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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 We thus set out to review both published and unpublished information on the presentation, causes, management, and outcomes of heart failure in LMICs.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 Additional unpublished data were requested from investigators and international heart failure experts.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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Family Caregivers Providing Complex Chronic Care to People with Cognitive and Behavioral Health Conditions

August 28, 2014 Comments off

Family Caregivers Providing Complex Chronic Care to People with Cognitive and Behavioral Health Conditions
Source: AARP Public Policy Institute

Family caregiving is difficult and stressful. Providing care and support to people with cognitive or behavioral health conditions is doubly challenging. This paper reports on results from a national survey showing that caregivers of family members with challenging behaviors were more likely to perform more than one medical/nursing task, such as managing medications, and often do so with resistance from the person they are trying to help. Yet they receive little or no instruction or guidance on how to do this important work. This analysis offers recommendations for assisting family caregivers who play this dual role.

This is the third “Insight on the Issues” series, drawn from additional analysis of data based on a December 2011 national survey of 1,677 family caregivers, 22 percent of whom were caring for someone with one or more challenging behaviors. Earlier findings were published in the groundbreaking Public Policy Institute/United Hospital Fund report Home Alone: Family Caregivers Providing Complex Chronic Care.
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CDC Digital Press Kit: Ebola Outbreak – 2014

August 27, 2014 Comments off

CDC Digital Press Kit: Ebola Outbreak – 2014
Source: Centers for Disease Control and Prevention

CDC is rapidly increasing its ongoing efforts to curb the expanding West African Ebola outbreak and deploying staff to four African nations currently affected: Guinea, Sierra Leone, Liberia, and Nigeria.

This is the largest Ebola outbreak in history and the first in West Africa. The outbreak in West Africa is worsening, but CDC, along with other U.S. government agencies and international partners, is taking active steps to respond to this rapidly changing situation.

CDC elevated its Emergency Operations Center (EOC) to a Level 1 activation, its highest level, because of the significance of the outbreak in West Africa.
CDC is surging our response with the current challenges that we are facing. CDC is sending additional CDC disease control specialists into the four countries.

From the American Academy of Pediatrics — Policy Statement: School Start Times for Adolescents

August 27, 2014 Comments off

From the American Academy of Pediatrics — Policy Statement: School Start Times for Adolescents
Source: Pediatrics

The American Academy of Pediatrics recognizes insufficient sleep in adolescents as an important public health issue that significantly affects the health and safety, as well as the academic success, of our nation’s middle and high school students. Although a number of factors, including biological changes in sleep associated with puberty, lifestyle choices, and academic demands, negatively affect middle and high school students’ ability to obtain sufficient sleep, the evidence strongly implicates earlier school start times (ie, before 8:30 AM) as a key modifiable contributor to insufficient sleep, as well as circadian rhythm disruption, in this population. Furthermore, a substantial body of research has now demonstrated that delaying school start times is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to students with regard to physical and mental health, safety, and academic achievement. The American Academy of Pediatrics strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep (8.5–9.5 hours) and to improve physical (eg, reduced obesity risk) and mental (eg, lower rates of depression) health, safety (eg, drowsy driving crashes), academic performance, and quality of life.

Age Differences in Visits to Office-based Physicians by Patients With Diabetes: United States, 2010

August 26, 2014 Comments off

Age Differences in Visits to Office-based Physicians by Patients With Diabetes: United States, 2010
Source: National Center for Health Statistics

Key findings
Data from the National Ambulatory Medical Care Survey

  • Office-based physician visits by patients with diabetes increased 20%, from 94.4 million in 2005 to 113.3 million in 2010, but the rate did not change between 2005 and 2010.
  • The visit rate for diabetes increased with age and averaged 1,380 visits per 1,000 persons aged 65 and over in 2010.
    A majority of visits made by patients with diabetes (87%) were by those with multiple chronic conditions, and the number of chronic conditions increased with advancing age.
  • Medications were prescribed or continued at a majority of visits (85%) made by patients with diabetes, with the number of medications prescribed or continued increasing as age increased.

CRS — Immigration Policies and Issues on Health-Related Grounds for Exclusion (August 13, 2014)

August 26, 2014 Comments off

Immigration Policies and Issues on Health-Related Grounds for Exclusion (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

News of humans infected with Ebola in West Africa, avian influenza in China, polio in the Middle East, and dengue fever in the Caribbean are examples of reports that heighten concerns about the health screenings of people arriving in the United States. Under current law, foreign nationals who wish to come to the United States generally must obtain a visa and submit to an inspection to be admitted. One of the reasons why a foreign national might be deemed inadmissible is on health-related grounds. The diseases that trigger inadmissibility in the Immigration and Nationality Act (INA) are those communicable diseases of public health significance as determined by the Secretary of Health and Human Services (HHS).

Currently there are seven diseases deemed a communicable disease of public health significance: chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, active tuberculosis, and infectious syphilis. Other diseases incorporated by reference are cholera; diphtheria; infectious tuberculosis; plague; smallpox; yellow fever; viral hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named); severe acute respiratory syndrome (SARS); and “[i]nfluenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic.”

Use of Sunscreen and Indoor Tanning Devices Among a Nationally Representative Sample of High School Students, 2001–2011

August 24, 2014 Comments off

Use of Sunscreen and Indoor Tanning Devices Among a Nationally Representative Sample of High School Students, 2001–2011
Source: Preventing Chronic Disease (CDC)

Adolescents are particularly vulnerable to engaging in poor skin-protection behaviors. The objective of this study was to examine use of sunscreen and indoor tanning devices among a nationally representative sample of high school students during a 10-year period (2001–2011) using data from the Youth Risk Behavior Surveillance System. The percentage of youth who reported using sunscreen declined from 67.7% in 2001 to 56.1% in 2011. The prevalence of using indoor tanning devices was highest among white females: 37.4% in 2009 and 29.3% in 2011. These findings indicate the need for prevention efforts aimed at adolescents to reduce risks for skin cancer.

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