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Cardiovascular disease in the Americas: optimizing primary and secondary prevention of cardiovascular disease series: cardiovascular disease in the Americas.
Get PDFWhile, many interventions can prevent cardiovascular disease (CVD), and its resulting morbidity or mortality, these are used sub-optimally in most countries. Therefore, health systems need to develop new approaches to ensure that proven CVD therapies are delivered widely. In this review, we describe five impactful implementation strategies which include: (1) Task shifting, (2) Use of mobile-Health (mHealth) support and virtual access to care, (3) simplified diagnostic and management algorithms for the prevention of CVD, (4) improving the use of combinations of medicines (i.e., polypill), and (5) patient engagement and role of patient-nominated peer support (i.e., treatment supporters). Adapting and tailoring these strategies to the local context in different settings in various countries in the Americas and the Caribbean can reduce the morbidity and mortality of CVD substantially
Prevalence and causes of blindness and vision impairment among people 50 years and older in Nepal: A national Rapid Assessment of Avoidable Blindness survey.
Get PDFPURPOSE: To determine the prevalence and causes of blindness and vision impairment among people 50 years and older in Nepal. METHODS: We conducted seven provincial-level Rapid Assessment of Avoidable Blindness (RAAB) cross-sectional, population-based surveys between 2018-2021. Provincial prevalence estimates were weighted to give nationally representative estimates. Sampling, enumeration, and examination of the population 50 years and older were done at the province level following standard RAAB protocol. RESULTS: Across seven surveys, we enrolled 33,228 individuals, of whom 32,565 were examined (response rate 98%). Females (n = 17,935) made up 55% of the sample. The age-sex-province weighted national prevalence of blindness (better eye presenting visual acuity <3/60) was 1.1% (95% confidence interval [CI] 1.0-1.2%), and any vision impairment <6/12 was 20.7% (95% CI 19.9-21.5%). The prevalence of blindness was higher in women than men (1.3% [95% CI 1.1-1.5%] vs 0.9% [95% CI 0.7-1.0%]). Age-sex weighted blindness prevalence was highest in Lumbini Province (1.8% [95% CI 1.3-2.2%]) and lowest in Bagmati Province (0.7% [95% CI 0.4-0.9%]) and Sudurpaschim Province (0.7% [95% CI 0.4-0.9%]). Cataract (65.2%) was the leading cause of blindness in our sample, followed by corneal opacity (6.4%), glaucoma (5.8%) and age-related macular degeneration (5.3%). Other posterior segment diseases accounted for 8.4% of cases. Cataract was also the leading cause of severe vision impairment (83.9%) and moderate vision impairment (66.8%), while refractive error was the leading cause of mild vision impairment (66.5%). CONCLUSION: The prevalence of blindness was higher among women than men and varied by province. The Lumbini and Madesh Provinces in the Terai (plains) region had higher prevalence of blindness than elsewhere. Cataract was the leading cause of blindness, severe vision impairment and moderate vision impairment while refractive error was the leading cause of mild vision impairment
Measuring the duration of kangaroo mother care for neonates: a scoping review.
Get PDFOBJECTIVES: Kangaroo mother care (KMC) is high impact for survival of low birth weight neonates, but there are few rigorous evaluations of duration required for impact. We conducted a scoping review of KMC duration measurement methods and assessed their validation. DESIGN: Scoping review in accordance with Joanna Briggs Institute guidance for conducting scoping review. DATA SOURCES: MEDLINE, Embase, Cochrane Library, PsycINFO, African Index Medicus, Latin American and Caribbean Health Sciences Literature, ClinicalTrials.gov, International Clinical Trials Registry Platform, International Standard Randomised Controlled Trial Number Registry, Medrxiv and OpenGrey were searched through November 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Publications with primary data on KMC duration were included. We excluded short procedural skin-to-skin care studies. DATA EXTRACTION AND SYNTHESIS: Selection and data abstraction were conducted by two independent reviewers. A data charting form based on the variables of interest was used to abstract data. RESULTS: A total of 213 publications were included, of which 54 (25%) documented a method of measuring KMC duration. Only 20 publications (9%) provided a detailed description of the duration measurement method, and none reported validity. Most studies used caregiver reports (29, 54%) or healthcare worker observations (17, 31%). Other methods included independent observers and electronic monitoring devices. CONCLUSION: Only 9% of KMC studies reporting duration documented the measurement method applied, and no studies were found with documented validation of duration measurement methods. Accurate and comparable data on the dose response of KMC will require duration measurement methods to be validated against a gold standard such as an independent observer
Landscape of guidance documents used at TropNet and GeoSentinel centres for the clinical management of schistosomiasis outside endemic areas: A systematic appraisal.
