scholarly journals Hypertensive Urgency in Tanzanian Adults: A 1-Year Prospective Study

2020 ◽  
Author(s):  
Karl G Reis ◽  
Raymond Wilson ◽  
Fredrick Kalokola ◽  
Bahati Wajanga ◽  
Myung-Hee Lee ◽  
...  
Keyword(s):  
Medication Adherence ◽  
High Risk ◽  
Prospective Study ◽  
Low Income ◽  
Hypertensive Crisis ◽  
The United States ◽  
Low Income Countries ◽  
Improve Medication Adherence ◽  
Hypertensive Urgency ◽  
Poor Outcomes

Abstract BACKGROUND Hypertensive urgency is associated with a high risk for cardiovascular events and mortality in the United States and Europe, but data from low-income countries and interventions to improve outcomes are lacking. METHODS We conducted a 1-year prospective study of the prevalence and outcomes of hypertensive urgency (blood pressure (BP) ≥180 mm Hg/120 mm Hg without end-organ damage) in a busy outpatient clinic in Tanzania. RESULTS Of 7,600 consecutive adult outpatients screened with 3 unattended automated BP measurements according to standard protocol, the prevalence of hypertensive crisis was 199/7,600 (2.6%) (BP ≥180 mm Hg/120 mm Hg) and the prevalence of hypertensive urgency was 164/7,600 (2.2%). Among 150 enrolled patients with hypertensive urgency, median age was 62 years (54–68), 101 (67.3%) were women, and 53 (35%) were either hospitalized or died within 1 year. In a multivariate model, the strongest predictor of hospitalization/death was self-reported medication adherence on a 3 question scale (hazard ratio: 0.06, P < 0.001); 90% of participants with poor adherence were hospitalized or died within 1 year. CONCLUSIONS Patients with hypertensive urgency in Africa are at high risk of poor outcomes. Clinicians can identify the patients at highest risk for poor outcomes with simple questions related treatment adherence. New interventions are needed to improve medication adherence in patients with hypertensive urgency.

scholarly journals Satisfaction with health care system: A comparative study between market-based insurance model of the United States and “out-of-pocket” model in developing and low-income countries

2020 ◽  
Vol 6 (1) ◽  
pp. 41
Author(s):  
Ram Lakhan ◽  
Sean Y. Gillette ◽  
Sean Lee ◽  
Manoj Sharma
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care System ◽  
Undergraduate Students ◽  
Low Income ◽  
Access To Health Care ◽  
The United States ◽  
Low Income Countries ◽  
Healthcare Needs ◽  
Care System

Background and purpose: Access to healthcare services is an essential component for ensuring the quality of life. Globally, there is inequity and disparities regarding access to health care. To meet the global healthcare needs, different models of healthcare have been adopted around the world. However, all healthcare models have some strengths and weaknesses. The purpose of this study was to examine the satisfaction among a group of undergraduate students from different countries with their health care models namely, insurance-based model in the United States and “out-of-pocket” model prevalent in low-income countries.Methods and materials: The study utilized a cross-sectional research design. Undergraduate students, representing different nationalities from a private Southeastern College, were administered a researcher-designed 14-item self-reported electronic questionnaire. Independent t-test and χ2 statistics were used to examine the differences between two health care systems and the qualitative responses were analyzed thematically.Results: Satisfaction towards health care system between the United States and low-income countries was found significantly different (p < .05). However, students in both settings experienced an inability toward affording quality healthcare due to economic factors and disparities.Conclusions: There is dissatisfaction with health care both in the United States and low-income developing countries among a sample of undergraduate students representing these countries. Efforts to ensure low-cost affordable health care should be a global goal.

Immigration and Contract Problems Experienced by Foreign-Educated Nurses

2012 ◽  
Vol 69 (3) ◽  
pp. 351-365 ◽  
Author(s):  
Patricia Pittman ◽  
Carolina Herrera ◽  
Joanne Spetz ◽  
Catherine R. Davis
Keyword(s):  
United States ◽  
Health Care ◽  
Low Income ◽  
The United States ◽  
Low Income Countries ◽  
Labor Rights ◽  
Care Practice ◽  
Quality Health Care ◽  
International Recruitment ◽  
The Impact

More than 8% of employed RNs licensed since 2004 in the United States were educated overseas, yet little is known about the conditions of their recruitment or the impact of that experience on health care practice. This study assessed whether the labor rights of foreign-educated nurses were at risk during the latest period of high international recruitment: 2003 to 2007. Using consensus-based standards contained in the Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Health Professionals to the United States, this study found 50% of actively recruited foreign-educated nurses experienced a negative recruitment practice. The study also found that nurses educated in low-income countries and nurses with high contract breach fees, were significantly more likely to report such problems. If, as experts believe may occur, the nursing shortage in the United States returns around 2014, oversight of international recruitment will become critically important to delivering high-quality health care to Americans.

