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Heart Failure Care in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

September 1, 2014 Comments off

Heart Failure Care in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
Source: PLoS Medicine

Background
Heart failure places a significant burden on patients and health systems in high-income countries. However, information about its burden in low- and middle-income countries (LMICs) is scant. We thus set out to review both published and unpublished information on the presentation, causes, management, and outcomes of heart failure in LMICs.

Methods and Findings
Medline, Embase, Global Health Database, and World Health Organization regional databases were searched for studies from LMICs published between 1 January 1995 and 30 March 2014. Additional unpublished data were requested from investigators and international heart failure experts. We identified 42 studies that provided relevant information on acute hospital care (25 LMICs; 232,550 patients) and 11 studies on the management of chronic heart failure in primary care or outpatient settings (14 LMICs; 5,358 patients). The mean age of patients studied ranged from 42 y in Cameroon and Ghana to 75 y in Argentina, and mean age in studies largely correlated with the human development index of the country in which they were conducted (r = 0.71, p<0.001). Overall, ischaemic heart disease was the main reported cause of heart failure in all regions except Africa and the Americas, where hypertension was predominant. Taking both those managed acutely in hospital and those in non-acute outpatient or community settings together, 57% (95% confidence interval [CI]: 49%–64%) of patients were treated with angiotensin-converting enzyme inhibitors, 34% (95% CI: 28%–41%) with beta-blockers, and 32% (95% CI: 25%–39%) with mineralocorticoid receptor antagonists. Mean inpatient stay was 10 d, ranging from 3 d in India to 23 d in China. Acute heart failure accounted for 2.2% (range: 0.3%–7.7%) of total hospital admissions, and mean in-hospital mortality was 8% (95% CI: 6%–10%). There was substantial variation between studies (p<0.001 across all variables), and most data were from urban tertiary referral centres. Only one population-based study assessing incidence and/or prevalence of heart failure was identified.

Conclusions
The presentation, underlying causes, management, and outcomes of heart failure vary substantially across LMICs. On average, the use of evidence-based medications tends to be suboptimal. Better strategies for heart failure surveillance and management in LMICs are needed.

See: Heart failure is a substantial health burden in low- and middle-income countries (EurekAlert!)

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Information and Communication Technologies to Promote Social and Psychological Well-Being in the Air Force

September 1, 2014 Comments off

Information and Communication Technologies to Promote Social and Psychological Well-Being in the Air Force
Source: RAND Corporation

This report presents the findings from a pioneering exploratory survey of 3,479 active-duty, guard, and reserve Airmen on their use of information and communication technology (ICT), the association between ICT use and social and psychological well-being, and the potential for Air Force mental-health professionals to use ICT to meet the needs of Airmen. The survey data were weighted to ensure that the analytic sample would be representative of the gender, age group, rank (officer, enlisted), and affiliation (active, guard, reserve) composition of the U.S. Air Force. Rates of ICT usage by Airmen are presented, along with Airmen’s perceptions of the relationship between social support and ICT use, their attitudes about seeking and receiving health information via technology, and the differences in ICT use, social support, and psychological well-being among different groups of Airmen. Finally, recommendations are presented on ways the Air Force can leverage ICT to promote the social and psychological well-being of Airmen.

Same-sex intimate partner homicide in Australia

September 1, 2014 Comments off

Same-sex intimate partner homicide in Australia
Source: Australian Institute of Criminology

While there is a sizable body of research on intimate partner homicide in general, there has been limited focus on intimate partner homicide involving people in same-sex relationships.

The present study, one of the first of its kind, uses data from the National Homicide Monitoring Program (NHMP) within a context of national and international research to describe what is known about the trends and key characteristics of same-sex intimate partner homicide in Australia.

An analysis is provided of the similarities and differences between same-sex and opposite-sex intimate partner homicide incidents, including identification of some of the factors associated with these incidents.

Consideration is also given to the role of sexual discrimination and marginalisation in same-sex intimate partner homicide.

