scholarly journals The use of telemedicine in the management of acute stroke

2014 ◽  
Vol 36 (1) ◽  
pp. E4 ◽  
Author(s):  
Mark N. Rubin ◽  
Bart M. Demaerschalk
Keyword(s):  
Secondary Prevention ◽  
Acute Stroke ◽  
Public Health Problem ◽  
Cost Effective ◽  
Stroke Care ◽  
Rapid Expansion ◽  
Major Public Health Problem ◽  
Financial Barriers ◽  
Education Of Patients ◽  
The Us

Cerebrovascular disease, including acute ischemic stroke, remains a major public health problem in the US and throughout the world. There has been a concerted effort to apply evidence-based practices to stroke care to improve primary and secondary prevention as well as poststroke outcomes. Geography and workforce shortages contribute to a disparity in stroke care, however, among the substantial proportion of the US population that lives outside the reach of an acute stroke–ready hospital or a primary or comprehensive stroke center. In an attempt to combat the rural-to-urban disparity and expand the availability of best stroke practices, Levine and Gorman proposed the development of telemedical outreach for acute stroke evaluation and management, which they called “telestroke.” Since then, the practice of telestroke has been found to have a high interrater agreement with a bedside assessment of the National Institutes of Health Stroke Scale score, to enhance correct thrombolysis decision making as compared with telephone-only consultation, and to be cost-effective. In light of these findings and the perception of benefit by acute stroke providers and patients, there has been growing interest in and a rapid expansion of telestroke networks in the US and internationally. There are legal and financial barriers to more widespread use of telemedicine in general, including telestroke. Further research is needed to understand the potential merits of telestroke infrastructure for the many phases of stroke care including poststroke hospitalization, prevention of complications, enhancing secondary prevention, and education of patients and providers.

Resilience Wellness Program for Suicide Prevention: Implementing the VA Whole Health Paradigm

2019 ◽  
Author(s):  
Amanda Vitale ◽  
Lauren Byma ◽  
Evan Podolak ◽  
Zhaoyu Wang ◽  
Shengnan Sun ◽  
...  
Keyword(s):  
Suicide Prevention ◽  
Suicide Attempts ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Integrative Health ◽  
Outpatient Program ◽  
Innovative Program ◽  
Measurement Based Care ◽  
The Us ◽  
Mental Health Programs

Suicide is a major public health problem in the US, specifically among Veterans. The Resilience and Wellness Center (RWC) is an innovative program focused on suicide prevention. The RWC targets vulnerable veterans by augmenting traditional treatments with complementary and integrative health interventions. One critical problem in suicide prevention is lack of engagement in traditional mental health programs, with stigma an oft-cited barrier. The RWC, an alternative paradigm, attempts to break through this barrier by addressing isolation through promoting group camaraderie and accountability, integral to the success of the program. This innovative program provides a unique opportunity to enhance life skills through Whole Health intervention, including: meditation, yoga, music therapy, exercise/dance etc. Specifically, the RWC is a four-week outpatient program, where admission is determined via hospital-wide consults. With a focus on Measurement Based Care, Veterans complete baseline and post-program assessments such as the Personal Health Questionnaire (PHQ9) and scales measuring: depression, hopelessness, sleep quality, and diet & nutrition. Data for 9 cohorts to date demonstrate significant improvements, with large treatment effects as evidenced by reduction in PHQ-9 totals and feelings of depression and hopelessness, especially for Veterans with histories of suicide attempts or ideation. Overall, Veterans found the RWC program experience favorable, with > 98% completing. The RWC can be rapidly deployed in the VHA by drawing on existing hospital services and clinics. According to participants, the RWC engages Veterans in building a partnership to pave the way towards a healthier, more sustainable lifestyle.

