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Beshah SA, Husain MJ, Dessie GA, Worku A, Negeri MG, Banigbe B, Moran AE, Basu S, Kostova D. Cost analysis of the WHO-HEARTS program for hypertension control and CVD prevention in primary health facilities in Ethiopia. PUBLIC HEALTH IN PRACTICE 2023; 6:100423. [PMID: 37727705 PMCID: PMC10506051 DOI: 10.1016/j.puhip.2023.100423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/13/2023] [Accepted: 08/17/2023] [Indexed: 09/21/2023] Open
Abstract
Background In 2020, Ethiopia launched the Ethiopia Hypertension Control Initiative (EHCI) program to improve hypertension care using the approach described in the WHO HEARTS technical package. Objective To estimate the costs of implementing the HEARTS program for hypertension control and cardiovascular disease (CVD) prevention in the primary care setting in Ethiopia for adult primary care users in the catchment area of five examined facilities. Study design This study entails a program cost analysis using cross-sectional primary and secondary data. Methods Micro-costing facility surveys were used to assess activity costs related to training, counselling, screening, lab diagnosis, medications, monitoring, and start-up costs at five selected health facilities. Cost data were obtained from primary and secondary sources, and expert opinion. Annual costs from the health system perspective were estimated using the Excel-based HEARTS costing tool under two intervention scenarios - hypertension-only control and a CVD risk management program, which addresses diabetes and hypercholesterolemia in addition to hypertension. Results The estimated cost per adult primary care user was USD 5.3 for hypertension control and USD 19.3 for integrated CVD risk management. The estimated medication cost per person treated for hypertension was USD 9.0, whereas treating diabetes and high cholesterol would cost USD 15.4 and USD 15.3 per person treated, respectively. Medications were the major cost driver, accounting for 37% of the total cost in the hypertension control program. In the CVD risk management scenario, the proportions of medication and lab diagnostics of total costs were 18% and 64%, respectively. Conclusions The results from this study can inform planning and budgeting for HEARTS scale-up to prevent CVD across Ethiopia.
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Affiliation(s)
| | - Muhammad Jami Husain
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | | | | | - Andrew E. Moran
- Resolve to Save Lives, New York, USA
- Columbia University Irving Medical Center, New York, USA
| | - Soumava Basu
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Deliana Kostova
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, USA
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Chikumbanje MM, Raza S, Barham L. The Budget Impact Analysis of Adopting Direct Oral Anticoagulants for Stroke Prevention in Nonvalvular Atrial Fibrillation Patients in Malawi. Value Health Reg Issues 2023; 37:53-61. [PMID: 37321105 DOI: 10.1016/j.vhri.2023.04.005] [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: 11/05/2022] [Revised: 03/20/2023] [Accepted: 04/19/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study aimed to estimate the budget impact of adopting direct oral anticoagulants (DOACs) for stroke prevention in patients with nonvalvular atrial fibrillation in Malawi after the inclusion of DOACs in the World Health Organization's essential medicine list. METHODS A model was developed in Microsoft Excel. An eligible population of 201 491 was adjusted with 0.05 % incidence rate and mortality rates yearly according to the treatments. The model estimated the implication of supplementing rivaroxaban or apixaban to the standard treatment mix (also the comparator), thus warfarin and aspirin. The current market share of 43% aspirin and 57% warfarin was adjusted proportionally with 10% DOAC uptake in the first year and 5% annually over the subsequent 4 years. Clinical events of stroke and major bleeding from the ROCKET-AF and ARISTOTLE trials were used because health outcome indicators affect resource utilization. The analysis was conducted solely from the Malawi Ministry of Health perspective and it considered direct costs over 5 years. The sensitivity analysis involved varying drug costs, population, and care costs from both public and private sectors. RESULTS The research suggests that despite potential savings of $6 644 141 to $6 930 812 in stroke care because of fewer stroke events, the total Ministry of Health healthcare budget (approximately $260 400 000) may increase by between $42 488 342 to $101 633 644 in 5 years because drug acquisition costs are greater than savings. CONCLUSIONS With a fixed budget and current DOACs prices, Malawi can consider using DOACs in patients at the highest risk while waiting for cheaper generic versions.
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Affiliation(s)
- Mirriam M Chikumbanje
- Faculty of Life Sciences and Education, Learna Ltd in Partnership with University of South Wales, Cardiff, Wales, UK.
| | - Syed Raza
- Faculty of Life Sciences and Education, Learna Ltd in Partnership with University of South Wales, Cardiff, Wales, UK
| | - Leela Barham
- Faculty of Life Sciences and Education, Learna Ltd in Partnership with University of South Wales, Cardiff, Wales, UK
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Oliveira NCD, Balikian Júnior P, Júnior ATDC, Bento EDS, Tonholo J, Aquino T, Sousa FADB, Araujo GGD, Ferreira ML. Environmental Planning and Non-Communicable Diseases: A Systematic Review on the Role of the Metabolomic Profile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6433. [PMID: 37510665 PMCID: PMC10380082 DOI: 10.3390/ijerph20146433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
Non-communicable diseases (NCDs) are the major cause of death worldwide and have economic, psychological, and social impacts. Air pollution is the second, contributing to NCDs-related deaths. Metabolomics are a useful diagnostic and prognostic tool for NCDs, as they allow the identification of biomarkers linked to emerging pathologic processes. The aim of the present study was to review the scientific literature on the application of metabolomics profiling in NCDs and to discuss environmental planning actions to assist healthcare systems and public managers based on early metabolic diagnosis. The search was conducted following PRISMA guidelines using Web of Science, Scopus, and PubMed databases with the following MeSH terms: "metabolomics" AND "noncommunicable diseases" AND "air pollution". Twenty-nine studies were eligible. Eleven involved NCDs prevention, eight addressed diabetes mellitus, insulin resistance, systemic arterial hypertension, or metabolic syndrome. Six studies focused on obesity, two evaluated nonalcoholic fatty liver disease, two studied cancer, and none addressed chronic respiratory diseases. The studies provided insights into the biological pathways associated with NCDs. Understanding the cost of delivering care where there will be a critical increase in NCDs prevalence is crucial to achieving universal health coverage and improving population health by allocating environmental planning and treatment resources.
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Affiliation(s)
| | - Pedro Balikian Júnior
- Institute of Physical Education and Sport (IEFE), Federal University of Alagoas, Campus AC Simões, Maceió 57072-900, AL, Brazil
| | - Arnaldo Tenório da Cunha Júnior
- Kineanthropometry, Physical Activity and Health Promotion Laboratory (LACAPS), Physical Education Department, Federal University of Alagoas, Campus Arapiraca, Arapiraca 57309-005, AL, Brazil
| | - Edson de Souza Bento
- Institute of Chemistry and Biotechnology (IQB), Federal University of Alagoas, Campus AC Simões, Maceió 57072-900, AL, Brazil
| | - Josealdo Tonholo
- Institute of Chemistry and Biotechnology (IQB), Federal University of Alagoas, Campus AC Simões, Maceió 57072-900, AL, Brazil
| | - Thiago Aquino
- Institute of Chemistry and Biotechnology (IQB), Federal University of Alagoas, Campus AC Simões, Maceió 57072-900, AL, Brazil
| | - Filipe Antonio de Barros Sousa
- Institute of Physical Education and Sport (IEFE), Federal University of Alagoas, Campus AC Simões, Maceió 57072-900, AL, Brazil
| | - Gustavo Gomes de Araujo
- Institute of Physical Education and Sport (IEFE), Federal University of Alagoas, Campus AC Simões, Maceió 57072-900, AL, Brazil
| | - Maurício Lamano Ferreira
- Department of Geoenvironmental Analysis, Guarulhos University, Central Campus, Guarulhos 07023-070, SP, Brazil
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Xie P, Li X, Guo F, Zhang D, Zhang H. Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City. Front Public Health 2023; 11:1146914. [PMID: 37228711 PMCID: PMC10203198 DOI: 10.3389/fpubh.2023.1146914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction This study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China. Methods Data were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses. Results The total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P < 0.05]. The direct medical costs and OOP expenses for all patients increased from 2008 to 2009, and then decreased during the period of 2009-2012. The time trends of direct medical costs between the UEBMI and URBMI patients were different during the period of 2008-2012. The regression analysis indicated that the UEBMI enrollees had higher direct medical costs (P < 0.001) but had lower OOP expenses (P < 0.001) than the URBMI enrollees. Male patients, patients having percutaneous coronary intervention operation and intensive care unit admission, patients treated in secondary hospitals and tertiary hospitals, patients with the LOS of 15-30 days, 30 days and longer had significantly higher direct medical costs and OOP expenses (all P < 0.001). Conclusions The direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.
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Affiliation(s)
- Peixuan Xie
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xuezhu Li
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Feifan Guo
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Donglan Zhang
- Division of Health Services Research, New York University Long Island School of Medicine, Mineola, NY, United States
| | - Hui Zhang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Wu S, Zheng C, Liu N, Deng T, Wang J, Qi L, Xia L. Liuzijue training improves hypertension and modulates gut microbiota profile. Front Cardiovasc Med 2023; 10:1075084. [PMID: 36760555 PMCID: PMC9905721 DOI: 10.3389/fcvm.2023.1075084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Background Liuzijue training (LZJ) is a traditional exercise integrating breathing meditation and physical exercise, which could prevent and improve hypertension symptoms. Purpose We aimed to evaluate the therapeutic effect of LZJ on hypertensive patients from the perspectives of blood pressure (BP), vascular endothelial function, immune homeostasis, and gut microbiota. Methods We conducted a randomized, controlled, single-blind experiment to assess the effect of 12 weeks LZJ in hypertensive patients. We measured the blood pressure level, vascular endothelial function, serum inflammatory factor concentration, and fecal microbial composition of hypertension patients. Results Compared with aerobic training, LZJ has a more significant effect on serum inflammatory factors (IL-6 and IL-10) and gut microbiota. PCoA analysis showed that LZJ tended to transform the gut microbiota structure of hypertensive subjects into that of healthy people. This process involves significant changes in Bacteroides, Clostridium_sensu_stricto_1, Escherichia-Shigella, Haemophilus, Megamonas, and Parabacteroides. In particular, Bacteroides and Escherichia-Shigella, these bacteria were closely related to the improvement of BP in hypertensive patients. Conclusion In conclusion, our results confirm that LZJ could be used as an adjuvant treatment for hypertensive patients, which could effectively reduce BP, improve the immune homeostasis and gut microbiota structure in patients, and provide a theoretical reference for the use of LZJ in the clinic. Clinical trial registration http://www.chictr.org.cn/listbycreater.aspx, identifier: ChiCTR2200066269.
