arnold
- Occupational Health Service, Boston Police Department, One City Hall Plaza, Boston, MA 02201, USA.
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Abstract
In many ways, preparation for medical service outside the United States is not greatly different from preparation for a self-guided vacation tour of another country. The major differences are in the rigor that one should apply to being sure all details are set, particularly if one is planning to go to a site away from a capital city. Additionally, the mental preparation is required in terms of the understanding of global health issues in a holistic sense and the personal mental preparation for working under what may be austere conditions. With solid preparation, anyone interested in IH experiences should be able to have a rewarding, trouble-free experience.
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Affiliation(s)
- Suzanne Sarfaty
- Department of Medicine, Boston University School of Medicine, Office of Student Affairs, 715 Albany Street, L-109 Boston, MA 02118, USA.
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Abstract
STUDY OBJECTIVE To describe inequalities in all cause premature mortality between and within regions of Great Britain and how these inequalities have changed between 1979 and 1998. DESIGN Retrospective study using routine population and death data aggregated into five year age and sex groups for each of 20 years. SETTING All 459 local authority districts (England and Wales) and local government districts (Scotland). PARTICIPANTS Estimated population and registered deaths aged 0-64. MAIN OUTCOME MEASURES Indirectly standardised mortality ratios for all cause mortality; percentages of deaths that would be avoided if there were no inequalities between and within regions. RESULTS The decrease in premature mortality of 36% seen in Great Britain ranged from 42% in Wales to 33% in Scotland and 31% in London. Differences between regions led to excess mortality of about 25% in Scotland, the North East, and the North West. In London excess mortality increased from 14% to 19%. Inequalities within regions increased in most parts of Great Britain, the exceptions being Wales, London, and the South West. The largest increase was seen in Scotland where the percentage of excess deaths increased from 23% to 33%. CONCLUSIONS A decrease in premature mortality in Great Britain was seen in all regions, although less pronounced in London, but the gap between regions remained. Inequalities between districts within regions vary from one region to another and have increased in nearly every part of Great Britain.
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Affiliation(s)
- A H Leyland
- Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
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Murata C, Watanabe T, Furuya H, Sugioka Y, Mikurube H, Yokoyama A, Atsumi Y, Matsuoka K, Okazaki I. Aldehyde dehydrogenase 2 and beta3-adrenergic receptor gene polymorphisms: their association with elevated liver enzymes and metabolic syndrome. Metabolism 2003; 52:1096-101. [PMID: 14506613 DOI: 10.1016/s0026-0495(03)00183-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Recent studies indicate that some patients with nonalcoholic fatty liver have ongoing liver injury that may progress from steatosis to steatohepatitis or fibrosis. The present study was designed to clarify the clinical features of liver dysfunction observed in the course of workplace physical check-ups in relation to multiple risk factor syndrome including obesity, hyperlipidemia, hypertension, and impaired glucose tolerance, and to clarify the involvement of aldehyde dehydrogenase 2 (ALDH2) and beta(3)-adrenergic receptor (beta3-AR) gene polymorphisms in elevation of liver enzymes. One hundred forty-eight male workers 35 years of age were enrolled. They were requested to answer questionnaires about drinking and smoking habits, and underwent urinalysis, physical and peripheral blood examinations, blood chemistry, electrocardiogram and chest x-rays. The genotypes of ALDH2 and beta3-AR were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The subjects were divided into active ALDH2 or inactive ALDH2 groups. They were also divided into 2 groups according to the beta3-AR genotype. The relationships between ALDH2 and beta3-AR gene polymorphism and the results of the physical examination including liver function tests were analyzed. The subjects were also divided according to the number of components of metabolic syndrome. The prevalence of elevated alanine aminotransferase (ALT) level increased with the accumulation of components of metabolic syndrome. Active ALDH2 was associated with elevated ALT level to a greater degree than beta3-AR polymorphism. Among those with normal body mass index (BMI), the genotypes of ALDH2 and beta3-AR were strongly associated with elevated ALT level. Logistic regression analysis revealed that BMI, triglyceride level, and ALDH2 genotype were associated with ALT elevation. In conclusion, evaluating the genotype of ALDH2 and beta3-AR may assist in predicting and preventing the development of fatty liver which may be related to multiple risk factor syndrome.