Data for Building a National Suicide Prevention Strategy

August 29, 2014 Comments off

Data for Building a National Suicide Prevention Strategy (PDF)
Source: American Journal of Public Health

Suicide is a leading cause of death in the U.S. As both the rate and number of suicides continue to climb, the country struggles with how to reverse this alarming trend. Using population-based data from publically available sources including the Web-based Injury Statistics Query and Reporting System, National Survey on Drug Use and Health, the authors identified patterns of suicide that can be used to steer a public health – based suicide prevention strategy. That most suicide deaths occur upon the first attempt, for example, suggests that a greater investment in primary prevention is needed. The fact that definable subgroups receiving care through identifiable service systems, such as individuals in specialty substance use treatment, exhibit greater concentrations of suicide risk than the general public suggests that integrating suicide prevention strategies into those service system platforms is an efficient way to deliver care to those with heightened need. The data sets that reveal these patterns have both strengths (e.g., population-level) and weaknesses (e.g., lack of longitudinal data linking changing health status, intervention encounters, suicidal behavior, and death records). Some of the data needed for crafting a comprehensive, public health – based approach for dramatically reducing suicide are currently available or may be available in the near term. Other resources will have to be built, perhaps by enhancing existing federal surveillance systems or constructing new ones. The article concludes with suggestions for immediate and longer-term actions that can strengthen public data resources in the service of reducing suicide in the U.S.

Where More Americans Die at the Hands of Police

August 29, 2014 Comments off

Where More Americans Die at the Hands of Police
Source: The Atlantic (Richard Florida)

The death of 18-year-old Michael Brown at the hands of a Ferguson, Missouri, police officer has reintroduced police-related killings as a topic of major national debate. Brown is just the latest in a long line of young, unarmed black men killed by law enforcement agents.

It’s been widely reported that roughly 400 Americans die at the hands of police per year. And yet, that figure is likely a significant underestimate, as Reuben Fischer-Baum details at FiveThirtyEight.

We ask a slightly different question: Where are Americans more likely to die at the hands of police or while under arrest?

With the help of my colleagues Charlotta Mellander and Nick Lombardo of the Martin Prosperity Institute (MPI), we mapped data from two sources: “arrest related deaths” from the Department of Justice’s Bureau of Justice Statistics, and from the FBI’s annual Supplementary Homicide Report (SHR) on “felons killed by police.” We also got input from three leading American criminologists: Alfred Blumstein and Daniel Nagin, my former colleagues at Carnegie Mellon, and John Roman of the Urban Institute.

It’s important to reiterate that both data sources suffer from serious deficiencies, not the least of which is under-reporting. Roman worries about “reporting bias,” particularly the possibility that “more responsible agencies”—those least likely to use force in the first place—”are more likely to report, and less responsible agencies are less likely to report.” But he also adds that what looks like missing data may not be. “It might be that few policing agencies have an officer-involved shooting and the agencies that don’t simply don’t report any data,” he writes in an email.

But, taken together and in light of their limits, the maps are broadly suggestive of the geography of U.S. police killings as well as the states where arrests are likely to result in more deaths. As Roman puts it: “It is important to shine a light on the subject. Because there is such limited data, our ability to define the scope of the problem greatly limits our ability to form an appropriate response.”

Key factors associated with Asperger’s syndrome and implications for effective teaching to enhance student participation and engagement

August 29, 2014 Comments off

Key factors associated with Asperger’s syndrome and implications for effective teaching to enhance student participation and engagement (PDF)
Source: International Journal of Human Sciences

This paper discuses the key factors associated with Asperger’s syndrome and the implications for effective teaching to enhance student participation and engagement. Firstly, it presents a brief introduction to Asperger’s syndrome and its main characteristics. Secondly, it explores student communication, social interaction, challenging behaviours and learning, and the implications for effective teaching. Thirdly, the importance of and the implications for collaborating with parents, teachers, professionals and individuals living with Asperger’s syndrome are discussed.

What is the Result of States Not Expanding Medicaid?

August 29, 2014 Comments off

What is the Result of States Not Expanding Medicaid?
Source: Urban Institute

In states not expanding Medicaid, 6.7 million residents will remain uninsured in 2016 as a result. These states are foregoing $423.6 billion in federal Medicaid funds from 2013 to 2022, lessening economic activity and job growth. Their hospitals are also losing $167.8 billion in Medicaid revenue. Every comprehensive state-level fiscal analysis that we could find concluded that expansion helps state budgets, generating savings and revenues that exceed increased Medicaid costs. Future federal cuts to ACA’s high federal match rate are unlikely. Of more than 100 federal Medicaid cuts since 1980, just one lowered the federal share of Medicaid spending.

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