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Affiliation(s)
- Sha Wu
- State Administration of Traditional Chinese Medicine, Key Laboratory of Traditional Chinese Medicine Regimen and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Regimen and Health of Sichuan Province, Chengdu, Sichuan, China
| | | | - Nannan Liu
- State Administration of Traditional Chinese Medicine, Key Laboratory of Traditional Chinese Medicine Regimen and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Regimen and Health of Sichuan Province, Chengdu, Sichuan, China
| | - Tingting Deng
- State Administration of Traditional Chinese Medicine, Key Laboratory of Traditional Chinese Medicine Regimen and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Regimen and Health of Sichuan Province, Chengdu, Sichuan, China
- Nursing College of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jie Wang
- State Administration of Traditional Chinese Medicine, Key Laboratory of Traditional Chinese Medicine Regimen and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Regimen and Health of Sichuan Province, Chengdu, Sichuan, China
| | - Luming Qi
- State Administration of Traditional Chinese Medicine, Key Laboratory of Traditional Chinese Medicine Regimen and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Regimen and Health of Sichuan Province, Chengdu, Sichuan, China
| | - Lina Xia
- State Administration of Traditional Chinese Medicine, Key Laboratory of Traditional Chinese Medicine Regimen and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Regimen and Health of Sichuan Province, Chengdu, Sichuan, China
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Catharina de Beer J, Snyman J, Ker J, Miller-Janson H, Stander M. Budget Impact Analysis of Empagliflozin in the Treatment of Patients With Type 2 Diabetes With Established Cardiovascular Disease in South Africa. Value Health Reg Issues 2023; 33:91-98. [PMID: 36327769 DOI: 10.1016/j.vhri.2022.08.012] [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: 10/25/2021] [Revised: 07/08/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aimed to estimate the budget impact and affordability of empagliflozin added to usual care compared with usual care alone, in a diabetic population with established cardiovascular disease, from a private healthcare payer perspective in South Africa. METHODS A budget impact model was adapted and localized. Epidemiological data were obtained from the South African Council for Medical Schemes. Clinical event rates were sourced from the EMPA-REG OUTCOME trial and drug costs from list prices. Clinical event costs were derived from a claims data analysis of the South African private healthcare sector and microcosting. Scenario analyses were performed on select inputs. The modeled outcomes included annual budget impact of empagliflozin, the incremental cost per life per month, cardiovascular deaths averted, and incremental cost per life saved, over 3 years. RESULTS A total of 9 503 patients were eligible for empagliflozin (year 1), 12 670 (year 2), and 16 947 (year 3). The incremental cost was $1 272 297, $1 764 705, and $2 455 235, for years 1 to 3, respectively. The incremental cost per beneficiary per month was calculated as $0.012 (year 1), $0.016 (year 2), and $0.023 (year 3). The model estimated a 38.6% reduction in cardiovascular deaths, 305 lives saved, and an incremental cost per life saved of $17 999. CONCLUSIONS Adding empagliflozin to usual care has a marginal budget implication and is highly affordable for private healthcare payers, with an acceptable incremental cost based on clinical outcomes.
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Affiliation(s)
| | | | - James Ker
- University of Pretoria, South Africa
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Masuku SD, Lekodeba N, Meyer-Rath G. The costs of interventions for type 2 diabetes mellitus, hypertension and cardiovascular disease in South Africa - a systematic literature review. BMC Public Health 2022; 22:2321. [PMID: 36510178 PMCID: PMC9743545 DOI: 10.1186/s12889-022-14730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In the context of a move to universal health coverage, three separate systematic reviews were conducted to summarise available evidence on the direct costs of interventions for type 2 diabetes mellitus, hypertension, and cardiovascular disease in South Africa. METHODS PubMed® and Web of Science was searched for literature published between 01 and 1995 and 27 October 2022. Additionally, reference and citations lists of retrieved articles and experts were consulted. We also tracked reference lists of previous, related systematic reviews. Eligible publications were cost analyses of clinical interventions targeted at adults age 15 + reporting primary estimates of in- and out-of-hospital costs from a provider perspective. Costs were extracted and converted to 2021 US dollars, and article methodological and reporting quality was appraised using the 2013 CHEERS checklist. RESULTS Of the 600, 1,172 and 1,466 identified publications for type 2 diabetes mellitus, hypertension, and cardiovascular disease, respectively, 10, 12, and 17 met full inclusion criteria. 60% of articles reported cardiovascular disease costs, 52% were of good reporting quality, and 10%, 50%, and 39% of type 2 diabetes mellitus, hypertension and cardiovascular disease papers reported private-sector costs only. Hypertension drug costs ranged from $2 to $85 per person-month, while type 2 diabetes mellitus drug costs ranged between $57 and $630 per person-year (ppy). Diabetes-related complication treatment costs ranged from $55 for retinopathy treatment to $25,193 ppy for haemodialysis, while cardiovascular disease treatment costs were between $160 and $37,491 ppy. Drugs and treatment of complications were major cost drivers for hypertension and type 2 diabetes mellitus, while hospitalisation drove cardiovascular disease costs. CONCLUSION The intervention costs of type 2 diabetes mellitus, hypertension and cardiovascular disease care have received more attention recently, particularly diabetes-related complications and cardiovascular disease. However, 39% of identified cardiovascular disease treatment costs used a private sector perspective, leaving significant research gaps in the public sector and the cheaper to treat hypertension and type 2 diabetes mellitus. This review fills an information gap regarding the intervention costs of these diseases in South Africa.
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Affiliation(s)
- Sithabiso D. Masuku
- grid.11951.3d0000 0004 1937 1135Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Unit 2, 39 Empire Road, Parktown, Johannesburg, 2193 South Africa
| | - Nkgomeleng Lekodeba
- grid.11951.3d0000 0004 1937 1135Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Unit 2, 39 Empire Road, Parktown, Johannesburg, 2193 South Africa
| | - Gesine Meyer-Rath
- grid.11951.3d0000 0004 1937 1135Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Unit 2, 39 Empire Road, Parktown, Johannesburg, 2193 South Africa ,grid.189504.10000 0004 1936 7558Department of Global Health, Boston University, Boston, MA USA
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Nindorera F, Nduwimana I, Sinzakaraye A, Havyarimana E, Bleyenheuft Y, Thonnard JL, Kossi O. Effect of mixed and collective physical activity in chronic stroke rehabilitation: A randomized cross-over trial in low-income settings. Ann Phys Rehabil Med 2022; 66:101704. [PMID: 36115574 DOI: 10.1016/j.rehab.2022.101704] [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: 02/12/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The prevalence of physical inactivity after stroke is high and exercise training improves many outcomes. However, access to community training protocols is limited, especially in low-income settings. OBJECTIVE To investigate the feasibility and efficacy of a new intervention: Circuit walking, balance, cycling and strength training (CBCS) on activity of daily living (ADL) limitations, motor performance, and social participation restrictions in people after stroke. METHODS Forty-six community-dwelling individuals with chronic stroke who were no longer in conventional rehabilitation were randomized into an immediate CBCS group (IG; initially received CBCS training for 12 weeks in phase 1), and a delayed CBCS group (DG) that first participated in sociocultural activities for 12 weeks. In phase 2, participants crossed over so that the DG underwent CBCS and the IG performed sociocultural activities. The primary outcome was ADL limitations measured with the ACTIVLIM-Stroke scale. Secondary outcomes included motor performance (balance: Berg Balance Scale [BBS], global impairment: Stroke Impairment Assessment Set [SIAS] and mobility: 6-minute and 10-metre walk tests [6MWT and 10mWT] and psychosocial health [depression and participation]). Additional outcomes included feasibility (retention, adherence) and safety. RESULTS ADL capacity significantly improved pre to post CBCS training (ACTIVLIM-stroke, +3,4 logits, p < 0.001; effect size [ES] 0.87), balance (BBS, +21 points, p < 0.001; ES 0.9), impairments (SIAS, +11 points, p < 0.001; ES 0.9), and mobility (+145 m for 6MWT and +0.37 m/s for 10mWT; p < 0.001; ES 0.7 and 0.5 respectively). Similar improvements in psychosocial health occurred in both groups. Adherence and retention rates were 95% and 100%, respectively. CONCLUSION CBCS was feasible, safe and improved functional independence and motor abilities in individuals in the chronic stage of stroke. Participation in CBCS improved depression and social participation similarly to participation in sociocultural activities. The benefits persisted for at least 3 months after intervention completion. PROTOCOL REGISTRATION NUMBER PACTR202001714888482.
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Affiliation(s)
- Félix Nindorera
- MSL-IN Laboratory, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium; National Center of Reference in Physical Therapy and Medical Rehabilitation, University Hospital Roi-Khaled, Bujumbura, Burundi.
| | - Ildephonse Nduwimana
- MSL-IN Laboratory, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium; National Center of Reference in Physical Therapy and Medical Rehabilitation, University Hospital Roi-Khaled, Bujumbura, Burundi
| | - Alexis Sinzakaraye
- National Center of Reference in Physical Therapy and Medical Rehabilitation, University Hospital Roi-Khaled, Bujumbura, Burundi
| | - Eric Havyarimana
- National Center of Reference in Physical Therapy and Medical Rehabilitation, University Hospital Roi-Khaled, Bujumbura, Burundi
| | - Yannick Bleyenheuft
- MSL-IN Laboratory, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium
| | - Jean-Louis Thonnard
- MSL-IN Laboratory, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium
| | - Oyéné Kossi
- Service de Kinésithérapie et d'Appareillage Orthopédique, Hôpital Universitaire de Parakou, Parakou, Benin; ENATSE, Ecole Nationale de Santé Publique et d'Epidémiologie, Université de Parakou, Parakou, Benin
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Vasorelaxant-Mediated Antihypertensive Effect of the Leaf Aqueous Extract from Stephania abyssinica (Dillon & A. Rich) Walp (Menispermaceae) in Rat. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4730341. [PMID: 34660790 PMCID: PMC8519676 DOI: 10.1155/2021/4730341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/17/2021] [Indexed: 11/21/2022]
Abstract
Stephania abyssinica is a medicinal plant used in Cameroon alternative medicine to treat arterial hypertension (AHT). Previous in vitro studies demonstrated the endothelium nitric oxide-independent vasorelaxant property of the aqueous extract from Stephania abyssinica (AESA). But its effect on AHT is unknown. The present study was undertaken to explore other vasorelaxant mechanisms and to determine the antihypertensive effects of AESA in male Wistar rats. Phytochemical analysis of AESA was carried out using the liquid chromatography-mass spectrometry (LC-MS) method. The vasorelaxant effects of AESA (1-1000 μg/mL) were studied on rat isolated thoracic aorta rings, in the absence or presence of indomethacin (10 μM) or methylene blue (10 μM). The inhibitory effect of AESA on phenylephrine (PE, 10 μM) or KCl- (60 mM) induced contraction as well as the intracellular calcium release was also evaluated. The in vivo antihypertensive activity of AESA (43, 86, or 172 mg/kg/day) or captopril (20 mg/kg/day) administered orally was assessed in L-NAME- (40 mg/kg/day) treated rats. Blood pressure and heart rate (HR) were measured at the end of each week while serum or urinary nitric oxide (NO), creatinine, and glomerular filtration rate (GFR) were determined at the end of the 6 weeks of treatment, as well as histological analysis of the heart and the kidney. The LC-MS profiling of AESA identified 9 compounds including 7 alkaloids. AESA produced a concentration-dependent relaxation on contraction induced either by PE and KCl, which was significantly reduced in endothelium-denuded vessels, as well as in vessels pretreated with indomethacin and methylene blue. Moreover, AESA inhibited the intracellular Ca2+ release-induced contraction. In vivo, AESA reduced the AHT, heart rate (HR), and ventricular hypertrophy and increased serum NO, urine creatinine, and GFR. AESA also ameliorated heart and kidney lesions as compared to the L-NAME group. These findings supported the use of AESA as a potential antihypertensive drug.