scholarly journals Cerebrovascular Disease and Statins

2021 ◽  
Vol 8 ◽  
Author(s):  
Luis M. Beltrán Romero ◽  
Antonio J. Vallejo-Vaz ◽  
Ovidio Muñiz Grijalvo
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Cerebrovascular Disease ◽  
Small Vessel Disease ◽  
Recurrent Stroke ◽  
Public Health Problem ◽  
Lipid Lowering ◽  
Major Public Health Problem ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cholesterol Levels

Elevated low-density lipoprotein-cholesterol (LDL-C) is a causal factor for the development of atherosclerotic cardiovascular disease (ASCVD); accordingly, LDL-C lowering is associated with a decreased risk of progression of atherosclerotic plaques and development of complications. Currently, statins play a central role in any ASCVD management and prevention strategies, in relation to their lipid-lowering action and potentially to pleiotropic effects. After coronary artery disease, stroke is the most frequent cause of ASCVD mortality and the leading cause of acquired disability, a major public health problem. There is often a tendency to aggregate all types of stroke (atherothrombotic, cardioembolic, and haemorrhagic), which have, however, different causes and pathophysiology, what may lead to bias when interpreting the results of the studies. Survivors of a first atherothrombotic ischemic stroke are at high risk for coronary events, recurrent stroke, and vascular death. Although epidemiological studies show a weak relationship between cholesterol levels and cerebrovascular disease as a whole compared with other ASCVD types, statin intervention studies have demonstrated a decrease in the risk of stroke in patients with atherosclerosis of other territories and a decrease in all cardiovascular events in patients who have had a stroke. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial demonstrated the benefit of high doses of atorvastatin in the secondary prevention of ischemic stroke. In this review, we discuss the evidence, use and recommendations of statins in the primary and secondary prevention of stroke, and their role in other scenarios such as the acute phase of ischemic stroke, cerebral hemorrhage, cardioembolic stroke, small vessel disease, and cognitive impairment.

scholarly journals Antiparasitic phytotherapy perspectives, scope and current development

Infectio ◽  
2019 ◽  
Vol 23 (2) ◽  
pp. 189 ◽  
Author(s):  
Jhon Carlos Castaño Osorio ◽  
Alejandra María Giraldo García
Keyword(s):  
Low Income ◽  
Public Health Problem ◽  
Cost Effective ◽  
Prolonged Treatment ◽  
Major Public Health Problem ◽  
Middle Income ◽  
Middle Income Countries ◽  
Commercial Markets ◽  
Health And Economic Development ◽  
New Treatments

Tropical protozoan diseases are currently a major public health problem throughout the world and are strongly linked with poverty, this combined with a lack of commercial markets for potential drugs has created a large burden on the health and economic development of low-income and middle-income countries in Africa, Asia, and the Americas. Due to the low research interest and the high increase of resistance against the existing treatments, as well as increasing inefficiency, toxicity, prolonged treatment schedules and costs, there is an urgent need for cost-effective, safe and easy-to-administer, new effective compounds with novel mechanisms of action. Several studies of crude plant extracts have already identified potential compounds to treat Chagas’ disease, Leishmaniasis, Toxoplasmosis, Giardiasis, and Malaria among other protozoan parasites. Natural compounds of medicinal plants have shown lower toxicity together with higher specificity, creating an optimistic view of new treatments for diseases. Out of 1010 new active substances approved as drugs for medical conditions by regulatory agencies during the past 25 years, 490(48.5%) were from a natural origin.

Psychotic Disorders and Serious Mental Illness

2017 ◽  
Author(s):  
Alexander Thompson ◽  
Daniel Williams ◽  
Oliver Freudenreich ◽  
Andrew Angelino ◽  
Glenn Treisman
Keyword(s):  
Mental Illness ◽  
Serious Mental Illness ◽  
Psychotic Disorders ◽  
Public Health Problem ◽  
Cost Effective ◽  
Models Of Care ◽  
Major Public Health Problem ◽  
Effective Care ◽  
Psychiatric Conditions ◽  
Hiv Aids