Global Health Perspective in Sarcomas and Other Rare Cancers

2018 ◽  
pp. 916-924 ◽  
Author(s):  
Vaia Florou ◽  
Antonio G. Nascimento ◽  
Ashish Gulia ◽  
Gilberto de Lima Lopes
Keyword(s):  
Radiation Therapy ◽  
Global Health ◽  
Low Income ◽  
Multidisciplinary Approach ◽  
Low Income Countries ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Management Guidelines ◽  
Systemic Treatments ◽  
Poor Outcomes

Sarcomas, rare and heterogenous malignancies that comprise less than 1% of all cancers, have poor outcomes in the metastatic and refractory setting. Their management requires a multidisciplinary approach that consists of medical and surgical oncologists, radiation oncologists, and pathologists as well as ancillary support. In addition to systemic treatments, most patients will require surgical resection and radiation therapy, which mandates the use of the latest technologies and specialized expertise. Management guidelines have been developed in high-income countries, but their applicability in low-income countries, where resources may be limited, remains a challenge. In this article, we propose the best possible evidence-based practices specifically for income-constrained settings to overcome this challenge. In addition, we review the different methods that can be used in low-income countries to access new and expensive treatments, which often times carry prohibitive costs for these areas.

scholarly journals Political violence and mental health in Nepal: prospective study

2012 ◽  
Vol 201 (4) ◽  
pp. 268-275 ◽  
Author(s):  
Brandon A. Kohrt ◽  
Daniel J. Hruschka ◽  
Carol M. Worthman ◽  
Richard D. Kunz ◽  
Jennifer L. Baldwin ◽  
...  
Keyword(s):  
Mental Health ◽  
Prospective Study ◽  
Political Violence ◽  
Low Income ◽  
Stressful Life Events ◽  
Psychiatric Morbidity ◽  
Low Income Countries ◽  
Post Traumatic Stress ◽  
Post Conflict ◽  
Before And After

BackgroundPost-conflict mental health studies in low-income countries have lacked pre-conflict data to evaluate changes in psychiatric morbidity resulting from political violence.AimsThis prospective study compares mental health before and after exposure to direct political violence during the People's War in Nepal.MethodAn adult cohort completed the Beck Depression Inventory and Beck Anxiety Inventory in 2000 prior to conflict violence in their community and in 2007 after the war.ResultsOf the original 316 participants, 298 (94%) participated in the post-conflict assessment. Depression increased from 30.9 to 40.6%. Anxiety increased from 26.2 to 47.7%. Post-conflict post-traumatic stress disorder (PTSD) was 14.1%. Controlling for ageing, the depression increase was not significant. The anxiety increase showed a dose–response association with conflict exposure when controlling for ageing and daily stressors. No demographic group displayed unique vulnerability or resilience to the effects of conflict exposure.ConclusionsConflict exposure should be considered in the context of other types of psychiatric risk factors. Conflict exposure predicted increases in anxiety whereas socioeconomic factors and non-conflict stressful life events were the major predictors of depression. Research and interventions in postconflict settings therefore should consider differential trajectories for depression v. anxiety and the importance of addressing chronic social problems ranging from poverty to gender and ethnic/caste discrimination.

scholarly journals Article processing charges, the geographic diversity of author communities, and barriers to publication for authors in the Global South

2020 ◽  
Author(s):  
Audrey Culver Smith ◽  
Leandra Merz ◽  
Jesse B. Borden ◽  
Chris Gulick ◽  
Akhil Ravindra Kshirsagar ◽  
...  
Keyword(s):  
Low Income ◽  
United States Of America ◽  
The United States ◽  
Global South ◽  
Low Income Countries ◽  
Editorial Boards ◽  
Geographic Diversity ◽  
The Usa ◽  
Article Processing Charges ◽  
The Relationship

