scholarly journals Sodium Consumption: An Individual's Choice?

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Norm R. C. Campbell ◽  
Jillian A. Johnson ◽  
Tavis S. Campbell
Keyword(s):  
Developing Economies ◽  
Behavioural Change ◽  
International Health ◽  
Cost Effective ◽  
Developed Countries ◽  
Population Based ◽  
Dietary Salt ◽  
Dominant Source ◽  
International Health Organizations ◽  
Improve Health

Excess intake of dietary salt is estimated to be one of the leading risks to health worldwide. Major national and international health organizations, along with many governments around the world, have called for reductions in the consumption of dietary salt. This paper discusses behavioural and population interventions as mechanisms to reduce dietary salt. In developed countries, salt added during food processing is the dominant source of salt and largely outside of the direct control of individuals. Population-based interventions have the potential to improve health and to be cost saving for these countries. In developing economies, where salt added in cooking and at the table is the dominant source, interventions based on education and behaviour change have been estimated to be highly cost effective. Regardless, countries with either developed or developing economies can benefit from the integration of both population and behavioural change interventions.

scholarly journals Management of Hypertension: A Bangladeshi Perspective

1970 ◽  
Vol 39 (1) ◽  
pp. 40-43
Author(s):  
SM Mustafa Zaman ◽  
Mohammad Salman ◽  
Kaniz Fatema
Keyword(s):  
Cardiovascular Disease ◽  
Fruits And Vegetables ◽  
Lifestyle Modification ◽  
Clinical Care ◽  
Cost Effective ◽  
Developed Countries ◽  
Population Based ◽  
Lifestyle Changes ◽  
Optimum Level ◽  
Lifestyle Modifications

Hypertension is a silent killer. Bangladeshis are racially predisposed to cardiovascular disease, and the increasing burden of hypertension has only added to the problem. Economic constraints and the allure of additional benefits without adverse effects have made lifestyle modifications an attractive proposition in developing and developed countries alike. Blood pressure is a continuum and any increase above optimum level confers additional independent risk of cardiovascular disease. We review screening, diagnosis and management using lifestyle measures and pharmacotherapy. We then discuss the barriers and challenges to implementing this approach and what can be done regarding prevention, screening, lifestyle modification and pharmacotherapy in our country. By adopting a comprehensive population based approach including policy level interventions directed at promoting lifestyle changes; a healthy diet (appropriate calories, low in saturated fats and salt and rich in fruits and vegetables), increased physical activity, and a smoking free society, properly balanced with a high risk approach of cost effective clinical care, Bangladesh can effectively control hypertension and improve public health. DOI: 10.3329/bmj.v39i1.6232 Bangladesh Medical Journal 2010; 39(1): 40-43

P6142LATIN telemedicine - expanded umbrella of cost-effective ami coverage for 100 million people

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M A Torres ◽  
S Mehta ◽  
R Botelho ◽  
F Fernandez ◽  
J Cade ◽  
...  
Keyword(s):  
Systems Of Care ◽  
Cost Effective ◽  
Developed Countries ◽  
Population Based ◽  
Primary Pci ◽  
Hub And Spoke ◽  
Web Based ◽  
Catheterization Laboratory ◽  
Number Of Patients ◽  
And Training

Abstract Background AMI is a unique entity where the immediate diagnosis can be made by a single test, the EKG. Despite this matchless attribute of easy diagnosis, developing (and some developed) countries lack resources and efficient pathways for urgent and reliable diagnosis of AMI. With Latin Telemedicine Infarct Network (LATIN), we have previously presented Telemedicine as a pragmatic solution for urgent and accurate diagnosis of AMI. In this work, we reveal pathways of scalable population-based AMI management models. Purpose To utilize telemedicine as a foundation pillar for creating cost-effective and global models of AMI management. Methods LATIN pilot tested the hypothesis of remote guidance of AMI management and expanded access by creating a hub and spoke, STEMI systems of care that exploited regional resources. A highly efficient, web-based, cloud-computing prototype was developed and scrupulously monitored with a new metric of time to telemedicine diagnosis (TTD). STEMI systems of care were created to efficiently triage the diagnosed patients for being treated with thrombolysis, pharmaco-invasive management or Primary PCI. This stratagem had enormous provincial variability and was constrained mainly by ambulance structure. Telemedicine and IT costs were forced lower and enabled a cost-effective process to hugely provide access to 100 million patients located in poorer regions of Colombia, Brazil, Mexico, and Argentina. Education and training have formed the mantra for LATIN and stakeholder development, and ambulance systems development has remained immutable goals. Results Almost 800,000 patients were successfully screening through LATIN with a cost for accurate STEMI diagnosis of < $3, a tele accuracy that exceeded 95% and with TTD <4 minutes. A total of 8,440 (1.1%) of patients were diagnosed with AMI in this manner and 3,924 (46.5%) urgently reperfused, mainly with Primary PCI (3,048, 77.8%). D2B times have been lowered now to 51 minutes but this is fortuitous, as several PCI-capable facilities are small, and direct transfer to the catheterization laboratory is easy. Door in and Door out times and transport times remain high as a large number of patients are denied by insurance and other payers for treatment. Overall, mortality is 5.2%. Conclusions Global financial and philanthropic institutions should contemplate models analogous to LATIN for saving the lives of millions of poor patients in developing countries from AMI.

