scholarly journals A primer on hypertension and on the racial / ethnic disparities in diagnosis and management: a comprehensive overview

2021 ◽  
Vol 5 (6) ◽  
pp. 229-239
Author(s):  
Ivy Njoloma ◽  
Nasheria Lewis ◽  
Frantz Sainvil ◽  
George P Einstein ◽  
Andrew Sciranka ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Racial Differences ◽  
Low Income ◽  
Access To Health Care ◽  
African American Men ◽  
Ethnic Disparities ◽  
World Health ◽  
Treatment Of Hypertension ◽  
Adrenergic Blockers

Hypertension is a major cause of premature death worldwide, where it contributes to stroke, cardiovascular and renal disease. Forty percent of adults aged 30-79 years worldwide have hypertension, two-thirds of whom are living in low and middle-income countries. Most adults with hypertension are not fully aware that they have the condition, therefore it often goes ignored and untreated. Of the 1.28 billion people worldwide, who have been reported to have hypertension, data indicates that one in five females and one in four males are included in that estimate. Moreover, data from World Health Organization reports that less than half of adults (42%) with hypertension are diagnosed and treated adequately and approximately only one in five adults (21%) with hypertension have it under adequate control. One of the worldwide goals for non-communicable diseases is to scale back the prevalence of hypertension by 33% between 2010 and 2030. In African Americans, readily available thiazide diuretics or Calcium Channel Blockers (CCBs) have been shown to be more effective in lowering blood pressure than Renin Angiotensin System inhibitors (RAS) or β-adrenergic blockers and are also more effective in reducing cardiovascular disease (CVD) events than RAS inhibitors or adrenergic blockers. The ethnical difference in hypertension and hypertension- related complaint issues are associated with lesser mortality and morbidity pitfalls compared with their white counterparts. These redundant pitfalls from elevated blood pressure have a dramatic effect on life expectancy and career productivity for African American men and women and which is significantly lower than has been reported for Caucasian Americans of either gender. These present challenges remain to be completely understood and give a result to overcome ethnical and racial differences in the frequency and treatment of hypertension. Social determinants of health similar as educational status, access to health care and low income play a crucial part in frequency and blood pressure control rates. Development of appropriate health care programs at the state and public situations to address these issues will be essential to reduce these differences. Thus, the purpose of this paper is to review the prevalence and ethnic disparities in the diagnosis and treatment of hypertension and to suggest steps to improve the outcomes.

scholarly journals Using Prospective Methods to Identify Fieldwork Locations Favourable to Understanding Divergences in Health Care Accessibility

2021 ◽  
Vol 10 (8) ◽  
pp. 506
Author(s):  
Jan Ketil Rød ◽  
Arne H. Eide ◽  
Thomas Halvorsen ◽  
Alister Munthali
Keyword(s):  
Health Care ◽  
Low Income ◽  
Access To Health Care ◽  
Health Care Services ◽  
Good Health ◽  
Low Income Countries ◽  
Care Services ◽  
Health Care Accessibility ◽  
Barriers To Health ◽  
Walking Time

Central to this article is the issue of choosing sites for where a fieldwork could provide a better understanding of divergences in health care accessibility. Access to health care is critical to good health, but inhabitants may experience barriers to health care limiting their ability to obtain the care they need. Most inhabitants of low-income countries need to walk long distances along meandering paths to get to health care services. Individuals in Malawi responded to a survey with a battery of questions on perceived difficulties in accessing health care services. Using both vertical and horizontal impedance, we modelled walking time between household locations for the individuals in our sample and the health care centres they were using. The digital elevation model and Tobler’s hiking function were used to represent vertical impedance, while OpenStreetMap integrated with land cover map were used to represent horizontal impedance. Combining measures of walking time and perceived accessibility in Malawi, we used spatial statistics and found spatial clusters with substantial discrepancies in health care accessibility, which represented fieldwork locations favourable for providing a better understanding of barriers to health access.

Advocacy for a Digital Oral Health That Leaves No One Behind

2021 ◽  
pp. 238008442110266
Author(s):  
N. Giraudeau ◽  
B. Varenne
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Access To Health Care ◽  
Universal Access ◽  
Digital Health ◽  
World Health ◽  
Noncommunicable Diseases ◽  
Central Component ◽  
Health Coverage ◽  
The Impact