Get PDFBACKGROUND: The diagnostic and treatment approaches for schistosomiasis in individual patients, outside endemic areas, are not standardised. This study aimed to appraise the reference documents that the experts from the TropNet and GeoSentinel networks use in practice as guidance for the clinical management of their patients with (suspect) schistosomiasis. METHODS: We systematically appraised the following data from the referenced guidance documents: i) document type, ii) case definitions, iii) diagnostic techniques envisaged; iv) treatment recommendations; v) follow-up recommendations; vi) screening recommendations, and vii) symptom-based diagnostic suspicion. RESULTS: Twenty-two of the 30 responders (73.3 %) indicated 19 reference documents, three of which were WHO material not intended for individual clinical management. Only 4/19 (21.1 %) documents were national recommendations; no international guideline was indicated. Case definitions were explicitly presented in only one document (1/19; 5.3 %). Diagnostic tools were detailed in 11/16 (68.8 %) and follow-up guidance in 8/16 (50 %) documents. Treatment guidance was provided in 14/16 (87.5 %) documents. CONCLUSIONS: Heterogeneity in clinical guidance was evident, although with noticeable overlap at least for chronic schistosomiasis. This confirms the need to formalise case definitions, which should be used to design trials to rigorously assess diagnostic tools and treatment schemes, and eventually come to harmonization of clinical management guidance
Beyond proximity: an observational study of stillbirth rates and emergency obstetric and newborn care accessibility in The Gambia.
Get PDFINTRODUCTION: Stillbirths are disproportionately concentrated in sub-Saharan Africa, where geographical accessibility to basic/comprehensive emergency obstetric and newborn care (BEmONC and CEmONC) significantly influences maternal and perinatal outcomes. This study describes stillbirth rates within healthcare facilities in The Gambia and examines their distribution in relation to the geographical accessibility of these facilities. METHODS: We analysed 97 276 births recorded between 1 January 2013 and 31 December 2018, from 10 major public healthcare facilities in The Gambia. To standardise definitions, stillbirths were defined as fetal deaths with a birth weight of ≥500 g. Fresh stillbirths were reclassified as intrapartum, and macerated stillbirths were reclassified as antepartum. Linear regression with cubic splines was used to model trends, and AccessMod software estimated travel times to facilities. RESULTS: Among recorded births, 5.1% (4873) were stillbirths, with an overall stillbirth rate of 51.3 per 1000 births (95% CI: 27.5 to 93.6). Intrapartum stillbirths accounted for 53.8% (27.6 per 1000 births; 95% CI: 14.4 to 49.8). Fully functional CEmONC facilities reported the highest stillbirth rates, including the National Teaching Hospital (101.7 per 1000 births, 95% CI: 96.8 to 106.8). Approximately 42.8%, 58.9% and 68.3% of women aged 15-49 lived within a 10, 20 and 30 min travel time, respectively, to fully functional CEmONC facilities, where high stillbirth rates were concentrated. CONCLUSIONS: In The Gambia, intrapartum stillbirth rates remain alarmingly high, even in geographically accessible CEmONC facilities. Inadequate documentation of fetal heart rate on admission hampers accurate classification, complicating targeted interventions. Ensuring that EmONC-designated facilities-particularly those providing BEmONC services-are fully functional with essential equipment, trained staff and robust referral systems, while enhancing the timeliness and quality of obstetric care, is crucial to reducing stillbirth rates
Attenuation of Chikungunya Virus by a Single Amino Acid Substitution in the nsP1 Component of a Non-Structural Polyprotein.
