287 research outputs found
Preventing cardiovascular disease in rural South Africa
No full textA Thesis Submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Doctor of Philosophy, Jphannesburg October 2018Background: The epidemiological, nutritional and demographic transitions occurring in developing countries, have resulted in an unprecedented rise in noncommunicable diseases, in particular, cardiovascular disease (CVD). Consequently, CVD are contributing significantly to disease burden in populations where infectious diseases and maternal and perinatal conditions still persist. Rural areas which are least equipped to deal with this burden are no exception; recent evidence points towards a similar trend of increased CVD, particularly stroke. Understanding the disease burden and cost-effective strategies for prevention is therefore of critical importance. Such information should assist policymakers to justify policy decisions on interventions to prevent cardiovascular disease.
Aims: To better understand the epidemiological profile and pattern of stroke and its risk factors in rural South Africa so as to select interventions that are effectively targeted, are cost-effective, and have the potential to reduce the cardiovascular disease burden in key populations.
Methods: The study utilised two methodological approaches to address the research aims. First, existing validated methods and epidemiological tools were used. The Global Burden of Disease Study approach was the framework for analysing years lost due to premature mortality (YLL), years lived with disability (YLD) and disability adjusted life years (DALYs). The mathematical tool - Dismod II - was used to estimate the disease incidence. The World Health Organization’s comparative risk assessment framework was used to estimate burden attributable to metabolic risk factors; namely high blood pressure, raised blood glucose and excess body mass index. All data for the analyses were derived from the Agincourt health and sociodemographic surveillance system, which covers a population of over 100,000 individuals in rural North-east, South Africa, adjacent to Southern Mozambique. Extrapolation to ‘mostly rural’ South Africa was based on the conservative assumption that all municipalities that are considered ‘mostly rural’ share an epidemiological profile similar to that of Agincourt sub-district; thus only population figures (by age and sex) adjusted the incidence and DALYs. Second, an economic model to assess the cost-effectiveness of CVD prevention interventions was developed, customised for the Agincourt sub-district population. This is a Markov model which simulates disease progression in a cohort of people, starting from a healthy (disease-free) state until death or 100 years of age by accounting for changing risk factor profiles in each age-sex cohort. The application of the model is illustrated by estimating the cost-effectiveness of alternative pharmaceutical interventions for CVD prevention. Interventions are targeted to groups with varying degrees of absolute CVD risk over the next 10 years of ‘<10%’ (low risk), ‘≥10% & <20%’ (medium risk) and ‘≥20%’ (high risk). A fourth target group was individuals with untreated stage 2 hypertension.
Results: Baseline burden of CVD was substantial: crude stroke incidence rate was 244 per 100,000 person years in Agincourt sub-district. An estimated 33, 500 strokes occurred in 2011 in “predominantly” rural municipalities of South Africa, a population of some 13,000,000 people. Crude stroke mortality was 114 per 100,000 personyears in 2007–11 in Agincourt sub-district whilst 1,070 DALYs (CI 750 - 1680) were lost due to stroke. Preventable risk factors were responsible for a significant proportion of the stroke burden: Among males, 40% of the stroke burden was attributable to high blood pressure. Similarly, 38% of the stroke burden in females was attributable to high blood pressure. There was marked variation in stroke burden attributable to excess body mass index (BMI) by gender. Approximately 11.4% of the stroke burden in males was attributable to excess BMI compared to 22.5% in females. Despite some uncertainty, it appears that diabetes plays a relatively small contributory role to the overall CVD burden. Furthermore, it has been assumed that cholesterol does not play an important role in this setting based on previously published data. By combining actual health care utilization estimates from the Agincourt sub-district with incidence and prevalence data, we estimated that direct costs of stroke treatment comprised 1-3% of the sub-district expenditure in 2013. Average costeffectiveness ratios (ACERs) for all pharmacotherapies, across all target groups, fell in the range of US156 (combination of β-blocker and diuretic) and US373 (polypill – a single tablet containing a statin and three antihypertensive agents) per DALY averted for the high-risk group. ICERs indicate the additional cost needed to avert an additional DALY as successively less cost-effective strategies are adopted. The same interventions were cost-effective for the medium-risk group and patients with stage 2 hypertension. The optimal treatment pathway for low risk individuals (10-year risk of <10%) included low-dose diuretic with an ICER of US228; combination of β-blocker and diuretic (ICER: US683 per DALY averted) and ACE-I/diuretic combination which yielded an ICER of US4.06 million, US$6.28 million respectively.