Many OA journals require authors pay an article processing charge (APC), which researchers in the Global South often cite as an insurmountable financial barrier. This has led to speculation that there will be lower representation of these authors in OA journals charging APCs. We used “mirror journals” – APC-charging OA versions of paywalled (PW) titles with whom they share editorial boards and standards for acceptance – to investigate the relationship between APCs and the geographic diversity of authors. Most of the &gt;41,000 articles we reviewed were published in PW journals. Although lead authors were based in &gt;140 countries, ~45% were based in either the United States of America (USA) or China. After correcting for differences in sample size, we found no difference between OA and PW journals in the number of countries in which lead authors were based. After correcting for the dominance of China and the USA, we found that author diversity in OA journals was significantly lower than in PW journals. Most OA articles were written by authors in high-income countries; no articles in OA journals had first authors from low-income countries. Our results suggest APCs are a barrier to OA publication for scientists from the Global South.

scholarly journals Equitable vaccine distribution promotes socioeconomic benefits globally

2021 ◽  
Author(s):  
Nils Stenseth ◽  
Daoping Wang ◽  
Ruiyun Li ◽  
Tianyang Lei ◽  
Yida Sun ◽  
...  
Keyword(s):  
High Risk ◽  
Low Income ◽  
The Elderly ◽  
Economic Benefits ◽  
Benefit Sharing ◽  
Low Income Countries ◽  
Modeling Framework ◽  
Distribution Strategy ◽  
Health Gains ◽  
Vaccine Distribution

Abstract Ensuring a more equitable distribution of vaccines worldwide is an effective strategy to control the COVID-19 pandemic and support global economic recovery. Here, we analyze the socioeconomic effects - defined as health gains, lockdown-easing benefit, and supply-chain rebuilding benefit - of a set of idealized vaccine distribution scenarios, by coupling an epidemiological model with a global trade-modeling framework. We find that overall a perfectly equitable vaccine distribution across the world (Altruistic Age-informed Distribution Strategy) would increase global economic benefits by 11.7% ($950 billion) per year, compared to a strategy focusing on vaccinating the entire population within vaccine-producing countries first and then distributing vaccines to non-vaccine-producing countries (Selfish Distribution Strategy). With limited doses among mid- and low-income countries, prioritizing the elderly who are at high risk of dying, together with the key workforce who are at high risk of exposure, is found to be economically beneficial. We further show that such a strategy would cascade the protection to other production sectors while rebuilding the supply chains. Our results point to a benefit-sharing mechanism which highlights the potential of collaboration between vaccine-producing and other countries to guide an economically preferable vaccine distribution worldwide.

scholarly journals Assessment of a new low-cost, PCR-based strategy for high-risk human papillomavirus DNA detection for cervical cancer prevention

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Pedro Surriabre ◽  
Andrea Torrico ◽  
Tania Vargas ◽  
Fuantina Ugarte ◽  
Patricia Rodriguez ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
High Risk ◽  
Low Income ◽  
Low Cost ◽  
Low Income Countries ◽  
Hybrid Capture ◽  
Hpv Test ◽  
Novel Strategy ◽  
Level Of Agreement

Abstract Background HPV test implementation as a primary screening tool has the potential to decrease cervical cancer incidence as shown by several studies around the world. However, in many low-resource settings, the HPV test introduction has been backed down mainly due to its price. In this study, we present a novel low-cost strategy involving simple devices and techniques for high-risk human papillomavirus (HR-HPV) detection. The analytical performance to detect HR-HPV infections of this novel strategy was assessed by comparing it with the Hybrid Capture 2 system (HC2), which is used as gold standard. Methods Paired-cervical samples were collected from 541 women assisting to gynecological services in an outpatient clinic. One sample was transported in the Hybrid Capture Standard Transport Medium for HR-HPV detection by the HC2. The second sample was transported on glass slide for detection by PCR-based techniques (GP-EIA, BSGP-EIA and pU 1 M-L/2R). Results The level of agreement between the PCR-based techniques and HC2 system was determined with the Cohen’s kappa value. The kappa values between HC2 and GP-EIA, BSGP-EIA and pU 1 M-L/2R were 0.71 (CI 95% 0.63–0.78), 0.78 (CI 95% 0.71–0.84) and 0.63 (CI 95% 0.55–0.72), respectively. However, when the results from both BSGP-EIA and pU 1 M-L/2R were combined, the level of agreement with HC2 was increased to 0.82 (CI 95% 0.76–0.88), reflecting a very good agreement between the two HR-HPV detection strategies. Furthermore, the sensitivity of both techniques combined was also increased compared to the BSGP-EIA (88.7% vs 77.4%) and the pU (88.7 vs 60.9%) without penalizing the specificity obtained with the BSGP-EIA (95.1% vs 96.9%) and the pU (95.1% vs 96.5%). Conclusions This novel strategy, combining two PCR-based techniques for HR-HPV detection, could be useful for cervical cancer screening in self-collected samples in low-income countries.