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Affiliation(s)
- Chisato Murata
- Department of Community Health, Tokai University School of Medicine, Kanagawa, Japan
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Folch E, Hernandez I, Barragan M, Franco-Paredes C. Infectious diseases, non-zero-sum thinking, and the developing world. Am J Med Sci 2003; 326:66-72. [PMID: 12920437 DOI: 10.1097/00000441-200308000-00003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite some improvements in the health status of the world during the last few decades, major obstacles remain. Improvements in health outcomes have not been shared equally among countries and poverty is clearly the main reason. Infectious diseases, which remain the major cause of death worldwide, are an incalculable source of human misery and economic loss. In fact, 25% of all deaths and 30% of the global burden of disease are attributed to infectious diseases. Unfortunately, more than 95% of these deaths, most of which are preventable, occur in the developing world, where poverty is widespread. The 3 major infectious disease killers in these countries are HIV/AIDS, tuberculosis, and malaria. The principles of social justice and health as a human right in the developing world have been advocated as the main justification for health assistance from rich to poor countries. Although we do not disagree with this, we argue that a strategy that emphasizes the shared benefit to rich and poor countries would facilitate this process. We propose that the accomplishment of these challenging tasks should be viewed from the perspective of game theory, where the interests of the parties (in this case rich and poor countries) overlap. As the world becomes increasingly integrated, economic development in resource-poor countries will increase the opportunities for richer countries to profit from investment in the developing world. Global health has political and international security implications for the developed world, as well. In view of the current health status of the developing world, we are not playing a game but facing a matter of life and death. "When health is absent, wisdom cannot reveal itself, art cannot become manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied" --Herophilus, 325 BCE (Physician to Alexander the Great). The purpose of this article is to address the relationship between health, poverty, and development in the context of game theory. We will focus on the link between economic inequalities and health outcomes, exclusively concentrating our analysis on the impact of infectious diseases. Subsequently, we will outline the game, the players, and the potential win-win outcomes that may potentially result.
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Affiliation(s)
- Erik Folch
- AIDS Internastional Training and Research program, Rollins School of Public Health, Emory University, Atlanta, GA 30303, USA.
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Abstract
Abstract Humanism includes, among its many contexts, the ideal of the universal perfection of health. Procedures for alleviation of disease existed through all epochs of human history, but efficacy was mostly lacking. The prototypic humanism of the Renaissance (ad 1300-1600) scarcely involved the medical -sciences other than human anatomy. The Enlightenment of the seventeenth century included discovery of the circulation of the blood, and applications of microscopy. Discoveries relevant to medical practice began in the nineteenth century, ushered in by vaccination and the germ theory of disease. This 200-year period saw a transformation of human health according to the surrogate marker of increased life--expectancy. This has been variously attributed to: (i) increased prosperity following the industrial revolution, (ii) efforts of humanistic social and public health reformers and, more recently, (iii) advances in medical science. Yet the beneficiaries remain a minority of the world's population. The nexus between poverty, illness and low life-expectancy between and within nations is the major challenge for the future. Contemporary science is providing ever-expanding knowledge on means to achieve the goal of perfection of human health, but the need for humanism is as great as at any previous age. Fortunately, however, the targets are more clearly visible than during the periods of poverty, plagues and pestilence of the past.
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Affiliation(s)
- I R Mackay
- Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Victoria, Australia.
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Sans-Sabrafen J. [Unavoidable death and quest for immortality]. Med Clin (Barc) 2002; 119:99-102. [PMID: 12106538 DOI: 10.1016/s0025-7753(02)73330-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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London L. Human rights and public health: dichotomies or synergies in developing countries? Examining the case of HIV in South Africa. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2002; 30:677-691. [PMID: 12561273 DOI: 10.1111/j.1748-720x.2002.tb00435.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Despite growing advances in medical technologies, health status inequalities continue to increase across the globe. Developing countries have been faced with declining expenditures in health and social services, increasing burdens posed by both communicable and non-communicable diseases, and economic systems poorly geared to fostering sustainable development for the poorest and most marginalized. Under such circumstances, the challenges facing health practitioners in countries in transition are complex and diverse, and require the balancing of many conflicting imperatives. This is particularly so in relation to the development of public health policy, where equity, redress of past inequalities, and the god of social justice may seemingly be pitted against macroeconomic adjustments required for national economic development in an increasingly globalized economic order.For example, pressures to deregulate as part of a market-oriented development philosophy will increase the risks from occupational hazards in populations desperate for paid employment.
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Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001; 104:2746-53. [PMID: 11723030 DOI: 10.1161/hc4601.099487] [Citation(s) in RCA: 1617] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiologic transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.
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Affiliation(s)
- S Yusuf
- Population Health Research Institute and Division of Cardiology, McMaster University, Hamilton, Ontario, Canada.
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Affiliation(s)
- R Beaglehole
- Department of Community Health, Faculty of Medicine and Health Science, University of Auckland, New Zealand
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