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Bherwani H, Kumar S, Musugu K, Nair M, Gautam S, Gupta A, Ho CH, Anshul A, Kumar R. Assessment and valuation of health impacts of fine particulate matter during COVID-19 lockdown: a comprehensive study of tropical and sub tropical countries. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:44522-44537. [PMID: 33852112 PMCID: PMC8044290 DOI: 10.1007/s11356-021-13813-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/01/2021] [Indexed: 05/10/2023]
Abstract
A novel coronavirus disease (COVID-19) continues to challenge the whole world. The disease has claimed many fatalities as it has transcended from one country to another since it was first discovered in China in late 2019. To prevent further morbidity and mortality associated with COVID-19, most of the countries initiated a countrywide lockdown. While physical distancing and lockdowns helped in curbing the spread of this novel coronavirus, it led to massive economic losses for the nations. Positive impacts have been observed due to lockdown in terms of improved air quality of the nations. In the current research, ten tropical and subtropical countries have been analysed from multiple angles, including air pollution, assessment and valuation of health impacts and economic loss of countries during COVID-19 lockdown. Countries include Brazil, India, Iran, Kenya, Malaysia, Mexico, Pakistan, Peru, Sri Lanka, and Thailand. Validated Simplified Aerosol Retrieval Algorithm (SARA) binning model is used on data collated from moderate resolution imaging spectroradiometer (MODIS) for particulate matters with a diameter of less than 2.5 μm (PM2.5) for all the countries for the month of January to May 2019 and 2020. The concentration results of PM2.5 show that air pollution has drastically reduced in 2020 post lockdown for all countries. The highest average concentration obtained by converting aerosol optical depth (AOD) for 2020 is observed for Thailand as 121.9 μg/m3 and the lowest for Mexico as 36.27 μg/m3. As air pollution is found to decrease in the April and May months of 2020 for nearly all countries, they are compared with respective previous year values for the same duration to calculate the reduced health burden due to lockdown. The present study estimates that cumulative about 100.9 Billion US$ are saved due to reduced air pollution externalities, which are about 25% of the cumulative economic loss of 435.9 Billion US$.
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Affiliation(s)
- Hemant Bherwani
- CSIR-National Environmental Engineering Research Institute (CSIR-NEERI), Nagpur, Maharashtra 440020 India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh 201002 India
| | - Suman Kumar
- CSIR-National Environmental Engineering Research Institute (CSIR-NEERI), Nagpur, Maharashtra 440020 India
| | - Kavya Musugu
- CSIR-National Environmental Engineering Research Institute (CSIR-NEERI), Nagpur, Maharashtra 440020 India
| | - Moorthy Nair
- Asian Development Research Institute (ADRI), Patna, Bihar 800013 India
| | - Sneha Gautam
- Karunya Institute of Technology and Sciences, Coimbatore, Tamil Nadu 641114 India
| | - Ankit Gupta
- CSIR-National Environmental Engineering Research Institute (CSIR-NEERI), Nagpur, Maharashtra 440020 India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh 201002 India
| | - Chang-Hoi Ho
- School of Earth and Environmental Sciences, Seoul National University, Seoul, 08826 South Korea
| | - Avneesh Anshul
- CSIR-National Environmental Engineering Research Institute (CSIR-NEERI), Nagpur, Maharashtra 440020 India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh 201002 India
| | - Rakesh Kumar
- CSIR-National Environmental Engineering Research Institute (CSIR-NEERI), Nagpur, Maharashtra 440020 India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh 201002 India
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11
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Opara CC, Du Y, Kawakatsu Y, Atala J, Beaton AZ, Kansiime R, Nakitto M, Ndagire E, Nalubwama H, Okello E, Watkins DA, Su Y. Household Economic Consequences of Rheumatic Heart Disease in Uganda. Front Cardiovasc Med 2021; 8:636280. [PMID: 34395548 PMCID: PMC8363312 DOI: 10.3389/fcvm.2021.636280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/08/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Rheumatic heart disease (RHD) has declined dramatically in wealthier countries in the past three decades, but it remains endemic in many lower-resourced regions and can have significant costs to households. The objective of this study was to quantify the economic burden of RHD among Ugandans affected by RHD. Methods: This was a cross-sectional cost-of-illness study that randomly sampled 87 participants and their households from the Uganda National RHD registry between December 2018 and February 2020. Using a standardized survey instrument, we asked participants and household members about outpatient and inpatient RHD costs and financial coping mechanisms incurred over the past 12 months. We used descriptive statistics to analyze levels and distributions of costs and the frequency of coping strategies. Multivariate Poisson regression models were used to assess relationships between socioeconomic characteristics and utilization of financial coping mechanisms. Results: Most participants were young or women, demonstrating a wide variation in socioeconomic status. Outpatient and inpatient costs were primarily driven by transportation, medications, and laboratory tests, with overall RHD direct and indirect costs of $78 per person-year. Between 20 and 35 percent of households experienced catastrophic healthcare expenditure, with participants in the Northern and Western Regions 5-10 times more likely to experience such hardship and utilize financial coping mechanisms than counterparts in the Central Region, a wealthier area. Increases in total RHD costs were positively correlated with increasing use of coping behaviors. Conclusion: Ugandan households affected by RHD, particularly in lower-income areas, incur out-of-pocket costs that are very high relative to income, exacerbating the poverty trap. Universal health coverage policy reforms in Uganda should include mechanisms to reduce or eliminate out-of-pocket expenditures for RHD and other chronic diseases.
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Affiliation(s)
- Chinonso C. Opara
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Yuxian Du
- Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Yoshito Kawakatsu
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Community-Based Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Jenifer Atala
- Department of RHD Research, Uganda Heart Institute, Kampala, Uganda
| | - Andrea Z. Beaton
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, School of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | | | - Miriam Nakitto
- Department of RHD Research, Uganda Heart Institute, Kampala, Uganda
| | - Emma Ndagire
- Division of Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Haddy Nalubwama
- Department of RHD Research, Uganda Heart Institute, Kampala, Uganda
| | - Emmy Okello
- Division of Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - David A. Watkins
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Community-Based Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yanfang Su
- Department of Community-Based Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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12
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Kazibwe J, Tran PB, Annerstedt KS. The household financial burden of non-communicable diseases in low- and middle-income countries: a systematic review. Health Res Policy Syst 2021; 19:96. [PMID: 34154609 PMCID: PMC8215836 DOI: 10.1186/s12961-021-00732-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/30/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The chronic nature of noncommunicable diseases (NCD) and costs associated with long-term care can result in catastrophic health expenditure for the patient and their household pushing them deeper into poverty and entrenching inequality in society. As the full financial burden of NCDs is not known, the objective of this study was to explore existing evidence on the financial burden of NCDs in low- and middle-income countries (LMICs), specifically estimating the cost incurred by patients with NCDs and their households to inform the development of strategies to protect such households from catastrophic expenditure. METHODS This systematic review followed the PRISMA guidelines, PROSPERO: CRD42019141088. Eligible studies published between 1st January 2000 to 7th May 2020 were systematically searched for in three databases: Medline, Embase and Web of Science. A two-step process, comprising of qualitative synthesis proceeded by quantitative (cost) synthesis, was followed. The mean costs are presented in 2018 USD. FINDINGS 51 articles were included, out of which 41 were selected for the quantitative cost synthesis. Most of the studies were cross-sectional cost-of-illness studies, of which almost half focused on diabetes and/or conducted in South-East Asia. The average total costs per year to a patient/household in LMICs of COPD, CVD, cancers and diabetes were $7386.71, $6055.99, $3303.81, $1017.05, respectively. CONCLUSION This review highlighted major data and methodological gaps when collecting data on costs of NCDs to households along the cascade of care in LMICs. More empirical data on cost of specific NCDs are needed to identify the diseases and contexts where social protection interventions are needed most. More rigorous and standardised methods of data collection and costing for NCDs should be developed to enable comprehensive and comparable evidence of the economic and financial burden of NCDs to patients and households in LMICs. The available evidence on costs reveals a large financial burden imposed on patients and households in seeking and receiving NCD care and emphasizes the need for adequate and reliable social protection interventions to be implemented alongside Universal Health Coverage.
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Affiliation(s)
- Joseph Kazibwe
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- The Health and Social Protection Action Research and Knowledge Sharing Network (SPARKS), Solna, Sweden
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Phuong Bich Tran
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- The Health and Social Protection Action Research and Knowledge Sharing Network (SPARKS), Solna, Sweden
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Kristi Sidney Annerstedt
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
- The Health and Social Protection Action Research and Knowledge Sharing Network (SPARKS), Solna, Sweden.
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13
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A Model for Risk Prediction of Cerebrovascular Disease Prevalence-Based on Community Residents Aged 40 and above in a City in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126584. [PMID: 34207332 PMCID: PMC8296485 DOI: 10.3390/ijerph18126584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
Cerebrovascular disease (CVD) is the leading cause of death in many countries including China. Early diagnosis and risk assessment represent one of effective approaches to reduce the CVD-related mortality. The purpose of this study was to understand the prevalence and influencing factors of cerebrovascular disease among community residents in Qingyunpu District, Nanchang City, Jiangxi Province, and to construct a model of cerebrovascular disease risk index suitable for local community residents. A stratified cluster sampling method was used to sample 2147 community residents aged 40 and above, and the prevalence of cerebrovascular diseases and possible risk factors were investigated. It was found that the prevalence of cerebrovascular disease among local residents was 4.5%. Poisson regression analysis found that old age, lack of exercise, hypertension, diabetes, smoking, and family history of cerebrovascular disease are the main risk factors for local cerebrovascular disease. The relative risk ORs were 3.284, 2.306, 2.510, 3.194, 1.949, 2.315, respectively. For these six selected risk factors, a cerebrovascular disease risk prediction model was established using the Harvard Cancer Index method. The R value of the risk prediction model was 1.80 (sensitivity 81.8%, specificity 47.0%), which was able to well predict the risk of cerebrovascular disease among local residents. This provides a scientific basis for the further development of local cerebrovascular disease prevention and control work.
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14
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Luyckx VA, Moosa MR. Priority Setting as an Ethical Imperative in Managing Global Dialysis Access and Improving Kidney Care. Semin Nephrol 2021; 41:230-241. [PMID: 34330363 DOI: 10.1016/j.semnephrol.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Priority-setting dilemmas arise when trade-offs must be made regarding the kinds of services that should be provided and to whom, thereby withholding other services from individuals or groups that could benefit from them. Currently, it is practically impossible for lower-income countries to provide dialysis for all patients with kidney failure; however, the fundamental premise of the human right to health, while acknowledging the current resource constraints, is the progressive realization of access to care for all. In this article we outline the rationale for priority setting, starting with the global goal of achieving universal health coverage, the prerequisites for fair and transparent priority setting, and discuss how these may apply to expensive care such as dialysis. Priority is inherently a value-laden process, and cannot be whittled down to technical considerations of clinical or cost effectiveness alone. Fair and transparent priority setting should originate from population health needs, be based on evidence, and be associated with ethical values or principles. This requires effective engagement with relevant stakeholders. Once policies are developed and implemented, good oversight is crucial to ensure accountability and to provide iterative feedback such that the goals of universal health coverage may be progressively realized.
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Affiliation(s)
- Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Child Health and Pediatrics, University of Cape Town, Cape Town, South Africa.
| | - M Rafique Moosa
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
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15
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Simic R, Ratkovic N, Dragojevic Simic V, Savkovic Z, Jakovljevic M, Peric V, Pandrc M, Rancic N. Cost Analysis of Health Examination Screening Program for Ischemic Heart Disease in Active-Duty Military Personnel in the Middle-Income Country. Front Public Health 2021; 9:634778. [PMID: 33748069 PMCID: PMC7969704 DOI: 10.3389/fpubh.2021.634778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular diseases, including ischemic heart disease, are the most common causes of morbidity and death in the world, including Serbia, as a middle-income European country. The aim of the study was to determine the costs of preventive examinations for ischemic heart disease in active-duty military personnel, as well as to assess whether this was justified from the point of view of the limited health resources allocated for the treatment of the Republic of Serbia population. This is a retrospective cost-preventive study which included 738 male active-duty military personnel, aged from 23 to 58. The costs of primary prevention of ischemic heart disease in this population were investigated. Out of 738 subjects examined, arterial hypertension was detected in 101 subjects (in 74 of them, arterial hypertension was registered for the first time, while 27 subjects were already subjected to pharmacotherapy for arterial hypertension). Average costs of all services during the periodic-health-examination screening program were €76.96 per subject. However, average costs of all services during the periodic-health-examination screening program for patients with newfound arterial hypertension and poorly regulated arterial hypertension were €767.54 per patient and €2,103.63 per patient, respectively. Since periodic-health-examination screening program in military personnel enabled not only discovery of patient with newfound arterial hypertension but also regular monitoring of those who are already on antihypertensive therapy, significant savings of €690.58 per patient and €2,026.67 per patient can be achieved, respectively. As financial resources for providing health care in Serbia, as a middle-income country, are limited, further efforts should be put on screening programs for ischemic heart disease due to possible significant savings.