Get PDFChikungunya virus (CHIKV) is a mosquito-transmitted alphavirus that, since its re-emergence in 2004, has become recognised as a major public health concern throughout many tropical and sub-tropical regions of the world. Amongst the insights gained from studies on other alphaviruses, several key determinants of virulence have been identified, including one present at the P3 position in the nsP1/nsP2 cleavage domain of the S.A.AR86 Sindbis (SINV) strain. This strain is associated with neurovirulence in adult mice; however, when a threonine-to-isoleucine substitution is engineered at this P3 position, an attenuated phenotype results. A reverse genetics system was developed to evaluate the phenotype that resulted from the substitution of alanine, present at the P3 position in the wild-type CHIKV clone, with valine. The A533V-mutant CHIKV induced milder disease symptoms in the C57BL/6 mouse model than the wild-type virus, in terms of severity of inflammation, length of viraemic period, and histological changes. Furthermore, the induction of type I IFN occurred more rapidly in both CHIKV-infected cell cultures and the mouse model with the mutant CHIKV
Determinants of Ukrainian Mothers' Intentions to Vaccinate Their Children in Poland: A Cross-Sectional Study.
Get PDFBACKGROUND/OBJECTIVES: In 2022, the full-scale invasion in Ukraine forced over 6 million Ukrainians, primarily mothers and children, to seek safety outside of the country. This massive influx has posed a significant challenge to the Polish healthcare system, particularly regarding routine vaccination for children. This study aims to examine the vaccination intentions of displaced Ukrainian mothers, their compliance with the Polish National Immunisation Programme (PNIP), and the factors that influence these intentions. METHODS: A web-based survey (June-July 2023) was conducted among Ukrainian mothers in Poland. The questionnaire assessed the importance placed on vaccination, knowledge of PNIP, and concerns related to displacement and vaccination. Hierarchical logistic regression identified key determinants. RESULTS: Among 2572 respondents, 64.5% reported that their children had received only some or none of the recommended vaccines. Key barriers included unfamiliarity with PNIP, limited knowledge of vaccines, and concerns about vaccine side effects. Of mothers whose children had not followed PNIP, 41.7% intended to vaccinate, 33.1% refused, and 25.2% were undecided. Regression analysis identified perception of vaccination importance as the strongest predictor. Partial adherence to PNIP doubled vaccination likelihood, while a firm plan to return to Ukraine reduced it 2.4 times. Mistrust in vaccines increased refusal risk tenfold. The final model confirmed mothers' attitudes towards vaccination and future plans (return to Ukraine) as dominant factors. CONCLUSIONS: This study underscores the complex determinants shaping vaccination decisions in conflict-displaced communities. It provides insights for public health strategies to enhance vaccine uptake by reducing access barriers, restoring trust, and strengthening vaccine literacy
Community resilience to health emergencies: a scoping review.
Get PDFBACKGROUND: There is recognition of the importance of community resilience in mitigating long-term effects of health emergencies on communities. To guide policy and practice, conceptual clarity is needed on what community resilience involves and how it can be operationalised for community protection in ways that empower and strengthen local agency. OBJECTIVES: To identify the core components of community resilience to health emergencies using a scoping review methodology. SEARCH METHODS: PubMed, EMCARE, Scopus, Web of Science, PTSDpubs, APO and ProQuest Dissertations were systematically searched to identify review studies published from 2014. SELECTION CRITERIA: Studies were included if they reported a review of original research papers investigating community resilience in the context of a health emergency. DATA COLLECTION AND ANALYSIS: Data were extracted from included studies using a specially developed data extraction form. Qualitative data were subjected to a meta-synthesis consisting of three levels of analysis. MAIN RESULTS: 38 evidence reviews were included. Analysis identified recurring characteristics of community resilience. Six studies reported 10 abilities required for community resilience including: adapt, transform, absorb, anticipate, prepare, prevent, self-organise, include, connect and cope. 25 studies reported 11 types of resources: social, economic, environmental, governance, physical infrastructure, institutional, communication, human capital, health, emergency management and socioeconomic. CONCLUSIONS: 21 components have been identified that can be used as a basis for operationalising and measuring community resilience. In contexts of disaster management, community resilience is a fairly mature concept that reflects a community's inherent capacity/abilities to withstand and recover from shocks. There is a need to incorporate a 'resource' perspective that speaks to a wider enabling environment. There is scope to investigate whether the same set of components identified here has relevance in public health emergencies emanating from disease or human acts of aggression and to articulate resilience logics to critical endpoints for health emergency management
Consumption and Greenhouse Gas Emissions Impacts of Population-Wide Adoption of Dietary Guidelines in China.