Conclusions: The burden of stroke in Agincourt HDSS as estimated in this study is considerable and is currently propelled by, amongst other risk factors, the high prevalence of hypertension and obesity. If we assume similar prevalence and distribution of risk factors for the other 69 rural municipal areas, then the effect on rural South Africa is equally substantial. By applying the custom-built economic model, we show that several pharmaceutical options are potentially cost-effective and affordable in reducing CVD. Furthermore, the cost-effectiveness modelling showed that a total risk factor approach is more cost-effective than a single risk factor approach. The model, which is an output of this thesis can be applied across other health and socio-demographic surveillance sites to build an augmented dataset that will assist in better profiling of CVD prevention across other sub-Saharan African sites.XL201
Economic burden of stroke in a rural South African setting
No full textBackground: Stroke is the second leading cause of mortality and leading cause of disability in South Africa yet published data on the economic costs of stroke is lacking particularly in rural settings.
Methods: We estimate the total direct costs of stroke in 2012 from a health system perspective using a prevalence-based, bottom-up costing approach. Direct costs include diagnosis, inpatient and outpatient care. Analysis is based on the Agincourt health and socio-demographic surveillance system, which covers approximately 90,000 people. Published data from the SASPI study, Tintswalo Hospital Stroke register, and national cost databases were used. Sensitivity analysis was carried out to account for the variability in the data used.
Results: The total direct costs of stroke were estimated to be R2.5–R4.2 million (US485,000) in 2012 or 1.6–3% of the sub-district health expenditure. Of this, 80% was attributed to inpatient costs. Total costs were most sensitive to the underlying incidence rates and to assumptions regarding service utilisation.
Conclusions: Our study provides a snapshot of costs incurred on stroke in rural South Africa. We show that stroke is a disease with high economic costs. Further studies that assess the lifetime costs of stroke are needed to better understand savings accrued from intervening at different stages of the disease
Economic consequences for households of illness and of paying health care in Zimbabwe: A case study
No full textIncludes bibliographical references.This study investigates the economic consequences of illness and of paying for health care in Zimbabwe. It explores the incidence of out-of-pocket (OOP) payments, catastrophic health expenditure (CHE), impoverishment and the factors, (particularly socio-economic factors) associated with them. In addition, this study determines the strategies that households employ to cope with the financial burden of OOP payments in Zimbabwe. Data was collected from 499 households in Harare urban and Seke rural districts of Zimbabwe. Total monthly household OOP health expenditure was defined as 'catastrophic' if it exceeded the threshold level of 40% of a household's monthly capacity to pay. Logistic regression analysis was used to identify the factors that influence the incidence of CHEs. A non-poor household was impoverished by OOP health expenditure if its total household expenditure after deducting OOP payments was lower than the subsistence expenditure. The results of this study indicated that, the incidence of CHEs was very high amongst the study population. Households at all levels of wealth incurred catastrophic health expenditures, and the proportion of households incurring CHEs was similar across the asset quintiles. Out-of-pocket payments precipitated impoverishment of non-poor households. Poor households, households with members above 65 years, female headed households, households with member(s) suffering from chronic illness and households with greater use of health services were at higher risk of incurring CHEs. On the contrary, households with a disabled member were less likely to incur CHEs. Besides 'avoiding seeking care', selling of assets and borrowing were the 2 most popular strategies used to cope with OOP health care payments. An analysis of these results suggests that, targeted exemption of vulnerable households, as well as provision of subsidised health services could reduce the economic impact of illness on households. The results of this study also point out to the need for strengthening risk pooling mechanisms through the implementation of community based health insurance schemes and enhancing tax collection. In addition, other strategies that extend beyond the health sector such as economic empowerment of women could be effective in mitigating the economic impact of illness amongst female headed households in Zimbabwe
Binge drinking