Comparison of ColoPrint risk classification with clinical risk in the prospective PARSC trial.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 465-465 ◽  
Author(s):  
Ramon Salazar ◽  
Jaume Capdevila ◽  
Robert Rosenberg ◽  
Jan Willem de Waard ◽  
Bengt Glimelius ◽  
...  
Keyword(s):  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Prospective Study ◽  
The United States ◽  
Risk Classification ◽  
Low Risk ◽  
Stage Ii ◽  
High Risk Patients ◽  
Clinical Risk ◽  
Risk Patients

465 Background: The 18-gene expression profile, ColoPrint, has been developed and validated for identifying risk of recurrence in patients with early-stage colon cancer (CC). In a pooled stage II validation study ColoPrint identified 63% of patients as Low Risk with a 3-yr recurrence-free survival (RFS) of 93% while High Risk patients had a 3-yr RFS of 82% with a HR of 2.7 (p=0.001). PARSC is a prospective study for the assessment of recurrence risk in stage II CC patients using ColoPrint. ColoPrint classification is compared to NCCN risk classification. Methods: The study enrolled 468 patients with histologically proven stage II CC from 31 institutes in Europe, the United States, and Asia between October 2008 and May 2013. Synchronous tumors were excluded. ColoPrint results were not disclosed to the physician and patient. Treatment was at the discretion of the physician, adhering to NCCN approved regimens or a recognized alternative. A McNemars test is performed to compare ColoPrint with NCCN risk classification. A p value ≤ 0.05 indicates the two tests differ significantly. Results: ColoPrint classified 320 (68%) patients as Low Risk and 148 (32%) as High Risk. 89 patients (19%) received adjuvant chemotherapy. In the ColoPrint Low Risk group, 57 (18%) patients received adjuvant chemotherapy while 32 (22%) of ColoPrint High Risk patients received chemotherapy. According to NCCN high risk factors (T4, high grade (exclusive of MSI-H), lymphovascular/perineural invasion, perforation/obstruction, <12 nodes examined, positive margins) 234 (50%) patients were NCCN Low Risk and 234 were NCCN High Risk. 72 (31%) of the NCCN Low Risk patients are ColoPrint High Risk. 158 (68%) of the NCCN High Risk patients are ColoPrint Low Risk. MSI-status was assessed in 86 (18%) patients of which 29 were MSI high and 57 were MSS. All MSI high were classified as ColoPrint Low Risk. Conclusions: The PARSC study is the first prospective study to compare genomic and clinical risk assessment and we observed marked differences between NCCN risk classification and ColoPrint. The clinical validity of these methods will be based on the outcomes at 3 and 5 years. Clinical trial information: NCT00903565. [Table: see text]

scholarly journals Micronutrients - a Global Perspective on Intake, Health Benefits and Economics

2012 ◽  
Vol 82 (5) ◽  
pp. 316-320 ◽  
Author(s):  
Birgit Hoeft ◽  
Peter Weber ◽  
Manfred Eggersdorfer
Keyword(s):  
Low Income ◽  
Health Care Systems ◽  
The Elderly ◽  
The United States ◽  
Global Perspective ◽  
Low Income Countries ◽  
Micronutrient Deficiencies ◽  
Micronutrient Status ◽  
Care Systems ◽  
Development And Aging

The link between a sufficient intake of vitamins and long term health, cognition, healthy development and aging is increasingly supported by experimental animal, human and epidemiology studies. In low income countries billions of people still suffer from the burden of malnutrition and micronutrient deficiencies. However, inadequate micronutrient status might also be an issue in industrialized countries. Recent results from nutritional surveys in countries like the United States, Germany, and Great Britain indicate that the recommended intake of micronutrients is not reached. This notably concerns certain vulnerable population groups, such as pregnant women, young children and the elderly, but also greatly influences the general healthcare costs. An overview is provided on the gap that exists between current vitamin intakes and requirements, even in countries where diverse foods are plentiful. Folic acid and vitamin D intake and status are evaluated in more detail, providing insight on health and potential impact on health care systems.

Sign in / Sign up

Export Citation Format

Share Document