scholarly journals SARS-CoV-2 and the Possible Connection to ERs, ACE2 and RAGE: Focus on Susceptibility Factors

2020 ◽  
Author(s):  
Roberta Sessa Stilhano ◽  
Angelica Jardim Costa ◽  
Michelle Sayuri Nishino ◽  
Shahin Shams ◽  
Cynthia Silva Bartolomeo ◽  
...  
Keyword(s):  
Health Care Systems ◽  
Critical Role ◽  
The Elderly ◽  
Receptor Expression ◽  
Viral Receptor ◽  
Current State ◽  
Susceptibility Factors ◽  
Care Systems ◽  
Male Patients ◽  
Host Infection

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has provoked major stresses on the health care systems of several countries, and caused the death of more than a quarter of a million people globally, mainly in the elderly population with pre-existing pathologies. Previous studies with coronavirus (SARS-CoV) point to gender differences in infection and disease progression with increased susceptibility in male patients, indicating that estrogens may be associated with physiological protection against the coronavirus. Therefore, the objectives of this work are threefold. First, we aim to summarize the SARS-CoV-2 infection pathway and the roles both the virus and patient play in COVID-19 (Coronavirus disease 2019) progression, clinical symptomology, and mortality. Second, we detail the effect estrogen has on viral infection and host infection response, including its role in both the regulation of key viral receptor expression and the mediation of inflammatory activity. Finally, we describe how ERs (estrogen receptors) and RAGE (receptor for advanced glycation end-products) play a critical role in metabolic pathways, which we envisage could maintain a close interplay with SARS-CoV and COVID-19 mortality rates, despite a current lack of research directly determining how. Taken together, we present the current state of the field regarding SARS-CoV-2 research and illuminate where research is needed to better define the role both estrogen and metabolic comorbidities have in the COVID-19 disease state, which can be key in screening potential therapeutic options as the search for effective treatments continue.

scholarly journals The impact of chronic disease and disability on the elderly

1999 ◽  
Vol 55 (3) ◽  
pp. 9-14
Author(s):  
C. J. Eales
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Health Care Systems ◽  
The Elderly ◽  
Therapeutic Interventions ◽  
Elderly Persons ◽  
Care Systems ◽  
And Function ◽  
The Impact

Health care systems for elderly people should aim to delay the onset of illness, reducing the final period of infirmity and illness to the shortest possible time. The most effective way to achieve this is by health education and preventative medicine to maintain mobility and function. Changes in life style even in late life may result in improved health, effectively decreasing the incidence of chronic diseases associated with advancing age. This paper presents the problems experienced by elderly persons with chronic diseases and disabilities with indications for meaningful therapeutic interventions.

scholarly journals Comprehensive Review of Cardiovascular Involvement in COVID-19

2021 ◽  
pp. e1-e19
Author(s):  
Ruff Joseph Macale Cajanding
Keyword(s):  
Cardiac Involvement ◽  
Health Care Systems ◽  
The Body ◽  
Cardiac Pathology ◽  
Current State ◽  
Global Pandemic ◽  
Cardiovascular Involvement ◽  
Disease Causation ◽  
Care Systems ◽  
Clinically Significant

COVID-19 has emerged as one of the most devastating and clinically significant infectious diseases of the last decade. It has reached global pandemic status at an unprecedented pace and has placed significant demands on health care systems worldwide. Although COVID-19 primarily affects the lungs, epidemiologic reports have shown that the disease affects other vital organs of the body, including the heart, vasculature, kidneys, brain, and the hematopoietic system. Of importance is the emerging awareness of the effects of COVID-19 on the cardiovascular system. The current state of knowledge regarding cardiac involvement in COVID-19 is presented in this article, with particular focus on the cardiovascular manifestations and complications of COVID-19 infection. The mechanistic insights of disease causation and the relevant pathophysiology involved in COVID-19 as they affect the heart are explored and described. Relevant practice essentials and clinical management implications for patients with COVID-19 with a cardiac pathology are presented in light of recent evidence.