No full textRuntime 1:30 minutesThis resource is provided for informational purposes only and may not reflect current scientific knowledge or medical recommendations.Welcome to Public Health Moment from the University of Minnesota. Binge drinking is common among active-duty military personnel, according to a new study released by the University of Minnesota and the Centers for Disease Control and Prevention (CDC). In the study, involving more than 16,000 military personnel, binge drinking was reported by 43 percent of military personnel during the past month. How does one define binge drinking? Lead author of the study, Mandy Stahre, a University of Minnesota Ph.D. student, explains. Stahre says the study shows that binge drinking is a significant public health problem. With another Public Health Moment, I’m John Finnegan.Finnegan, John; Mandy Stahre. (2009). Binge drinking. Retrieved from the University Digital Conservancy, https://hdl.handle.net/11299/257616
The Human Leader: Leading from Weakness
No full textHow might human limitations empower rather than impede our leadership? Mandy Smith, author of The Vulnerable Pastor, will explore themes related to vulnerability and weakness in leadership and ministry. Interspersing teaching with guided roundtable discussion, this seminar will empower you to lead out of your deep humanity
Changes in science content knowledge and attitudes toward science teaching of educators attending a zoo-based neuroscience professional development
No full textInformal learning environments often host teachers for learning opportunities, but little is known about the impact of these experiences on teacher professional development (PD). This article describes a unique collaborative PD experience between zoological park personnel and university faculty, examining the impact on teacher content knowledge, attitudes, and classroom lessons. Our findings suggest that the PD improved science content, but made no impact on already high attitudes toward science. In light of the high level of self-reported satisfaction and high frequency of teacher lesson plan use, we propose that the PD had other positive outcomes such as pedagogical knowledge and authentic learning experiences.John L. Pecore, PhD, is an Assistant Professor in the School of Education, College of
Professional Studies at the University of West Florida, Pensacola, FL. Mandy L.
Kirchgessner is a doctoral candidate in Curriculum, Instruction and Technology in
Education at Temple University, Philadelphia, PA. Laura L. Carruth, PhD, is an
Associate Professor at the Neuroscience Institute, Georgia State University, Atlanta, GA.John L. Pecore , Mandy L. Kirchgessner & Laura L. Carruth (2013) Changes in Science Content Knowledge
and Attitudes toward Science Teaching of Educators Attending a Zoo-based Neuroscience Professional Development, The
Clearing House: A Journal of Educational Strategies, Issues and Ideas, 86:6, 238-245Journal Articl
Multi-source monitoring data and numerical analyses for the assessment of settlements affecting built-up areas in variable soil conditions
No full textThis paper presents an integrated analysis based on the use of multi-source wide-area datasets consisting of hydro-mechanical properties of geomaterials, in-situ investigations/measurements (e.g. groundwater levels in wells) and innovative space-borne data (i.e. DInSAR techniques) to support numerical analyses aimed at assessing and predicting the settlements affecting built-up areas in variable soil conditions. To this aim, an expeditious procedure was developed and tested with reference to a district in Rotterdam City (The Netherlands) affected by subsidence phenomena due to the presence of heterogeneous settling strata mainly composed by peat and organic soils. The results obtained allowed investigating the role of predisposing factors of the settlement occurrence and assessing the induced damage on buildings. Considering the widespread diffusion of such geohazards, the followed procedure could help the in-charge authorities to carry out activities at urban scale aimed at identifying the areas most affected by subsidence risk and to select the most suitable and sustainable mitigation strategies.Applied MechanicsGeo-engineerin
A hidden menace: Cardiovascular disease in South Africa and the costs of an inadequate policy response
No full textThe cardiovascular disease (CVD) burden in South Africa (SA) is increasing amongst all age groups and is predicted to become the prime contributor to overall morbidity and mortality in the over 50-year age group. Several factors contribute to this – an epidemiological transition, which has seen a rise in chronic non-communicable disease, and a demographic transition with much reduced fertility and a growing proportion of the population above 60 years. In parallel with unfolding urbanisation, the population burden of vascular risk factors namely hypertension, hypercholesterolemia, diabetes and obesity has increased. The scale of CVD burden poses a threat to the health system and calls for timely intervention. This paper discusses the burden of CVD in SA and current initiatives to address it. Evidence is presented from studies that focus on prevention including salt reduction and trans-fatty acids legislation. The economic and clinical impact of an inadequate private and public sector response is summarised. The paper documents lessons from other countries and proposes health systems strengthening measures that could improve care of patients with CVD
On unregulated markets and the freedom of media the transition of the East German press after 1989