During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, the lockdown enforced led to considerable disruption to the activities of dental services, even leading to closures. To mitigate the impact of the lockdowns, systems were quickly put in place in most countries to respond to dental emergencies, giving priority to distance screening, advice to patients by remote means, and treatment of urgent cases while ensuring continuous care. Digital health was widely adopted as a central component of this new approach, leading to new practices and tools, which in turn demonstrated its potential, limitations, and possible excesses. Political leaders must become aware of the universal availability of digital technology and make use of it as an additional, safe means of providing services to the public. In view of the multiple uses of digital technologies in health—health literacy, teaching, prevention, early detection, therapeutics, and public health policies—deployment of a comprehensive program of digital oral health will require the adoption of a multifaceted approach. Digital tools should be designed to reduce, not increase, inequalities in access to health care. It offers an opportunity to improve healthy behavior, lower risk factors common to oral diseases and others noncommunicable diseases, and contribute to reducing oral health inequalities. It can accelerate the implementation of universal health coverage and help achieve the 2030 Sustainable Development Agenda, leaving no one behind. Digital oral health should be one of the pillars of oral health care after COVID-19. Universal access to digital oral health should be promoted globally. The World Health Organization’s mOralHealth program aims to do that. Knowledge Transfer Statement: This position paper could be used by oral health stakeholders to convince their government to implement digital oral health program.

Health Policy in Cambodia: To What Extent Is an Aid-Dependent Country Able to Determine Its Own Policy?

2014 ◽  
Vol 44 (1) ◽  
pp. 171-187 ◽  
Author(s):  
VIRGINIE DIAZ PEDREGAL ◽  
BLANDINE DESTREMAU ◽  
BART CRIEL
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Low Income ◽  
Access To Health Care ◽  
Implementation Process ◽  
Health Care Provision ◽  
Care Provision ◽  
Low Income Country ◽  
Access To Health ◽  
Wide Range

AbstractThis article analyses the design and implementation process of arrangements for health care provision and access to health care in Cambodia. It points to the complexity of shaping a coherent social policy in a low-income country heavily dependent on international aid.At a theoretical level, we confirm that ideas, interests and institutions are all important factors in the construction of Cambodian health care schemes. However, we demonstrate that trying to hierarchically organise these three elements to explain policy making is not fruitful.Regarding the methodology, interviews with forty-eight selected participants produced the qualitative material for this study. A documentary review was also an important source of data and information.The study produces two sets of results. First, Cambodian policy aimed at the development of health care arrangements results from a series of negotiations between a wide range of stakeholders with different objectives and interests. International stakeholders, such as donors and technical organisations, are major players in the policy arena where health policy is constructed. Cambodian civil society, however, is rarely involved in the negotiations.Second, the Cambodian government makes political decisions incrementally. The long-term vision of the Cambodian authorities for improving health care provision and access is quite clear, but, nevertheless, day-to-day decisions and actions are constantly negotiated between stakeholders. As a result, donors and non-government organisations (NGOs) working in the field find it difficult to anticipate policies.To conclude, despite real autonomy in the decision-making process, the Cambodian government still has to prove its capacity to master a number of risks, such as the (so far under-regulated) development of the private health care sector.

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.

scholarly journals A Study Protocol for Increasing Access to Smoking Cessation Treatments for Low-Income Minority Smokers

2021 ◽  
Vol 9 ◽  
Author(s):  
Alicia K. Matthews ◽  
Karriem S. Watson ◽  
Cherdsak Duang ◽  
Alana Steffen ◽  
Robert Winn
Keyword(s):  
Health Care ◽  
Smoking Cessation ◽  
Health Care Providers ◽  
Low Income ◽  
Access To Health Care ◽  
Social Determinant ◽  
Evidence Based ◽  
Patient Portal ◽  
Care Providers ◽  
Access To Health

Background: Smoking rates among low-income patients are double those of the general population. Access to health care is an essential social determinant of health. Federally qualified health care centers (FQHC) are government-supported and community-based centers to increase access to health care for non-insured and underinsured patients. However, barriers to implementation impact adherence and sustainability of evidence-based smoking cessation within FQHC settings. To address this implementation barrier, our multi-disciplinary team proposes Mi QUIT CARE (Mile Square QUITCommunity-Access-Referral-Expansion) to establish the acceptability, feasibility, and capacity of an FQHC system to deliver an evidence-based and multi-level intervention to increase patient engagement with a state tobacco quitline.Methods: A mixed-method approach, rooted in an implementation science framework of RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance), will be used in this hybrid effectiveness-implementation design. We aim to evaluate the efficacy of a novel delivery system (patient portal) for increasing access to smoking cessation treatment. In preparation for a future randomized clinical trial of Mi QUIT CARE, we will conduct the following developmental research: (1) Examine the burden of tobacco among patient populations served by our partner FQHC, (2) Evaluate among FQHC patients and health care providers, knowledge, attitudes, barriers, and facilitators related to smoking cessation and our intervention components, (3) Evaluate the use of tailored communication strategies and patient navigation to increase patient portal uptake among patients, and (4) To test the acceptability, feasibility, and capacity of the partner FQHC to deliver Mi QUIT CARE.Discussion: This study provides a model for developing and implementing smoking and other health promotion interventions for low-income patients delivered via patient health portals. If successful, the intervention has important implications for addressing a critical social determinant of cancer and other tobacco-related morbidities.Trial Registration: U.S. National Institutes of Health Clinical Trials, NCT04827420, https://clinicaltrials.gov/ct2/show/NCT04827420.