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Affiliation(s)
- Radoje Simic
- Department for Plastic Surgery, Institute for Mother and Child Health Care of Serbia Dr. Vukan Cupic, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nenad Ratkovic
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia.,Sector for Treatment, Military Medical Academy, Belgrade, Serbia
| | - Viktorija Dragojevic Simic
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia.,Center for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
| | - Zorica Savkovic
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Mihajlo Jakovljevic
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan.,Department of Global Health Economics and Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Vitomir Peric
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia
| | - Milena Pandrc
- Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia
| | - Nemanja Rancic
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia.,Center for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
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16
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Oliveira GMMD, Brant LCC, Polanczyk CA, Biolo A, Nascimento BR, Malta DC, Souza MDFMD, Soares GP, Xavier Junior GF, Machline-Carrion MJ, Bittencourt MS, Pontes Neto OM, Silvestre OM, Teixeira RA, Sampaio RO, Gaziano TA, Roth GA, Ribeiro ALP. Cardiovascular Statistics - Brazil 2020. Arq Bras Cardiol 2020; 115:308-439. [PMID: 33027364 PMCID: PMC9363085 DOI: 10.36660/abc.20200812] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Gláucia Maria Moraes de Oliveira
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro , RJ - Brasil.,Disciplina de Cardiologia, Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro , RJ - Brasil
| | - Luisa Campos Caldeira Brant
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil.,Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
| | - Carisi Anne Polanczyk
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre , RS - Brasil.,Serviço de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS - Brasil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre , RS - Brasil
| | - Andreia Biolo
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre , RS - Brasil.,Serviço de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS - Brasil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre , RS - Brasil
| | - Bruno Ramos Nascimento
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil.,Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
| | - Deborah Carvalho Malta
- Programa de Pós-Graduação em Saúde Pública da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
| | - Maria de Fatima Marinho de Souza
- Programa de Pós-Graduação em Saúde Pública da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil.,Organização Vital Strategies , Nova York - EUA
| | - Gabriel Porto Soares
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro , RJ - Brasil.,Curso de Medicina da Universidade de Vassouras , Vassouras , RJ - Brasil
| | | | | | - Marcio Sommer Bittencourt
- Divisão de Clínica Médica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP - Brasil.,Faculdade Israelita de Ciências da Saúde Albert Einstein , São Paulo , SP - Brasil
| | - Octavio M Pontes Neto
- Serviço de Neurologia Vascular e Emergências Neurológicas, Divisão de Neurologia, Departamento de Neurociências e Ciências do Comportamento , Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (USP), São Paulo , SP - Brasil
| | | | - Renato Azeredo Teixeira
- Programa de Pós-Graduação em Saúde Pública da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
| | - Roney Orismar Sampaio
- Departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo , SP - Brasil.,Programa de Pós-Graduação da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo , SP - Brasil.,Unidade Clínica de Cardiopatias Valvares do Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | - Thomaz A Gaziano
- Brigham and Women's Hospital , Boston - EUA.,Department of Medicine , Cardiovascular, Harvard Medical School , Boston - EUA
| | - Gregory A Roth
- Global Health and Health Metrics Sciences at the Institute for Health Metrics and Evaluation (IHME), Washington - EUA.,Division of Cardiology at the University of Washington School of Medicine , Washington - EUA
| | - Antonio Luiz Pinho Ribeiro
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil.,Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
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Olowoyo P, Okekunle AP, Ojagbemi A, Akpa OM, Akinyemi R, Lackland D, Ovbiagele B, Owolabi M. Green leafy vegetable intakes are inversely related to the incidence of stroke. Eur J Prev Cardiol 2020; 28:e21-e23. [PMID: 33624025 DOI: 10.1093/eurjpc/zwaa040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/04/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, 371101 Ido-Ekiti, Nigeria.,College of Medicine and Health Sciences, Afe Babalola University, 361212 Ado-Ekiti, Nigeria
| | - Akinkunmi Paul Okekunle
- Department of Nutrition and Food Hygiene, Harbin Medical University, 150081 Harbin, China.,The Postgraduate College University of Ibadan, 200284 Ibadan, Nigeria.,Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan 200284 Ibadan, Nigeria
| | - Akin Ojagbemi
- Department of Psychiatry, College of Medicine, University of Ibadan 200284 Ibadan, Nigeria
| | - Onoja Matthew Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan 200284 Ibadan, Nigeria.,Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan 200284 Ibadan, Nigeria
| | - Rufus Akinyemi
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan 200284 Ibadan, Nigeria.,Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan 200284 Ibadan, Nigeria
| | - Daniel Lackland
- Department of Neurology, Medical University of South Carolina, Charleston, 29425 SC, USA
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco, USA
| | - Mayowa Owolabi
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan 200284 Ibadan, Nigeria.,Department of Medicine, College of Medicine, University of Ibadan, & University College Hospital, 200284 Ibadan, Nigeria.,Blossom Specialist Medical Centre, 20212 Ibadan, Nigeria
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18
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Opara CC, Aghassibake N, Watkins DA. Economic consequences of rheumatic heart disease: A scoping review. Int J Cardiol 2020; 323:235-241. [PMID: 32920073 DOI: 10.1016/j.ijcard.2020.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains endemic in less-resourced regions and countries and results in high medical and non-medical costs to households, health systems, and society. This scoping review maps out the available evidence on the economic impact of RHD and its antecedents and suggests future research priorities. METHOD We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We identified articles through systematic electronic database search supplemented by expert knowledge of unpublished literature. Studies were included if they collected empirical RHD-related costing data as a primary or secondary objective and if the data were collected from 2000 onward. Main quantitative findings by intervention, costing perspective, and location were charted, and a standardized quality assessment tool was used to appraise included studies. RESULTS The index search identified 2519 electronic records and two grey-literature graduate theses. Six full texts were included in the review. Primary prevention costs were modest, while secondary and especially tertiary prevention were more costly. Most estimates were of health sector costs and for tertiary interventions. Only two studies described RHD-related costs in non-high-income countries. Most studies were of adequate methodological quality. CONCLUSION Research into the costs of RHD has mostly been done in wealthy countries. Costs from the household perspective, which are particularly important in countries with limited public healthcare finance, are lacking. To inform advocacy and guide implementation of the 2018 World Health Assembly resolution on RHD, high-quality, local cost estimates will be needed from a range of representative, RHD-endemic countries.
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Affiliation(s)
- Chinonso C Opara
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - David A Watkins
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
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19
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Patel S, Ram F, Patel SK, Kumar K. Cardiovascular diseases and health care expenditure (HCE) of inpatient and outpatient: A study from India Human Development Survey. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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20
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Wang C, Wang C, Liu M, Chen Z, Liu S. Temporal and spatial trends of ischemic heart disease burden in Chinese and subgroup populations from 1990 to 2016: socio-economical data from the 2016 global burden of disease study. BMC Cardiovasc Disord 2020; 20:243. [PMID: 32448161 PMCID: PMC7247238 DOI: 10.1186/s12872-020-01530-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/14/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Ischemic heart disease (IHD) is the leading cause of premature death which poses public health challenges worldwide. Previous studies focused on the overall population in China. However, variations in temporal and spatial patterns across subgroups remain unknown. This study was to analyze how the IHD burden among Chinese and subgroup populations changes in response to temporal and spatial trends from 1990 to 2016. METHODS Based on data from the updated estimate in the 2016 Global Burden of Disease (GBD) study, we used years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) to describe the IHD burden. The percentage and annual average percentage changes were applied to illustrate temporal and spatial variations of the IHD burden stratified by age, sex, and province, over the periods 1990-2016, 1990-2005, and 2005-2016. We estimate population-attributable fraction (PAF) for 24 modifiable risk factors at the provincial level in 2016. RESULTS YLD rates, YLL rates, and DALY rates for IHD underwent a notable increase among all age groups and increased by 119.4, 83.3, and 84.5% nationally from 1990 to 2016. In YLD rates, a greater increase was seen in females (124.4%) compared to males (114.0%), while males experienced a more substantial increase than that in females in YLL rates (99.3% vs. 60.5%) and DALY rates (99.7% vs. 63.2%) from 1990 to 2016. Compared with 1990-2005, annual average changes in the overall population in YLL rates (3.5% vs. 1.8%) and DALY rates (3.5% vs. 1.9%) showed a tardier increase whereas an opposite increasing trend of YLD rates (3.5% vs. 4.0%) was observed between 2005 and 2016. Geographically, all provinces saw declines in the YLLs/YLDs ratio from 2005 to 2016, with seventeen of thirty-three provinces showing an upward trend between 1990 and 2005. Most provinces witnessed a remarkable upsurge in the age-standardised DALY rate from 1990 to 2016 whereas the economically advantaged region Macao (52.2%) saw the most marked reduction. High systolic blood pressure and high LDL cholesterol remained the two leading risk factors of IHD in all provinces in 2016. Diet high in sodium was the leading behavioral risks in twenty-eight provinces with smoking heading the list in five provinces. CONCLUSIONS China has made significant achievements in preventing premature death from IHD along with the increased risk of disability. Substantial disparities in temporal and spatial trends of the IHD burden emphasize concerns for elderly men and those in economically disadvantaged regions with resource constraints. Regional differences in the IHD burden can be partly explained by modifiable risk factors. By having identified these disparities, targeted IHD prevention and control strategies will help to bridge these gaps.
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Affiliation(s)
- Chenran Wang
- "Health Shandong" Major Social Risk Prediction and Governance Collaborative Innovation Center, School of Public Health and Management, Weifang Medical University, No.7166 Baotong Xi Street, Weicheng District, Weifang, 261053, China
| | - Chunping Wang
- "Health Shandong" Major Social Risk Prediction and Governance Collaborative Innovation Center, School of Public Health and Management, Weifang Medical University, No.7166 Baotong Xi Street, Weicheng District, Weifang, 261053, China.
| | - Mi Liu
- "Health Shandong" Major Social Risk Prediction and Governance Collaborative Innovation Center, School of Public Health and Management, Weifang Medical University, No.7166 Baotong Xi Street, Weicheng District, Weifang, 261053, China
| | - Zhe Chen
- "Health Shandong" Major Social Risk Prediction and Governance Collaborative Innovation Center, School of Public Health and Management, Weifang Medical University, No.7166 Baotong Xi Street, Weicheng District, Weifang, 261053, China
| | - Shiwei Liu
- Chinese Center for Disease Control and Prevention, No.27 Nanwei Road, Xicheng District, Beijing, 100050, China.