No full textThis paper uses an optimisation model to quantify the necessary food consumption adjustments for Chinese diets to fulfil the requirements in the health-based Chinese Dietary Guidelines (CDG) or WHO dietary guidelines. We further aim to determine whether adopting these guidelines could lead to lower levels of greenhouse gas emissions (GHGE) while maintaining diet affordability. Modelling outcomes under the CDG and WHO scenarios differ significantly from nutritional, GHGE and diet affordability perspectives: relative to observed eating patterns, diets following the WHO guidelines are equally emissions intensive, while diets consistent with the CDG recommendations are less sustainable. Further optimisations imposing significant reductions in GHGE indicate important environmental and nutritional co-benefits can be achieved through the WHO guidelines, while maintaining diet affordability. In the WHO scenario, the maximum diet-related GHGE reduction policymakers could aim for is 30%, since above this threshold, recommended diets would deviate considerably from observed patterns. The CDG model with a 20% emissions reduction does not converge for 64% of the initial data set, casting doubt on the affordability and compatibility of the CDG with China's decarbonisation goal. We recommend that future versions of the CDG be reformulated to closer align with WHO advice and explicitly include environmental considerations
A systematic review of the use of burden of treatment theory.
Get PDFBACKGROUND: Treatment burden describes the workload undertaken by people with chronic illness and multimorbidity to manage their healthcare demands and the impact on their wellbeing. Burden of Treatment Theory (BOTT) describes the work that people with multimorbidity do to self-manage chronic illness/multimorbidity and the factors that affect capacity (personal and healthcare resources, support network) to meet treatment demands. Here we aim to identify and characterise the different applications of Burden of Treatment Theory in research; to explore the contribution of Burden of Treatment Theory to advancing knowledge and understanding of treatment burden and capacity issues and to identify critiques or limitations of Burden of Treatment Theory in research. METHODS: Systematic review of BOTT research published in the English language. Databases searched were Web of Science, Scopus, Medline, CINAHL and medRxiv.org. We also consulted with experts in the field. Two reviewers screened titles, abstracts and papers and undertook data extraction. Quality appraisal was undertaken using adapted CASP checklists for qualitative studies and systematic reviews and a Mixed Studies Review checklist. RESULTS: Thirty papers included: 16 qualitative studies; 5 systematic reviews; 3 protocols; 3 discussion papers, a theory conceptual paper, a realist review and a feasibility trial. Most (n=17) originated in UK, with 3 from Australia and Argentina, 2 from Norway and one each from United States and Malawi. Nine papers mentioned use of BOTT constructs but 21 additionally provided rationale for BOTT use and demonstrated engagement with the theory. Two papers adapted/refined BOTT to the context of their research focus. Twenty-seven studies prospectively outlined use of BOTT, with only 3 applying BOTT retrospectively to report study outputs and 'inform analysis' of findings. CONCLUSION: BOTT provides a useful conceptual, analytical and sensitising lens in studies focusing on both the characterisation and alleviation of treatment burden through healthcare interventions, and the constructs discussed are stable and applicable across multiple settings. Future research could include use by empirical researchers in contexts needing more adaptation and critical assessment