Abstract MP043: Awareness of Hypertension and Determinants of Treatment in a Community-Based Observational Sample in Da Nang, Viet Nam

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Zachary P Boas ◽  
Annette L Fitzpatrick ◽  
Quang V Ngo ◽  
James P Logerfo
Keyword(s):  
Blood Pressure ◽  
Low Income ◽  
World Health ◽  
Viet Nam ◽  
Behavioral Modification ◽  
Community Based ◽  
Major Health Problem ◽  
Screening Programs ◽  
Urban Regions ◽  
Undiagnosed Hypertension

Introduction: Hypertension in Viet Nam is becoming an increasing source of mortality and morbidity. While data collection on hypertension in resource poor environments has been improving through the use of standardized surveys, little is known about how well treatments are being applied. Knowledge of gaps in diagnosis and treatment is necessary if appropriate public health programs are to developed. Using a community based observational sample in the Da Nang province of Viet Nam, we studied both the prevalence of undiagnosed hypertension, as well as the types of treatment those with hypertension received. Methods: Randomized cluster sampling methods were used to identify adults age 35 years and older in six communes of Da Nang province, Viet Nam. Using World Health Organization guidelines, data were collected on subject’s demographics, medical history, blood pressure and health behaviors. Subjects were also instructed to bring all medications they take regularly which were then recorded. Separate multivariate logistic regressions were used to identify both factors associated with awareness of hypertension as well as factors influencing whether one received medical therapy. Results: The initial survey examined 1,621 adults with 557 (34.5%) having hypertension. Of those, only 232 (41.7%) were aware of the diagnosis. Being male (OR 0.52, 95% CI: 0.36–0.75), older (OR 1.03, 95% CI: 1.02–1.05 per year) and having a low income (OR 1.11, 95% CI: 1.05–1.16 per million dong/month) were each independently associated with being unaware of one’s hypertension. Of those who were aware of their hypertension, 212 (91.4%) had been recommended some behavioral modification (exercise, decreased sodium intake, smoking cessation, or weight loss). Two-thirds (152/229) reported having taken antihypertensives in the past two weeks. Reported use of medication differed by region, 109/150 (72.7%) in urban regions versus 43/79 (54.4%) in rural/mixed-urban regions (p<0.05), but was not associated with any other demographic. Eighty-nine (38.9%) of those aware of their hypertension had adequately controlled blood pressure when evaluated, and this did not differ based on reported medication use. We were able to determine the actual medications used in 91 of the 152 (59.9%). Seven people were on dual therapy, the remainder were on monotherapy. Calcium channel blockers (54, 59.3%) and ACE inhibitors (36, 39.6%) were the most common therapies. Conclusions: Undiagnosed hypertension remains a major health problem in the Da Nang province of Viet Nam. The vast majority of those aware of their hypertension were receiving at least some level of behavioral modification with a smaller, but substantial, majority receiving medications. Screening programs focused on young and poor men may be a rich target for improving hypertension control in Viet Nam.

scholarly journals Timely Postpartum Visits for Low-Income Women: A Health System and Medicaid Payer Partnership

2020 ◽  
Vol 110 (S2) ◽  
pp. S215-S218 ◽  
Author(s):  
Elizabeth A. Howell ◽  
Amy Balbierz ◽  
Susan Beane ◽  
Rashi Kumar ◽  
Tom Wang ◽  
...  
Keyword(s):  
Health Care ◽  
New York ◽  
High Risk ◽  
Health Care System ◽  
Low Income ◽  
Access To Health Care ◽  
Health Care Services ◽  
Control Group ◽  
Postpartum Visit ◽  
Care System

A health care system and a Medicaid payer partnered to develop an educational intervention and payment redesign program to improve timely postpartum visits for low-income, high-risk mothers in New York City between April 2015 and October 2016. The timely postpartum visit rate was higher for 363 mothers continuously enrolled in the program than for a control group matched by propensity score (67% [243/363] and 56% [407/726], respectively; P < .001). An innovative partnership between a health care system and Medicaid payer improved access to health care services and community resources for high-risk mothers.

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