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21
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Baral R, Nonvignon J, Debellut F, Agyemang SA, Clark A, Pecenka C. Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates. BMC Public Health 2020; 20:619. [PMID: 32370763 PMCID: PMC7201538 DOI: 10.1186/s12889-020-08595-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 03/26/2020] [Indexed: 01/07/2023] Open
Abstract
Background Numerous studies have reported the economic burden of childhood diarrhea in low- and middle-income countries (LMICs). Yet, empirical data on the cost of diarrheal illness is sparse, particularly in LMICs. In this study we review the existing literature on the cost of childhood diarrhea in LMICs and generate comparable estimates of cost of diarrhea across 137 LMICs. Methods The systematic literature review included all articles reporting cost estimates of diarrhea illness and treatment from LMICs published between January 2006 and July 2018. To generate country-specific costs, we used service delivery unit costs from the World Health Organization’s Choosing Interventions that are Cost-Effective (WHO–CHOICE database). Non-medical costs were calculated using the ratio between direct medical and direct non-medical costs, derived from the literature review. Indirect costs (lost wages to caregivers) were calculated by multiplying the average GDP per capita per day by the average number of days lost to illness identified from the literature. All cost estimates are reported in 2015 USD. We also generated estimates using the IHME’s service delivery unit costs to explore input sensitivity on modelled cost estimates. Results We identified 25 articles with 64 data points on either direct or indirect cost of diarrhoeal illness in children aged < 5 years in 20 LMICs. Of the 64 data points, 17 were on the cost of outpatient care, 28 were on the cost of inpatient care, and 19 were unspecified. The average cost of illness was US$36.56 (median $15.73; range $4.30 – $145.47) per outpatient episode and $159.90 (median $85.85; range $41.01 – $538.33) per inpatient episode. Direct medical costs accounted for 79% (83% for inpatient and 74% for outpatient) of the total direct costs. Our modelled estimates, across all 137 countries, averaged (weighted) $52.16 (median $47.56; range $8.81 – $201.91) per outpatient episode and $216.36 (median $177.20; range $23.77 –$1225.36) per inpatient episode. In the 12 countries with primary data, there was reasonable agreement between our modelled estimates and the reported data (Pearson’s correlation coefficient = .75). Conclusion Our modelled estimates generally correspond to estimates observed in the literature, with a few exceptions. These estimates can serve as useful inputs for planning and prioritizing appropriate health interventions for childhood diarrheal diseases in LMICs in the absence of empirical data.
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Affiliation(s)
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana.,Health Economics, Systems and Policy Research Group, University of Ghana, Legon, Accra, Ghana
| | | | - Samuel Agyei Agyemang
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
| | - Andrew Clark
- London School of Hygiene and Tropical Medicine, London, UK
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22
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Prinja S, Chauhan AS, Rajsekhar K, Downey L, Bahuguna P, Sachin O, Guinness L. Addressing the Cost Data Gap for Universal Healthcare Coverage in India: A Call to Action. Value Health Reg Issues 2020; 21:226-229. [DOI: 10.1016/j.vhri.2019.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/10/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
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23
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Godman B, Basu D, Pillay Y, Mwita JC, Rwegerera GM, Anand Paramadhas BD, Tiroyakgosi C, Okwen PM, Niba LL, Nonvignon J, Sefah I, Oluka M, Guantai AN, Kibuule D, Kalemeera F, Mubita M, Fadare J, Ogunleye OO, Distiller LA, Rampamba EM, Wing J, Mueller D, Alfadl A, Amu AA, Matsebula Z, Kalungia A, Zaranyika T, Masuka N, Wale J, Hill R, Kurdi A, Timoney A, Campbell S, Meyer JC. Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future. Front Pharmacol 2020; 11:108. [PMID: 32265688 PMCID: PMC7098994 DOI: 10.3389/fphar.2020.00108] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention. Objective Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases. Our Approach Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance. Ongoing Activities A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities. Conclusion There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Yogan Pillay
- HIV & AIDS, TB and Maternal, Child and Women's Health, National Department of Health, Pretoria, South Africa
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | | | - Celda Tiroyakgosi
- Botswana Essential Drugs Action Program, Ministry of Health and Wellness, Gaborone, Botswana
| | - Patrick Mbah Okwen
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N Guantai
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Larry A Distiller
- Centre for Diabetes & Endocrinology (Pty) Ltd, Johannesburg, South Africa
| | - Enos M Rampamba
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Pharmacy, Tshilidzini Regional Hospital, Limpopo Department Of Health, Shayandima, South Africa
| | - Jeffrey Wing
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Debjani Mueller
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.,Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan.,Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | | | | | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Nyasha Masuka
- Independent Health Systems Consultant, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, United Kingdom
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,NHS Lothian Director of Pharmacy, NHS Lothian, Edinburgh, United Kingdom
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Mahdavi M, Parsaeian M, Mohajer B, Modirian M, Ahmadi N, Yoosefi M, Mehdipour P, Djalalinia S, Rezaei N, Haghshenas R, Pazhuheian F, Madadi Z, Sabooni M, Razi F, Samiee SM, Farzadfar F. Insight into blood pressure targets for universal coverage of hypertension services in Iran: the 2017 ACC/AHA versus JNC 8 hypertension guidelines. BMC Public Health 2020; 20:347. [PMID: 32183754 PMCID: PMC7076938 DOI: 10.1186/s12889-020-8450-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/03/2020] [Indexed: 01/13/2023] Open
Abstract
Background We compared the prevalence, awareness, treatment, and control of hypertension in Iran based on two hypertension guidelines; the 2017 ACC/AHA –with an aggressive blood pressure target of 130/80 mmHg- and the commonly used JNC8 guideline cut-off of 140/90 mmHg. We shed light on the implications of the 2017 ACC/AHA for population subgroups and high-risk individuals who were eligible for non-pharmacologic and pharmacologic therapies. Methods Data was obtained from the Iran national STEPS 2016 study. Participants included 27,738 adults aged ≥25 years as a representative sample of Iranians. Regression models of survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension. Results The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2–30.6), which soared to 53.7% (52.9–54.4) based on the 2017 ACC/AHA. The percentage of awareness, treatment, and control were 59.2% (58.0–60.3), 80.2% (78.9–81.4), and 39.1% (37.4–40.7) based on JNC8, which dropped to 37.1% (36.2–38.0), 71.3% (69.9–72.7), and 19.6% (18.3–21.0), respectively, by applying the 2017 ACC/AHA. Based on the new guideline, adults aged 25–34 years had the largest increase in prevalence (from 7.3 to 30.7%). They also had the lowest awareness and treatment rate, contrary to the highest control rate (36.5%) between age groups. Compared with JNC8, based on the 2017 ACC/AHA, 24, 15, 17, and 11% more individuals with dyslipidaemia, high triglycerides, diabetes, and cardiovascular disease events, respectively, fell into the hypertensive category. Yet, based on the 2017 ACC/AHA, 68.2% of individuals falling into the hypertensive category were eligible for receiving pharmacologic therapy (versus 95.7% in JNC8). LDL cholesterol< 130 mg/dL, sufficient physical activity (Metabolic Equivalents≥600/week), and Body Mass Index were found to change blood pressure by − 3.56(− 4.38, − 2.74), − 2.04(− 2.58, − 1.50), and 0.48(0.42, 0.53) mmHg, respectively. Conclusions Switching from JNC8 to 2017 ACC/AHA sharply increased the prevalence and drastically decreased the awareness, treatment, and control in Iran. Based on the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category; these individuals might benefit from earlier interventions such as lifestyle modifications. The low control rate among individuals receiving treatment warrants a critical review of hypertension services.
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Affiliation(s)
- Mahdi Mahdavi
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.,Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Mahboubeh Parsaeian
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohajer
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Modirian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parinaz Mehdipour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Forough Pazhuheian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Madadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sabooni
- Reference Health Laboratory, Ministry of Health and Medical Education, Tehran, Iran
| | - Farideh Razi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Mirab Samiee
- Reference Health Laboratory, Ministry of Health and Medical Education, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. .,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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25
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Efficacy of a Lupinus mutabilis Sweet snack as complement to conventional type 2 diabetes mellitus treatment. NUTR HOSP 2020; 36:905-911. [PMID: 31291739 DOI: 10.20960/nh.02590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: therapeutic lifestyles changes including frequent consumption of legumes have resulted in improved metabolic control and decreased blood pressure in type 2 diabetes-mellitus (T2DM) patients. Objective: this was a quasi-experimental-28-week crossover-study that assessed the effect of daily consumption of the legume Lupinus mutabilis (LM) on metabolic control of T2DM patients under hypoglycemic oral treatment. Material and methods: we recruited 79 adult male and female patients that were followed for 14-weeks without LM consumption and then received increasing doses of a LM-based-snack for other 14-weeks. Results: there was a significant decrease in blood pressure and a significant increase in HDL-cholesterol by the end of the study period. While patients with A1C concentrations > 8 and ≤ 10 did not significantly improve their metabolic control, patients with serum A1C concentrations ≤ 8.0% reduced significantly their A1C after the intervention and 71% achieved a target concentration of 6.5%. Conclusion: patients with T2DM could benefit with the addition of LM-snack to their conventional treatment.
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26
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Lin JK, Moran AE, Bibbins-Domingo K, Falase B, Pedroza Tobias A, Mandke CN, Kazi DS. Cost-effectiveness of a fixed-dose combination pill for secondary prevention of cardiovascular disease in China, India, Mexico, Nigeria, and South Africa: a modelling study. LANCET GLOBAL HEALTH 2019; 7:e1346-e1358. [PMID: 31477544 DOI: 10.1016/s2214-109x(19)30339-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/28/2019] [Accepted: 07/22/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Fewer than 25% of patients with atherosclerotic cardiovascular disease in countries of low and middle income (LMICs) use guideline-directed drugs for secondary prevention. A fixed-dose combination polypill might improve cardiovascular outcomes by increasing prescription rates and adherence, but the cost-effectiveness of this approach is uncertain. METHODS We developed microsimulation models to assess the cost-effectiveness of a polypill containing aspirin, lisinopril, atenolol, and simvastatin for secondary prevention of atherosclerotic cardiovascular disease compared with current care in China, India, Mexico, Nigeria, and South Africa. We modelled baseline use of secondary prevention drugs on the Prospective Urban Rural Epidemiological study. In the intervention arm, we assumed that patients currently prescribed any prevention drug for atherosclerotic cardiovascular disease would receive the polypill instead, which would improve adherence by 32% (from a meta-analysis of two randomised trials in LMICs). We assessed the cost-effectiveness of the polypill at prices in the public sector and on the retail market. Key outcomes were major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) over a 5-year period and the incremental cost-effectiveness ratio (ICER) from the perspective of the health-care sector and a lifetime analytical horizon. We assumed a cost-effectiveness threshold equal to each country's per capita gross domestic product (GDP) per disability-adjusted life-year (DALY) averted. In sensitivity analyses, we examined the population health effect achievable by increasing the uptake of the polypill in the eligible population. FINDINGS Among adults aged 30-84 years with established atherosclerotic cardiovascular disease, adoption of the polypill for secondary prevention compared with current care was projected to avert 40-54 major adverse cardiovascular events for every 1000 patients treated for 5 years and produce between three and ten additional serious adverse events. Assuming public-sector pharmaceutical prices, the ICER of the polypill compared with current care over a lifetime analytical horizon was Int$168 (95% UI 55 to 337) per DALY averted in China, $154 (57 to 289) in India, $88 (15 to 193) in Mexico, $364 (147 to 692) in Nigeria, and $64 (cost-saving to 203) in South Africa, amounting to 0·4-6·2% of the per capita GDP in these countries. The ICER of the polypill compared with current care increased to 3·3-14·6% of the per capita GDP at retail market pharmaceutical prices. Use of the polypill at current rates of prescription of secondary prevention drugs would produce modest health benefits, reducing DALYs from atherosclerotic cardiovascular disease among patients with established disease by 3·1-10·1% over 10 years. Increasing use to 50% or 75% of the eligible population would produce substantially larger health gains (up to 24·3% atherosclerotic cardiovascular disease DALYs averted). INTERPRETATION The polypill is projected to be cost-effective compared with current care for secondary prevention of atherosclerotic cardiovascular disease in China, India, Mexico, Nigeria, and South Africa, particularly if it is made available at public-sector pricing. However, achieving meaningful improvements in cardiovascular health will require simultaneous investments in health infrastructure to increase the uptake of the polypill among patients with established atherosclerotic cardiovascular disease. FUNDING Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Hellman Family Foundation, Department of Veterans Affairs, and University of California at San Francisco.