Australia—The Hidden Jewel

2018 ◽  
Author(s):  
Mahesh K. Joshi ◽  
J.R. Klein
Keyword(s):  
Natural Resources ◽  
Value Chain ◽  
Global Economy ◽  
Good Governance ◽  
Developing Economies ◽  
Raw Materials ◽  
Manufacturing Sector ◽  
Developed Countries ◽  
The United States ◽  
Dutch Disease

The twenty-first century is being touted as the Asian century. With its stable economy, good governance, education system, and above all the abundant natural resources, will Australia to take its place in the global economy by becoming more entrepreneurial and accelerating its rate of growth, or will it get infected with the so-called Dutch disease? It has been successful in managing trade ties with fast-developing economies like China and India as well as developed countries like the United States. It has participated in the growth of China by providing iron ore and coal. Because it is a low-risk country, it has enabled inflow of large foreign capital investments. A lot will depend on its capability and willingness to invest the capital available in entrepreneurial ventures, its ability to capture the full value chain of natural resources, and to export the finished products instead of raw materials, while building a robust manufacturing sector.

P3352Telemedicine transcends national boundaries in quest of creating a behemoth ami program

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mehta ◽  
R Botelho ◽  
F Fernandez ◽  
F Feres ◽  
A Abizaid ◽  
...  
Keyword(s):  
Community Health Centers ◽  
Developed Countries ◽  
Population Based ◽  
Primary Pci ◽  
Small Community ◽  
Hub And Spoke ◽  
Web Based ◽  
National Boundaries ◽  
Intelligent Tools ◽  
Time Of Presentation

Abstract Background The Latin America Telemedicine Infarct Network (LATIN) has exploited the remarkable competence of telemedicine for remote guidance. In doing so, LATIN created a mammoth population-based AMI network that employed experts located several hundred miles away to guide the reperfusion strategies for almost 800,000 screened patients. In this pioneering project, telemedicine was initially utilized to guide AMI management within national confines. We speculated whether LATIN telemedicine navigation could outstrip countrywide borders. Purpose To maximally harness the vast possibilities of telemedicine for improving AMI care. Methods During its pilot phase, LATIN began as a hub and spoke, AMI system in Colombia where 20 spokes (small community health centers and rural clinics) were configured with 3 hubs that could perform Primary PCI. These sites were linked through web-based connectivity. Expert cardiologists, located 50–250 miles away in Bogota, Colombia, used sophisticated telemedicine platforms for urgent EKG diagnosis and teleconsultation of the entire AMI process. Based upon the duration of chest pain and travel time to the hub, these experts guided patients through guideline-based strategies of thrombolysis, pharmaco invasive management or primary PCI. Efficiency of the telemedicine process was measured with the new metric of time to telemedicine diagnosis (TTD). Cloud computing, GPS navigation, and numerous business intelligent tools were gradually incorporated into LATIN telemedicine. As systems became more scalable, the program was expanded to Brazil, where LATIN flourished. Over the last 18 months, LATIN telemedicine capabilities have been pressed across national boundaries. Presently, all 82 LATIN centers in Mexico are guided by experts located in Bogota, Colombia and the 7 Argentina centers channeled through Santiago, Chile. Results 784,947 patients were screened for AMI at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). Navigation pathways are depicted in the attached figure. TTD remains extremely low in all four countries, and comparable efficiency and tele-accuracy have been achieved. With expanded geographic reach, 8,448 (1.08%) patients were diagnosed with STEMI and 3,911 (46.3%) urgently reperfused, including 3,049 (78%) with Primary PCI. Time to TTD ranged between 2.8 to 5.8 minutes, with a mean of 3.5 min. Tele-accuracy was 98.5%, D2B 51 min, and in-hospital mortality 5.2%. Various other comparative metrics for the 4 countries are being gathered and will be available at the time of presentation. Conclusions LATIN demonstrates the robust ability of telemedicine to transcend national boundaries to guide AMI management. This strategy can be adopted in under-developed countries in Asia and Africa to provide an umbrella of AMI care for the millions of disadvantaged patients.

scholarly journals Anti-meningococcal B vaccination in Italian adolescents: a cost-effective health opportunity