scholarly journals Structural and Regional Characteristics and Cost Efficiencies in the Local Public Health Insurance System: Empirical Evidence from the Japanese National Health Insurance System

2016 ◽  
Vol 2 (2) ◽  
pp. 262
Author(s):  
Michio Yuda
Keyword(s):  
Adverse Effect ◽  
Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Care Systems ◽  
The Elderly ◽  
Health Insurance System ◽  
Insurance System ◽  
Care Systems

<p><em>In this study, I use panel data from municipal Japanese National Health Insurance (JNHI) insurers to estimate their financial efficiency scores using nonparametric methods and to estimate the causal effects of structural and regional characteristics on the efficiency scores consistently using econometric methods. The major findings of this study are as follows. First, the estimated efficiency scores imply that many JNHI insurers have serious financial inefficiencies, and that total cost efficiency (economic efficiency) is strongly and positively correlated with allocative efficiency. Second, the empirical results of the effects of various factors on efficiency scores indicate that the two major policy reforms for health care systems for the elderly in 2008 contribute strongly to the improvement of JNHI insurers’ finances. Third, the subsidy from a prefectural government positively affects efficiencies, but subsidies from central and municipal governments have an adverse effect. Fourth, contributions to health care systems for the elderly still have an adverse effect on JNHI finances.</em></p>

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.

scholarly journals Transitioning the Adolescent with IBD from Pediatric to Adult Care: A Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Natasha Bollegala ◽  
Geoffrey C. Nguyen
Keyword(s):  
Chronic Conditions ◽  
Transitional Care ◽  
Health Care Systems ◽  
Developmentally Appropriate ◽  
Adult Care ◽  
Current State ◽  
Child Centered ◽  
Care Systems ◽  
Pediatric Populations ◽  
Inflammatory Bowel

The incidence of inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), has increased in pediatric populations over the last decade. Patients diagnosed during childhood often survive well into adulthood, and therefore their healthcare requires transfer to an adult gastroenterologist, usually at age 18 years. Transition has been defined in the literature as the “purposeful planned movement of adolescents and young adults with chronic conditions from child-centered to adult-oriented health care systems” (Blum et al., 1993). The purpose of this review is to establish the current state of knowledge regarding the transition from pediatric to adult care in IBD. This review highlights that developmentally appropriate transitional care is now recognized as a healthcare priority and thoughtful targeted intervention is needed.

Health, Healthcare and Ageing Populations in Europe, a Human Rights Challenge for European Health Systems

2016 ◽  
Vol 23 (5) ◽  
pp. 435-452 ◽  
Author(s):  
Henriette Roscam Abbing
Keyword(s):  
Social Services ◽  
Health Systems ◽  
Local Governments ◽  
Health Care Systems ◽  
The Elderly ◽  
Care Services ◽  
Innovative Solutions ◽  
Care Systems ◽  
European Health ◽  
Ageing Populations

Demographic changes (ageing populations) are a challenge for European health systems. Innovative solutions must ensure elderly patients equitable access to good quality, affordable healthcare. De-centralisation and de-institutionalisation in healthcare for the elderly have become policy priorities for European countries. Local governments must have sufficient experience for the necessary integration of health and social services. New ways of looking at health care systems are necessary for reasons of quality, accessibility, and costs-effectiveness. The implementation and co-ordinated monitoring of the health- and care rights of the aged in Europe should be given full attention. There needs to be a handbook on elderly as well as an ombudsman. The exchange of experiences and best practices, oversight of the quality and effectiveness of the health- and care services and the system as such are indispensable.