No full textThis thesis fills a gap in research, literature and our understanding of transitioning media in post-socialist countries. It tells the fascinating and complicated story of a press moving from state control to a Western free press model. The focus lies on the German Democratic Republic (GDR) between the fall of the Berlin Wall in November 1989 until after German unification in October 1990. It is a story untold in English-language literature, and it is a largely ignored part in contemporary German media history. Being written for an international readership while engaging largely with a unique moment in German and international media history, this thesis bridges a gap between national, continental and academic disciplines. Its primary question is in how far the democratic potential that existed in the moment of revolutionary change in 1989/1990 found its institutional and/or political manifestation in the post-socialist East German press. Contrary to current research, it answers this question by approaching it from the perspective of an expanding Western democratic, and market economic order. It is, thus, not concerned with case studies or one press-related sector but looks at structural change on various levels; its focus lies on the simultaneous battles fought over a free press. Core concern is the intersection between the normative role the press holds in a democratic society and that of a newly developing, or rather established expanding Western market economy.
This thesis analyzes three press-related sectors within a transitioning political setting: first, the opening of the GDR to (and sale of) West German print media; second, the reform and building of distribution infrastructures, and, third, emerging East-West joint ventures and subsequent changing newspaper ownerships. While closely interlinked, reforming distribution became the point of conflict over which issues of a “free press” were being debated. This thesis shows that nothing that happened in the GDR before, during and after the transition happened in isolation nor was it an exclusively East German problem. Instead, East Germany became the battle ground for various interests groups, East and West, but with clear and all-overshadowing interests of West German political and economic groups. These groups generally expanded and continued their long-established interests and disputes onto the newly opened political arena and economic market. Aiming for power at different levels, all had an interest in influencing media and its policies to their own advantage or, by simply circumventing them, created situations on the ground that, once put into place, were hard to change.Submission published under a 24 month embargo labeled 'U of I Access', the embargo will last until 2020-08-01The student, Mandy Troger, accepted the attached license on 2018-07-06 at 20:31.The student, Mandy Troger, submitted this Dissertation for approval on 2018-07-06 at 20:43.This Dissertation was approved for publication on 2018-07-10 at 13:34.DSpace SAF Submission Ingestion Package generated from Vireo submission #12765 on 2018-09-27 at 11:16:44Made available in DSpace on 2018-09-27T16:30:20Z (GMT). No. of bitstreams: 2
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Empirical fragility curves for settlement-affected buildings: Analysis of different intensity parameters for seven hundred masonry buildings in The Netherlands
No full textThe analysis and prediction of damage to buildings resting on highly compressible fine-grained ‘‘soft soils” containing (organic) clay
and peat are key issues to be addressed for a proper management of subsidence-affected urban areas. Among the probabilistic approaches suggested in literature, those oriented to the generation of empirical fragility curves are particularly promising provided that a comprehensive dataset for both the subsidence-related intensity (SRI) parameters and the corresponding damage severity to buildings is available. Following this line of thought, in the present paper, a rich sample of more than seven hundred monitored (by remote sensing) and surveyed masonry buildings – mainly resting with their (shallow or piled) foundations on soft soils – is analysed in four urban areas of The Netherlands. Probabilistic functions in the form of fragility curves for building damage are retrieved for three different SRI parameters (i.e., differential settlement, rotation and deflection ratio) derived from the processing of Synthetic Aperture Radar (SAR) images by way of a differential interferometric (DInSAR) technique in combination with the severity levels of the damage recorded from the visual inspection of over 700 masonry buildings. As a novelty with respect to earlier similar studies, the work points out the methodological steps to be followed in order to identify the most appropriate SRI parameter among the selected ones. Thus, the objective of the paper is to improve the existing geotechnical forecasting tools for subsidence-affected urban areas, in order to target areas that require more detailed investigations/analyses and/or to select/prioritize foundation repairing/replacing measures
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