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Panatto ◽  
P Landa ◽  
D Amicizia ◽  
P L Lai ◽  
E Lecini ◽  
...  
Keyword(s):  
Large Scale ◽  
Public Health Problem ◽  
Vaccination Strategy ◽  
Cost Effective ◽  
Dose Schedule ◽  
Developed Countries ◽  
Invasive Disease ◽  
International Setting ◽  
The Impact

Abstract Background Invasive disease due to Neisseria meningitidis (Nm) is a serious public health problem even in developed countries, owing to its high lethality rate (8-15%) and the invalidating sequelae suffered by many (up to 60%) survivors. As the microorganism is transmitted via the airborne route, the only available weapon in the fight against Nm invasive disease is vaccination. Our aim was to carry out an HTA to evaluate the costs and benefits of anti-meningococcal B (MenB) vaccination with Trumenba® in adolescents in Italy, while also considering the impact of this new vaccination strategy on organizational and ethics aspects. Methods A lifetime Markov model was developed. MenB vaccination with the two-dose schedule of Trumenba® in adolescents was compared with 'non-vaccination'. Two perspectives were considered: the National Health Service (NHS) and society. Three disease phases were defined: acute, post-acute and long-term. Epidemiological, economic and health utilities data were taken from Italian and international literature. The analysis was conducted by means of Microsoft Excel 2010®. Results Our study indicated that vaccinating adolescents (11th year of life) with Trumenba® was cost-effective with an ICER = € 7,912/QALY from the NHS perspective and € 7,758/QALY from the perspective of society. Vaccinating adolescents reduces the number of cases of disease due to meningococcus B in one of the periods of highest incidence of the disease, resulting in significant economic and health savings. Conclusions This is the first study to evaluate the overall impact of free MenB vaccination in adolescents both in Italy and in the international setting. Although cases of invasive disease due to meningococcus B are few, if the overall impact of the disease is adequately considered, it becomes clear that including anti-meningococcal B vaccination into the immunization program for adolescents is strongly recommended from the health and economic standpoints. Key messages Free, large-scale MenB vaccination is key to strengthening the global fight against invasive meningococcal disease. Anti-meningococcal B vaccination in adolescents is a cost-effective health opportunity.

scholarly journals A novel body circumferences-based estimation of percentage body fat

2018 ◽  
Vol 119 (6) ◽  
pp. 720-725 ◽  
Author(s):  
Yair Lahav ◽  
Yoram Epstein ◽  
Ron Kedem ◽  
Haggai Schermann
Keyword(s):  
Body Fat ◽  
Field Research ◽  
Cost Effective ◽  
Population Based ◽  
Reliable Estimate ◽  
Study Cohort ◽  
Anthropometric Measures ◽  
Percentage Body Fat ◽  
Health Club ◽  
Body Circumferences

AbstractAnthropometric measures of body composition are often used for rapid and cost-effective estimation of percentage body fat (%BF) in field research, serial measurements and screening. Our aim was to develop a validated estimate of %BF for the general population, based on simple body circumferences measures. The study cohort consisted of two consecutive samples of health club members, designated as ‘development’ (n 476, 61 % men, 39 % women) and ‘validation’ (n 224, 50 % men, 50 % women) groups. All subjects underwent anthropometric measurements as part of their registration to a health club. Dual-energy X-ray absorptiometry (DEXA) scan was used as the ‘gold standard’ estimate of %BF. Linear regressions where used to construct the predictive equation (%BFcal). Bland–Altman statistics, Lin concordance coefficients and percentage of subjects falling within 5 % of %BF estimate by DEXA were used to evaluate accuracy and precision of the equation. The variance inflation factor was used to check multicollinearity. Two distinct equations were developed for men and women: %BFcal (men)=10·1−0·239H+0·8A−0·5N; %BFcal (women)=19·2−0·239H+0·8A−0·5N (H, height; A, abdomen; N, neck, all in cm). Bland–Altman differences were randomly distributed and showed no fixed bias. Lin concordance coefficients of %BFcal were 0·89 in men and 0·86 in women. About 79·5 % of %BF predictions in both sexes were within ±5 % of the DEXA value. The Durnin–Womersley skinfolds equation was less accurate in our study group for prediction of %BF than %BFcal. We conclude that %BFcal offers the advantage of obtaining a reliable estimate of %BF from simple measurements that require no sophisticated tools and only a minimal prior training and experience.

scholarly journals Does access to care play a role in liver cancer survival? The ten-year (2006–2015) experience from a population-based cancer registry in Southern Italy

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Walter Mazzucco ◽  
Francesco Vitale ◽  
Sergio Mazzola ◽  
Rosalba Amodio ◽  
Maurizio Zarcone ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Access To Care ◽  
Cancer Registry ◽  
Health Care Services ◽  
Cancer Survival ◽  
Developed Countries ◽  
Population Based ◽  
Easy Access ◽  
Net Survival ◽  
Poor Access