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Affiliation(s)
- John K Lin
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Primary Care Outcomes Research, Stanford University, Stanford, CA, USA
| | - Andrew E Moran
- Division of General Medicine, Columbia University Medical Center and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California at San Francisco, San Francisco, CA, USA
| | - Bode Falase
- Cardiothoracic Division, Department of Surgery, Lagos State University College of Medicine, Lagos, Nigeria
| | - Andrea Pedroza Tobias
- Global Health Sciences, University of California at San Francisco, San Francisco, CA, USA; Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Charuta N Mandke
- H B T Medical College, and Dr R N Cooper Hospital, Mumbai, India
| | - Dhruv S Kazi
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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27
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Ryder S, Fox K, Rane P, Armstrong N, Wei CY, Deshpande S, Stirk L, Qian Y, Kleijnen J. A Systematic Review of Direct Cardiovascular Event Costs: An International Perspective. PHARMACOECONOMICS 2019; 37:895-919. [PMID: 30949988 DOI: 10.1007/s40273-019-00795-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION There is a lack of comprehensive cost information for cardiovascular events since 2013. OBJECTIVE A systematic review on the contemporary cost of cardiovascular events was therefore undertaken. METHODS Methods complied with those recommended by the Cochrane Collaboration and the Centre for Reviews and Dissemination. Studies were unrestricted by language, were from 2013 to 23 December 2017, and included cost-of-illness data in adults with the following cardiovascular conditions: myocardial infarction (MI), stroke, transient ischaemic attack (TIA), heart failure (HF), unstable angina (UA), coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), or peripheral artery disease (PAD). Seven electronic databases were searched, namely Embase (Ovid), MEDLINE (Ovid), MEDLINE In-Process Citations and Daily Update (Ovid), NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) database, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed. The included studies reported data from a variety of years (sometimes prior to 2013), so costs were inflated and converted to $US, year 2018 values, for standardization. RESULTS After de-duplication, 29,945 titles and abstracts and then 403 full papers were screened; 82 studies (88 papers) were extracted. Year 1 average cost ranges were as follows: MI ($11,970 in Sweden to $61,864 in the USA), stroke ($10,162 in Spain to $46,162 in the USA), TIA ($6049 in Sweden to $25,306 in the USA), HF ($4456 in China to $49,427 in the USA), UA ($11,237 in Sweden to $31,860 in the USA), PCI ($17,923 in Italy to $45,533 in the USA), CABG ($17,972 in the UK to $76,279 in the USA). One Swedish study reported PAD costs in a format convertible to $US, 2018 values, with a mean annual cost of $15,565. CONCLUSIONS There was considerable unexplained variation in contemporary costs for all major cardiovascular events. One emerging theme was that average costs in the USA were considerably higher than anywhere else.
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Affiliation(s)
- Steve Ryder
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK.
| | - Kathleen Fox
- Strategic Healthcare Solutions LLC, 133 Cottonwood Creek Lane, Aiken, SC, 29803, USA
| | - Pratik Rane
- Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, 91320-1799, USA
| | - Nigel Armstrong
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Ching-Yun Wei
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Sohan Deshpande
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Lisa Stirk
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Yi Qian
- Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, 91320-1799, USA
| | - Jos Kleijnen
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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28
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Wei HC, Xiao MX, Chen HY, Li YQ, Wu HT, Sun CK. Instantaneous frequency from Hilbert-Huang transformation of digital volume pulse as indicator of diabetes and arterial stiffness in upper-middle-aged subjects. Sci Rep 2018; 8:15771. [PMID: 30361528 PMCID: PMC6202317 DOI: 10.1038/s41598-018-34091-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 10/09/2018] [Indexed: 11/21/2022] Open
Abstract
To investigate the value of decomposed short-time digital volume pulse (DVP) signals in discerning systemic vascular anomaly in diabetic patients, demographic and anthropometric parameters, serum lipid profile, fasting blood glucose and glycated hemoglobin (HbA1c) levels were obtained from 29 healthy adults (Group 1) and 29 age-matched type 2 diabetes mellitus patients (Group 2). Six-second DVP signals from right index finger acquired through photoplethysmography were decomposed using ensemble empirical mode decomposition. Using one intrinsic mode function (IMF5), stiffness index (SI) and instantaneous energy of maximal energy (fEmax) were obtained. Other indicators of arterial stiffness, including electrocardiogram-pulse wave velocity of foot (ECG-PWVfoot), crest time (CT) and crest time ratio (CTR), were obtained from the testing subjects for comparison. The mean body weight, body mass index, waist circumference, HbA1c and fasting blood sugar levels were higher in Group 2 than those in Group 1, whereas values of systolic and diastolic blood pressure were lower in Group 2 than those in Group 1. SI and fEmax were significantly higher in Group 2 than those in Group 1. Moreover, fEmax was positively associated with HbA1c concentration, CT and SI in Group 2 (p < 0.05) but not in Group 1. When all subjects were considered, fEmax was highly significantly associated with HbA1c and fasting blood sugar levels, and SI (all p < 0.001). After Hilbert-Huang transformation, short-time DVP signals could give significant information on arterial stiffness and vascular anomaly in diabetic patients.
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Affiliation(s)
- Hai-Cheng Wei
- School of Electrical and Information Engineering, North Minzu University, No. 204 North - Wenchang St., Xixia District, Yinchuan, Ningxia, 750021, China
| | - Ming-Xia Xiao
- School of Electrical and Information Engineering, North Minzu University, No. 204 North - Wenchang St., Xixia District, Yinchuan, Ningxia, 750021, China.,School of Computer and Information, Hefei University of Technology, No. 193, Tunxi Rd., Hefei, Anhui, 230009, China
| | - Hong-Yu Chen
- School of Electrical and Information Engineering, North Minzu University, No. 204 North - Wenchang St., Xixia District, Yinchuan, Ningxia, 750021, China
| | - Yun-Qin Li
- School of Electrical and Information Engineering, North Minzu University, No. 204 North - Wenchang St., Xixia District, Yinchuan, Ningxia, 750021, China
| | - Hsien-Tsai Wu
- Department of Electrical Engineering, National Dong Hwa University, No. 1, Sec. 2, Da Hsueh Rd., Shoufeng, Hualien, 97401, Taiwan.
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University School of Medicine for International Students, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan.
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Huque R, Nasreen S, Ahmed F, Hicks JP, Walley J, Newell JN, Elsey H. Integrating a diabetes and hypertension case management package within primary health care: a mixed methods feasibility study in Bangladesh. BMC Health Serv Res 2018; 18:811. [PMID: 30352582 PMCID: PMC6199737 DOI: 10.1186/s12913-018-3601-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 10/03/2018] [Indexed: 11/17/2022] Open
Abstract
Background Almost three quarters of non-communicable disease (NCD) deaths, and 82% of premature NCD deaths, occur in low- and middle-income countries. Bangladesh has an estimated 7 million hypertensives and 10 million diabetics, and primary care is struggling to respond. Our aim was to develop and support implementation of a diabetes and hypertension case management package, and assess its appropriateness, feasibility and acceptability in two NCD clinics within two primary-care centres in Bangladesh. Methods We used a convergent mixed methods design. We first assessed the level of appropriate hypertension and cardiovascular disease patient management, based on a composite outcome indicator using data from patients’ treatment cards. Appropriate management was primarily informed by International Diabetes Federation (IDF) and World Health Organisation (WHO) guidelines. We then performed qualitative in-depth interviews with doctors and patients to explain these quantitative findings and to understand the challenges to achieving appropriate patient management in the NCD clinics. Results Eighty-one newly diagnosed patients were recruited. Over 3 months, 53.1% (95% CI 42.3% to 63.6%) of patients were appropriately managed. We found incomplete diagnosis (especially missing hypertension diagnosis alongside diabetes) and non-provision of follow-up appointments were the main causes of the relatively low level of appropriate management. We conducted interviews with 11 patients and 8 health professionals and found a shortage of human resources, reporting materials, available drugs and diagnostic equipment. This undermined patients’ willingness to attend clinics and doctors’ willingness to offer follow-ups. Hands-on skill-building training was valuable in increasing doctors’ competence for appropriate management, but was seen as a novel training method and faced constraints to implementation. Conclusions A clinical guide, skill-based training and recording package can be implemented in routine primary care and can lead to appropriate management of around half of diabetic and hypertensive patients in a low-income country. However, considerable health systems challenges must be addressed before more patients can be managed appropriately.
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Affiliation(s)
- R Huque
- Advancement through Research and Knowledge (ARK) Foundation, House No. B 130, Road No. 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh.
| | - S Nasreen
- Advancement through Research and Knowledge (ARK) Foundation, House No. B 130, Road No. 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - F Ahmed
- Advancement through Research and Knowledge (ARK) Foundation, House No. B 130, Road No. 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - J P Hicks
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9JT, UK
| | - J Walley
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9JT, UK
| | - J N Newell
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9JT, UK
| | - H Elsey
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9JT, UK
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30
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Gheorghe A, Griffiths U, Murphy A, Legido-Quigley H, Lamptey P, Perel P. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review. BMC Public Health 2018; 18:975. [PMID: 30081871 PMCID: PMC6090747 DOI: 10.1186/s12889-018-5806-x] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/05/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The evidence on the economic burden of cardiovascular disease (CVD) in low- and middle- income countries (LMICs) remains scarce. We conducted a comprehensive systematic review to establish the magnitude and knowledge gaps in relation to the economic burden of CVD and hypertension on households, health systems and the society. METHODS We included studies using primary or secondary data to produce original economic estimates of the impact of CVD. We searched sixteen electronic databases from 1990 onwards without language restrictions. We appraised the quality of included studies using a seven-question assessment tool. RESULTS Eighty-three studies met the inclusion criteria, most of which were single centre retrospective cost studies conducted in secondary care settings. Studies in China, Brazil, India and Mexico contributed together 50% of the total number of economic estimates identified. The quality of the included studies was generally low. Reporting transparency, particularly for cost data sources and results, was poor. The costs per episode for hypertension and generic CVD were fairly homogeneous across studies; ranging between $500 and $1500. In contrast, for coronary heart disease (CHD) and stroke cost estimates were generally higher and more heterogeneous, with several estimates in excess of $5000 per episode. The economic perspective and scope of the study appeared to impact cost estimates for hypertension and generic CVD considerably less than estimates for stroke and CHD. Most studies reported monthly costs for hypertension treatment around $22. Average monthly treatment costs for stroke and CHD ranged between $300 and $1000, however variability across estimates was high. In most LMICs both the annual cost of care and the cost of an acute episode exceed many times the total health expenditure per capita. CONCLUSIONS The existing evidence on the economic burden of CVD in LMICs does not appear aligned with policy priorities in terms of research volume, pathologies studied and methodological quality. Not only is more economic research needed to fill the existing gaps, but research quality needs to be drastically improved. More broadly, national-level studies with appropriate sample sizes and adequate incorporation of indirect costs need to replace small-scale, institutional, retrospective cost studies.