Critical Care Requirements Under Uncontrolled Transmission of SARS-CoV-2

2021 ◽  
pp. e1-e4
Author(s):  
Gonzalo Martínez-Alés ◽  
Arce Domingo-Relloso ◽  
José R. Arribas ◽  
Manuel Quintana-Díaz ◽  
Miguel A. Hernán
Keyword(s):  
Public Health ◽  
Critical Care ◽  
Control Strategies ◽  
Health Care Systems ◽  
The Elderly ◽  
Large Hospital ◽  
Protection Measures ◽  
Care Systems ◽  
Bed Capacity ◽  
Care Requirements

Objectives. To estimate the critical care bed capacity that would be required to admit all critical COVID-19 cases in a setting of unchecked SARS-CoV-2 transmission, both with and without elderly-specific protection measures. Methods. Using electronic health records of all 2432 COVID-19 patients hospitalized in a large hospital in Madrid, Spain, between February 28 and April 23, 2020, we estimated the number of critical care beds needed to admit all critical care patients. To mimic a hypothetical intervention that halves SARS-CoV-2 infections among the elderly, we randomly excluded 50% of patients aged 65 years and older. Results. Critical care requirements peaked at 49 beds per 100 000 on April 1—2 weeks after the start of a national lockdown. After randomly excluding 50% of elderly patients, the estimated peak was 39 beds per 100 000. Conclusions. Under unchecked SARS-CoV-2 transmission, peak critical care requirements in Madrid were at least fivefold higher than prepandemic capacity. Under a hypothetical intervention that halves infections among the elderly, critical care peak requirements would have exceeded the prepandemic capacity of most high-income countries. Public Health Implications. Pandemic control strategies that rely exclusively on protecting the elderly are likely to overwhelm health care systems. (Am J Public Health. Published online ahead of print March 18, 2021: e1–e4. https://doi.org/10.2105/AJPH.2020.306151 )

scholarly journals Medical Supply Acquisition in Italy and the United States in the Era of COVID-19: The Case for Strategic Procurement and Public–Private Partnerships

2020 ◽  
Vol 50 (6-7) ◽  
pp. 642-649
Author(s):  
Veronica Vecchi ◽  
Niccolò Cusumano ◽  
Eric J. Boyer
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Critical Role ◽  
The United States ◽  
Protective Equipment ◽  
Economic Market ◽  
Strategic Role ◽  
Care Systems ◽  
Strategic Procurement

The article analyzes contracting challenges faced by Italian health care authorities and U.S. procurement officials in the immediate aftermath of the COVID-19 crisis, and it provides practitioner-derived lessons for improving procurement in times of disaster. The lessons we have learned so far emphasize (a) the need to recognize the strategic role of procurement, (b) empowering procurement officials, (c) formalized coordinative mechanisms cannot ensure effectiveness without trust among different governance levels, (d) the ability to identify reliable and proactive suppliers of personal protective equipment, (e) the importance of stimulating the economic market to diversify the production of needed materials and to ensure a more risk-resilient supply chain, and (f) the critical role of public–private collaborations to ensure responsiveness and resilience of health care systems.

scholarly journals Heart failure management of the elderly patient: focus on frailty, sarcopaenia, cachexia, and dementia: conclusions

2019 ◽  
Vol 21 (Supplement_L) ◽  
pp. L36-L38
Author(s):  
Andrew J Stewart Coats
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Elderly Patient ◽  
Older Patients ◽  
Large Scale ◽  
Health Care Systems ◽  
The Elderly ◽  
Heart Failure Management ◽  
Care Systems ◽  
Effect Of Age

Abstract With the ageing of populations heart failure is becoming more common and more complex. It is affecting ever older patients and the number of prevalent comorbidities is rising. Even as we continue to gain success in large-scale clinical trials with more effective therapies so our patients are becoming more complex. One of the biggest challenges is the effect of age. Frailty, comorbidity, sarcopaenia, cachexia, polypharmacy, and cognitive decline are all challenging our patients as never before and these challenges will be difficult for cash strapped health care systems to manage. For these reasons, the Heart Failure Association brought together a panel of experts to debate and review this complex area, championing the need for us to establish better ways of caring for the patients of the future.

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