Abstract Background Hepatocellular carcinoma (HCC) is the most frequent primary invasive cancer of the liver. During the last decade, the epidemiology of HCC has been continuously changing in developed countries, due to more effective primary prevention and to successful treatment of virus-related liver diseases. The study aims to examine survival by level of access to care in patients with HCC, for all patients combined and by age. Methods We included 2018 adult patients (15–99 years) diagnosed with a primary liver tumour, registered in the Palermo Province Cancer Registry during 2006–2015, and followed-up to 30 October 2019. We obtained a proxy measure of access to care by linking each record to the Hospital Discharge Records and the Ambulatory Discharge Records. We estimated net survival up to 5 years after diagnosis by access to care (“easy access to care” versus “poor access to care”), using the Pohar-Perme estimator. Estimates were age-standardised using International Cancer Survival Standard (ICSS) weights. We also examined survival by access to care and age (15–64, 65–74 and ≥ 75 years). Results Among the 2018 patients, 62.4% were morphologically verified and 37.6% clinically diagnosed. Morphologically verified tumours were more frequent in patients aged 65–74 years (41.6%), while tumours diagnosed clinically were more frequent in patients aged 75 years or over (50.2%). During 2006–2015, age-standardised net survival was higher among HCC patients with “easy access to care” than in those with “poor access to care” (68% vs. 48% at 1 year, 29% vs. 11% at 5 years; p < 0.0001). Net survival up to 5 years was higher for patients with “easy access to care” in each age group (p < 0.0001). Moreover, survival increased slightly for patients with easier access to care, while it remained relatively stable for patients with poor access to care. Conclusions During 2006–2015, 5-year survival was higher for HCC patients with easier access to care, probably reflecting progressive improvement in the effectiveness of health care services offered to these patients. Our linkage algorithm could provide valuable evidence to support healthcare decision-making in the context of the evolving epidemiology of hepatocellular carcinoma.

Cyberspace at the Grassroots: E-Governance and Citizen/Stakeholder Perceptions at the Local Level in Bangladesh

2021 ◽  
pp. 245513332110340
Author(s):  
Habib Zafarullah ◽  
Jannatul Ferdous
Keyword(s):  
Service Delivery ◽  
Service Providers ◽  
Social Issues ◽  
Local Level ◽  
Cost Effective ◽  
Developed Countries ◽  
Information And Communications Technology ◽  
Least Developed Countries ◽  
Governance System ◽  
Citizen Perceptions

Bangladesh has experimented with e-governance since the early 2000s and currently ranks among the top 10 least developed countries. The deployment of e-governance at the local level has provided benefits to the rural people, with local councils increasingly using information and communications technology (ICT) to expand community-based delivery systems and augment rural service delivery. One-stop cyber centres provide a range of services that are user-friendly, cost-effective and less time-consuming. This study focuses on five sub-districts to inquire about the range of services provided by the e-service centres there. It has recorded citizen perceptions and the level of their satisfaction and the observations of service providers about the e-service mechanism. It also identifies key challenges in service delivery. Citizen satisfaction was measured using 12 indicators, while the service provider observations focused on social issues, governance, resource and technical issues. The study found several issues requiring attention to consolidate the e-governance system in the country.

Triage Management, Survival, and the Law in the Age of Ebola

2014 ◽  
Vol 9 (1) ◽  
pp. 38-43 ◽  
Author(s):  
Frederick M Burkle ◽  
Christopher M Burkle
Keyword(s):  
Public Health ◽  
International Health ◽  
Epidemiological Data ◽  
Population Based ◽  
World Health ◽  
Economic Stability ◽  
Budget Cuts ◽  
The Public ◽  
Level 3 ◽  
Health Organization

AbstractLiberia, Sierra Leone, and Guinea lack the public health infrastructure, economic stability, and overall governance to stem the spread of Ebola. Even with robust outside assistance, the epidemiological data have not improved. Vital resource management is haphazard and left to the discretion of individual Ebola treatment units. Only recently has the International Health Regulations (IHR) and World Health Organization (WHO) declared Ebola a Public Health Emergency of International Concern, making this crisis their fifth ongoing level 3 emergency. In particular, the WHO has been severely compromised by post-2003 severe acute respiratory syndrome (SARS) staffing, budget cuts, a weakened IHR treaty, and no unambiguous legal mandate. Population-based triage management under a central authority is indicated to control the transmission and ensure fair and decisive resource allocation across all triage categories. The shared responsibilities critical to global health solutions must be realized and the rightful attention, sustained resources, and properly placed legal authority be assured within the WHO, the IHR, and the vulnerable nations. (Disaster Med Public Health Preparedness. 2014;0:1-6)

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