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Affiliation(s)
- Adrian Gheorghe
- Oxford Policy Management Ltd, Level 3 Clarendon House, 52 Cornmarket St, Oxford, OX1 3HJ UK
- Department of Global Health and Development, LSHTM, Keppel Street, London, WC1E 7HT UK
| | - Ulla Griffiths
- UNICEF, 3 United Nations Plaza, New York, NY 10017 USA
- Department of Global Health and Development, LSHTM, Keppel Street, London, WC1E 7HT UK
| | - Adrianna Murphy
- Centre for Global Chronic Conditions, LSHTM, Keppel Street, London, WC1E 7HT UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
- LSHTM, Keppel Street, London, WC1E 7HT UK
| | - Peter Lamptey
- Department of Non-communicable Disease Epidemiology, LSHTM, Keppel Street, London, WC1E 7HT UK
| | - Pablo Perel
- Centre for Global Chronic Conditions, LSHTM, Keppel Street, London, WC1E 7HT UK
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Ballo P, Profili F, Policardo L, Roti L, Francesconi P, Zuppiroli A. Opposite trends in hospitalization and mortality after implementation of a chronic care model-based regional program for the management of patients with heart failure in primary care. BMC Health Serv Res 2018; 18:388. [PMID: 29848317 PMCID: PMC5975582 DOI: 10.1186/s12913-018-3164-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/30/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The chronic care model (CCM) is an established framework for the management of patients with chronic illness at the individual and population level. Its application has been previously shown to improve clinical outcome in several conditions, but the prognostic impact of CCM-based programs for the management of patients with chronic heart failure (HF) in primary care is still to be elucidated. METHODS We assessed the prognostic impact of a primary-care, CCM-based project applied in Tuscany, Italy, in 1761 patients with chronic HF enrolled in a retrospective matched cohort study. The project was based on predefined working teams including general practitioners and nurses, proactively scheduled regular follow-up visitations for each patient, counseling for therapy adherence and lifestyle modifications, appropriate diagnostic and therapeutic pathways according to international guidelines, and a key supporting role of the nurses, who were responsible for the practical coordination of the follow-up. A matched group of 3522 HF subjects assisted by general practitioners not involved in the project was considered as control group. The endpoints of this study were HF hospitalization and all-cause mortality. RESULTS Over a 4-year follow-up period, HF hospitalization rate was higher in the CCM group than the controls (12.1 vs 10.3 events/100 patient-years; incidence rate ratio 1.15[1.05-1.27], p = 0.0030). Mortality was lower in the CCM group than the controls (10.8 vs 12.6 events/100 patient-years; incidence rate ratio 0.82[0.75-0.91], p < 0.0001). In multivariable analysis, the CCM status was associated with a 34% higher risk of HF hospitalization and 18% lower risk of death (p < 0.0001 for both). The effect on HF hospitalization was mostly driven by a 50% higher rate of planned HF hospitalization. CONCLUSIONS Implementation of a CCM-based program for the management of HF patients in primary care led to reduced mortality and increased HF hospitalization. These findings support the hypothesis that the beneficial effects of CCM on survival might be extended to patients with chronic HF followed in primary care, but also support the need for further strategies aimed at improving the management of these patients in terms of hospitalizations.
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Affiliation(s)
- Piercarlo Ballo
- Cardiology Unit, S. Maria Annunziata Hospital, via dell’Antella 58, Florence, Italy
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Abstract
The number of patients requiring dialysis by 2030 is projected to double worldwide, with the largest increase expected in low- and middle-income countries (LMICs). Dialysis is seldom considered a high priority by health care funders, consequently, few LMICs develop policies regarding dialysis allocation. Dialysis facilities may exist, but access remains highly inequitable in LMICs. High out-of-pocket payments make dialysis unsustainable and plunge many families into poverty. Patients, families, and clinicians suffer significant emotional and moral distress from daily life-and-death decisions imposed by dialysis. The health system's obligation to provide financial risk protection is an important component of global and national strategies to achieve universal health coverage. An ethical imperative therefore exists to develop transparent dialysis priority-setting guidelines to facilitate public understanding and acceptance of the realistic limits within the health system, and facilitate fair allocation of scarce resources. In this article, we present ethical challenges faced by patients, families, clinicians, and policy makers where dialysis is not universally accessible and discuss the potential ethical consequences of various dialysis allocation strategies. Finally, we suggest an ethical framework for use in policy development for priority setting of dialysis care. The accountability for reasonableness framework is proposed as a procedurally fair decision-making, priority-setting process.
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Walker IF, Garbe F, Wright J, Newell I, Athiraman N, Khan N, Elsey H. The Economic Costs of Cardiovascular Disease, Diabetes Mellitus, and Associated Complications in South Asia: A Systematic Review. Value Health Reg Issues 2018; 15:12-26. [DOI: 10.1016/j.vhri.2017.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/25/2017] [Accepted: 05/01/2017] [Indexed: 10/19/2022]
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Prabhakaran D, Anand S, Watkins D, Gaziano T, Wu Y, Mbanya JC, Nugent R. Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition. Lancet 2018; 391:1224-1236. [PMID: 29108723 PMCID: PMC5996970 DOI: 10.1016/s0140-6736(17)32471-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 08/04/2017] [Accepted: 09/05/2017] [Indexed: 12/11/2022]
Abstract
Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action.
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Affiliation(s)
- Dorairaj Prabhakaran
- Public Health Foundation of India, Gurgaon, India; Centre for Chronic Disease Control, New Delhi, India; Department of Non-communicable Disease Epidemiology, London School of Hygiene Tropical Medicine, London, UK; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David Watkins
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Thomas Gaziano
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Yangfeng Wu
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
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Brody AM, Kumar VA, Levy PD. Hot Topic: Global Burden of Treating Hypertension-What is the Role of the Emergency Department? Curr Hypertens Rep 2018; 19:8. [PMID: 28176250 DOI: 10.1007/s11906-017-0707-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hypertension (HTN) is the most common modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality worldwide. Lower- and middle-income countries (LMICs) are projected to bear the vast majority of this disease burden, but local and regional health care delivery systems in these countries are ill equipped to meet this need. Emergency care is receiving increased recognition as a crucial component of public and community health. The rapid evolution of emergency care in LMICs provides a unique opportunity to develop innovative strategies, incorporating existing strengths of emergency departments, to address this paradigm shift in the disease burden associated with HTN on a global scale.
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Affiliation(s)
- Aaron M Brody
- Wayne State University School of Medicine, Detroit, MI, 48201, USA.
| | - Vijaya A Kumar
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, 48104, USA
| | - Phillip D Levy
- Department of Emergency Medicine and Cardiovascular Research Institute, Integrated Biosciences Center, Wayne State University School of Medicine, 6135 Woodward Ave, Detroit, MI, 48202, USA
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Puri K, Kazembe P, Mkaliainga T, Chiume M, Cabrera AG, Sims Sanyahumbi A. Pattern of inpatient pediatric cardiology consultations in sub-Saharan Africa. CONGENIT HEART DIS 2018; 13:334-341. [DOI: 10.1111/chd.12573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Kriti Puri
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital; Houston Texas USA
| | - Peter Kazembe
- Baylor College of Medicine; Children's Foundation Malawi; Lilongwe Malawi
| | | | - Msandeni Chiume
- Department of Pediatrics; Kamuzu Central Hospital; Lilongwe Malawi
| | - Antonio G. Cabrera
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital; Houston Texas USA
| | - Amy Sims Sanyahumbi
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital; Houston Texas USA
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Tran BX, Vu GT, Nguyen THT, Nguyen LH, Pham DD, Truong VQ, Thai TPT, Vu TMT, Nguyen TQ, Nguyen V, Nguyen THT, Latkin CA, Ho CS, Ho RC. Demand and willingness to pay for different treatment and care services among patients with heart diseases in Hanoi, Vietnam. Patient Prefer Adherence 2018; 12:2253-2261. [PMID: 30464415 PMCID: PMC6214407 DOI: 10.2147/ppa.s176262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In Vietnam, cardiovascular diseases (CVDs) are serious health issues, especially in the context of overload central heart hospitals, insufficient primary healthcare, and lack of customer-oriented care and treatment. Attempts to measure demand and willingness-to-pay (WTP) for different CVD treatments and care services have been limited. This study explored the preferences and WTP of patients with heart diseases for different home- and hospital-based services in Hanoi, Vietnam. METHODS A cross-sectional survey was performed at the Hanoi Heart Hospital from July to December 2017. A contingent valuation was adopted to determine the preferences of patients and measure their WTP. Interval regressions were employed to determine the potential predictors of patients' WTP. RESULTS Hospital-based services were most preferred by patients, with demand ranging from 45.6% to 82.3% of total participants, followed by home-based (45.4%-45.8%) and administrative services (28.9%-34%). WTP for hospital-based services were in the range of US$ 9.8 (US$ 8.4-11.2)-US$ 21.9 (US$ 20.3-23.4), while figures for home-based and administrative services were US$ 9.8 (US$ 8.4-11.2)-US$ 22 (US$ 18.7-25.3) and 1.9 (US$ 1.6-2.2)-US$ 7.5 (US$ 6.3-8.6), respectively. Patients who lived in urban areas, were employed, were having higher level of education, and were not covered by health insurance were willing to pay more for services, especially home-based ones. CONCLUSION Demand and WTP for home-based services among heart disease patients were moderately low compared with hospital-based ones. There is a need for more policies supporting home-based services, better communication of services' benefits to general public and patients, and introduction of services packages based on patients' preferences.
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Affiliation(s)
- Bach Xuan Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam,
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | | | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | | | | | - Thao Phuong Thi Thai
- Department of General Planning and Department of Cardiology, Friendship Hospital, Hanoi, Vietnam
| | | | | | - Vu Nguyen
- Department of Neurosurgery Spine-Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
| | | | - Carl A Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,
| | - Cyrus Sh Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger Cm Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Luyckx VA, Tuttle KR, Garcia-Garcia G, Gharbi MB, Heerspink HJL, Johnson DW, Liu ZH, Massy ZA, Moe O, Nelson RG, Sola L, Wheeler DC, White SL. Reducing major risk factors for chronic kidney disease. Kidney Int Suppl (2011) 2017; 7:71-87. [PMID: 30675422 DOI: 10.1016/j.kisu.2017.07.003] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease (CKD) is a global public health concern and a key determinant of poor health outcomes. While the burden of CKD is reasonably well defined in developed countries, increasing evidence indicates that the CKD burden may be even greater in developing countries. Diabetes, hypertension, and obesity are major contributors to the global burden of the disease and are important traditional CKD risk factors; however, nontraditional CKD risk factors such as nephrotoxin exposure, kidney stones, fetal and maternal factors, infections, environmental factors, and acute kidney injury are also increasingly being recognized as major threats to global kidney health. A broad approach to CKD prevention begins with the identification of CKD risk factors in the population, followed by the development of appropriate mitigation strategies. Effective prevention policies rely on an accurate understanding of the incidence and prevalence of CKD in a given setting, as well as the distribution and burden of risk factors. Populations or individuals at CKD risk must be screened and treated early to prevent the onset of and delay the progression of the kidney disease. Systematically collected data should be analyzed at country, province, and district levels to identify regional disparities and CKD hotspots and develop targeted prevention strategies. Race-ethnicity, genetics, sex, socioeconomic status, and geography are likely modifiers of CKD risk. A comprehensive, informed approach to prevention that takes into account all of these factors is therefore required to successfully tackle the global CKD epidemic.
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Affiliation(s)
- Valerie A Luyckx
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.,Klinik für Nephrologie, Universitätsspital, Zurich, Switzerland
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Health Care Kidney Research Institute, Nephrology Division and Institute for Translational Health Sciences, University of Washington, Spokane, Washington, USA
| | - Guillermo Garcia-Garcia
- Servicio de Nefrologia, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital 278, Guadalajara, Jalisco, Mexico
| | - Mohammed Benghanem Gharbi
- Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré Hospital, APHP, Boulogne Billancourt/Paris, France.,French National Institute of Health and Medical Research (INSERM) U1018, Team5, Centre for Research in Epidemiology and Population Health (CESP), Paris-Ile-de-France-West, Versailles-Saint-Quentin-en-Yvelines University, Villejuif, France
| | - Orson Moe
- Department of Internal Medicine and Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Laura Sola
- Division Epidemiologia, Direccion General de Salud (DIGESA)-Ministerio Salud Publica, Montevideo, Uruguay
| | - David C Wheeler
- Centre for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Sarah L White
- Charles Perkins Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Leong DP, Joseph PG, McKee M, Anand SS, Teo KK, Schwalm JD, Yusuf S. Reducing the Global Burden of Cardiovascular Disease, Part 2: Prevention and Treatment of Cardiovascular Disease. Circ Res 2017; 121:695-710. [PMID: 28860319 DOI: 10.1161/circresaha.117.311849] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this second part of a 2-part series on the global burden of cardiovascular disease, we review the proven, effective approaches to the prevention and treatment of cardiovascular disease. We specifically review the management of acute cardiovascular diseases, including acute coronary syndromes and stroke; the care of cardiovascular disease in the ambulatory setting, including medical strategies for vascular disease, atrial fibrillation, and heart failure; surgical strategies for arterial revascularization, rheumatic and other valvular heart disease, and symptomatic bradyarrhythmia; and approaches to the prevention of cardiovascular disease, including lifestyle factors, blood pressure control, cholesterol-lowering, antithrombotic therapy, and fixed-dose combination therapy. We also discuss cardiovascular disease prevention in diabetes mellitus; digital health interventions; the importance of socioeconomic status and universal health coverage. We review building capacity for conduction cardiovascular intervention through strengthening healthcare systems, priority setting, and the role of cost effectiveness.
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Affiliation(s)
- Darryl P Leong
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.).
| | - Philip G Joseph
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.)
| | - Martin McKee
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.)
| | - Sonia S Anand
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.)
| | - Koon K Teo
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.)
| | - Jon-David Schwalm
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.)
| | - Salim Yusuf
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.)
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Mendoza W, Miranda JJ. Global Shifts in Cardiovascular Disease, the Epidemiologic Transition, and Other Contributing Factors: Toward a New Practice of Global Health Cardiology. Cardiol Clin 2017; 35:1-12. [PMID: 27886780 DOI: 10.1016/j.ccl.2016.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
One of the major drivers of change in the practice of cardiology is population change. This article discusses the current debate about epidemiologic transition paired with other ongoing transitions with direct relevance to cardiovascular conditions. Challenges specific to patterns of risk factors over time; readiness for disease surveillance and meeting global targets; health system, prevention, and treatment efforts; and physiologic traits and human-environment interactions are identified. This article concludes that a focus on the most populated regions of the world will contribute substantially to protecting the large gains in global survival and life expectancy accrued over the last decades.
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Affiliation(s)
- Walter Mendoza
- United Nations Population Fund, Peru Country Office, Av. Guardia Civil 1231, San Isidro, Lima 27, Peru
| | - J Jaime Miranda
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres, Lima 31, Peru; CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru.
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Mirelman A. Economic evaluation of diabetes prevention: informing global health implementation decisions. Lancet Diabetes Endocrinol 2016; 4:879-880. [PMID: 27717765 DOI: 10.1016/s2213-8587(16)30289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 11/21/2022]
Affiliation(s)
- Andrew Mirelman
- Centre for Health Economics, University of York, York YO10 5DD, UK.
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Baldisserotto J, Kopittke L, Nedel FB, Takeda SP, Mendonça CS, Sirena SA, Diercks MS, de Lima LA, Nicolau B. Socio-demographic caracteristics and prevalence of risk factors in a hypertensive and diabetics population: a cross-sectional study in primary health care in Brazil. BMC Public Health 2016; 16:573. [PMID: 27422747 PMCID: PMC4946130 DOI: 10.1186/s12889-016-3230-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systemic arterial hypertension and diabetes mellitus, and their related morbidity and mortality, are currently the most common public health problems and also a higher burden of disease in Brazil. They represent a real challenge for primary health care. This study describes the methodology and baseline data of an adult population with hypertension and diabetes attending in primary health care. METHODS It is a cross sectional study which presents data from a longitudinal research. 3784 adults were randomly selected from the registry of a health service in Porto Alegre, Brazil. The eligibility criteria were: confirmed diagnosis of hypertension and/or diabetes, consulted at least once in the prior 3 years and 18 years of age or older. Home data collection consisted of a questionnaire with information on demographic, medical history, life style and socio-economic factors. RESULTS A total of 2482 users were interviewed (response rate of 71 %). The median age was 64 (IQR = 55.7) and the majority were women (68 %), and married (52 %). Whereas 66.5 % (CI 95 % 64.5-68.3) of the sample had only hypertension, 6.5 % (CI 95 % 5.5-7.5) had diabetes and 27.1 % (CI 95 % 25.3-28.8) had both diseases. The prevalence of diseases increased with age and with fewer years of study (p < 0.05). Subjects with both diseases had significantly more associated comorbidities. CONCLUSIONS Hypertension and diabetes are more prevalent in older individuals, especially women, and less educated people. People suffering with both chronic conditions simultaneously are more likely to have additional comorbidities.
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Affiliation(s)
- Julio Baldisserotto
- Social and Preventive Dentistry Department, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2492, Porto Alegre, CEP 90035-004, Brazil. .,Education and Research Center in Primary Health Care, CEPAPS and Pos Graduation Programe of Health Technology Assessment of Grupo Hospitalar Conceição, Porto Alegre, Brazil.
| | - Luciane Kopittke
- Education and Research Center in Primary Health Care, CEPAPS and Pos Graduation Programe of Health Technology Assessment of Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Fulvio Borges Nedel
- Health and Science Center, Public Health Department, Federal University of Santa Catarina, Florianópolis, Brazil.,Grups de Recerca d'Amèrica i Àfrica Llatines, Unitat de Bioestadística, Facultat de Medicina, Universitat Autònoma de Barcelona GRAAL/UAB, Barcelona, Spain
| | - Silvia Pasa Takeda
- Education and Research Center in Primary Health Care, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Claunara Schilling Mendonça
- Education and Research Center in Primary Health Care, CEPAPS and Pos Graduation Programe of Health Technology Assessment of Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Sérgio Antonio Sirena
- Education and Research Center in Primary Health Care, CEPAPS and Pos Graduation Programe of Health Technology Assessment of Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Margarita Silva Diercks
- Education and Research Center in Primary Health Care, CEPAPS and Pos Graduation Programe of Health Technology Assessment of Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Lena Azeredo de Lima
- Education and Research Center in Primary Health Care, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Belinda Nicolau
- Faculty of Dentistry, Division of Oral Health and Society, McGill University, Montreal, Canadá
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Oti SO, van de Vijver S, Gomez GB, Agyemang C, Egondi T, Kyobutungi C, Stronks K. Outcomes and costs of implementing a community-based intervention for hypertension in an urban slum in Kenya. Bull World Health Organ 2016; 94:501-9. [PMID: 27429489 PMCID: PMC4933135 DOI: 10.2471/blt.15.156513] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 12/21/2015] [Accepted: 02/04/2016] [Indexed: 01/16/2023] Open
Abstract
Objective To describe the processes, outcomes and costs of implementing a multi-component, community-based intervention for hypertension among adults aged > 35 years in a large slum in Nairobi, Kenya. Methods The intervention in 2012–2013 was based on four components: awareness-raising; improved access to screening; standardized clinical management of hypertension; and long-term retention in care. Using multiple sources of data, including administrative records and surveys, we described the inputs and outputs of each intervention activity and estimated the outcomes of each component and the impact of the intervention. We also estimated the costs associated with implementation, using a top-down costing approach. Findings The intervention reached 60% of the target population (4049/6780 people), at a cost of 17 United States dollars (US$) per person screened and provided access to treatment for 68% (660/976) of people referred, at a cost of US$ 123 per person with hypertension who attended the clinic. Of the 660 people who attended the clinic, 27% (178) were retained in care, at a cost of US$ 194 per person retained; and of those patients, 33% (58/178) achieved blood pressure control. The total intervention cost per patient with blood pressure controlled was US$ 3205. Conclusion With moderate implementation costs, it was possible to achieve hypertension awareness and treatment levels comparable to those in high-income settings. However, retention in care and blood pressure control were challenges in this slum setting. For patients, the costs and lack of time or forgetfulness were barriers to retention in care.
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Affiliation(s)
- Samuel Oji Oti
- African Population and Health Research Center, PO Box 10787-00100, Nairobi, Kenya
| | | | - Gabriela B Gomez
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Charles Agyemang
- Department of Public Health, University of Amsterdam, Amsterdam, Netherlands
| | - Thaddaeus Egondi
- African Population and Health Research Center, PO Box 10787-00100, Nairobi, Kenya
| | - Catherine Kyobutungi
- African Population and Health Research Center, PO Box 10787-00100, Nairobi, Kenya
| | - Karien Stronks
- Department of Public Health, University of Amsterdam, Amsterdam, Netherlands
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Schwartz JI, Guwatudde D, Nugent R, Kiiza CM. Looking at non-communicable diseases in Uganda through a local lens: an analysis using locally derived data. Global Health 2014; 10:77. [PMID: 25406738 PMCID: PMC4240853 DOI: 10.1186/s12992-014-0077-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 10/24/2014] [Indexed: 11/25/2022] Open
Abstract
The demographic and nutritional transitions taking place in Uganda, just as in other low- and middle-income countries (LMIC), are leading to accelerating growth of chronic, non-communicable diseases (NCDs). Though still sparse, locally derived data on NCDs in Uganda has increased greatly over the past five years and will soon be bolstered by the first nationally representative data set on NCDs. Using these available local data, we describe the landscape of the globally recognized major NCDs- cardiovascular disease, diabetes, cancer, and chronic respiratory disease- and closely examine what is known about other locally important chronic conditions. For example, mental health disorders, spawned by an extended civil war, and highly prevalent NCD risk factors such as excessive alcohol intake and road traffic accidents, warrant special attention in Uganda. Additionally, we explore public sector capacity to tackle NCDs, including Ministry of Health NCD financing and health facility and healthcare worker preparedness. Finally, we describe a number of promising initiatives that are addressing the Ugandan NCD epidemic. These include multi-sector partnerships focused on capacity building and health systems strengthening; a model civil society collaboration leading a regional coalition; and a novel alliance of parliamentarians lobbying for NCD policy. Lessons learned from the ongoing Ugandan experience will inform other LMIC, especially in sub-Saharan Africa, as they restructure their health systems to address the growing NCD epidemic.
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Affiliation(s)
- Jeremy I Schwartz
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
- Young Professionals Chronic Disease Network, Boston, MA, USA.
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda.
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
| | - Rachel Nugent
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Charles Mondo Kiiza
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda.
- Department of Medicine, Mulago National Referral Hospital, Kampala, Uganda.
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