The major public health problem that is HIV/AIDS in persons with a serious mental illness is aptly described a “syndemic.” Having HIV/AIDS puts one at much greater risk for developing a serious mental illness. Conversely, having a serious mental illness, such as schizophrenia, bipolar disorder, major depressive disorder, substance use disorder, is associated with many factors that place one at greater risk for contracting and transmitting HIV. And, in both cases of serious mental illness and HIV/AIDS, each disorder creates many new challenges in the management of the other disorder. This chapter addresses these challenges, which center around being able to participate actively and adhere to medication regimens needed to manage both medical and psychiatric conditions. Fortunately, specialized models of care like comprehensive, integrated clinics and nurse care managers are ways to provide effective, satisfying, and cost-effective care to this most vulnerable population.

scholarly journals Addressing Female Iron-Deficiency Anaemia in India: Is Vegetarianism the Major Obstacle?

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Anu Rammohan ◽  
Niyi Awofeso ◽  
Marie-Claire Robitaille
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Large Scale ◽  
Public Health Problem ◽  
Cost Effective ◽  
Vegetarian Diet ◽  
Major Public Health Problem ◽  
Daily Consumption ◽  
Indian Women ◽  
Deficiency Anaemia

Objectives. We examined the influence of vegetarian diet on the risk of developing anaemia among Indian women and suggest initiatives for addressing diet-related iron-deficiency anaemia. Methods. We analysed data on diet, social class, and haemoglobin levels from the nationally representative Indian National Family and Health Survey 2005/06 for a sample of 81,301 women aged 15–49 years using logistic regression models. Results. After controlling for individual-level factors and household level socioeconomic characteristics, daily consumption of meat, fish, and eggs was associated with lower odds of being moderately or severely anaemic. Our analysis also revealed that economic characteristics such as being from higher wealth quintiles, being in paid employment, and rural residence reduced the odds of having iron-deficiency anaemia among Indian women. Discussion. As a large proportion of Indians subsist on iron-poor vegetarian diets for religious, economic, and cultural reasons, large-scale iron supplementation and fortification of commonly consumed vegetarian foodstuffs constitute a feasible, culturally appropriate, and cost-effective strategy for addressing this major public health problem. Consumption of cheap iron-rich foodstuffs should be promoted. Effective poverty alleviation and hookworm prevention programs are also important. Large-scale cohort and intervention studies are urgently required to further define the influence of vegetarianism on iron deficiency anaemia in India.

scholarly journals The Changing Epidemiology of HIV-Associated Adult Meningitis, Uganda 2015–2017

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Jayne Ellis ◽  
Ananta S Bangdiwala ◽  
Fiona V Cresswell ◽  
Joshua Rhein ◽  
Edwin Nuwagira ◽  
...  
Keyword(s):  
Public Health Problem ◽  
Diagnostic Algorithm ◽  
Cost Effective ◽  
Primary Diagnosis ◽  
Viral Meningitis ◽  
Sub Saharan Africa ◽  
First Episode ◽  
Major Public Health Problem ◽  
Diagnostic Threshold ◽  
The Impact

Abstract Background Central nervous system (CNS) infections remain a major public health problem in Sub-Saharan Africa, causing 15%–25% of AIDS-related deaths. With widespread availability of antiretroviral therapy (ART) and the introduction of improved diagnostics, the epidemiology of infectious meningitis is evolving. Methods We prospectively enrolled adults presenting with HIV-associated meningitis in Kampala and Mbarara, Uganda, from March 2015 to September 2017. Participants had a structured, stepwise diagnostic algorithm performed of blood cryptococcal antigen (CrAg), CSF CrAg, Xpert MTB/RIF for tuberculous (TB) meningitis (TBM), Biofire multiplex polymerase chain reaction, and traditional microscopy and cultures. Results We screened 842 consecutive adults with HIV presenting with suspected meningitis: 57% men, median age 35 years, median CD4 26 cells/mcL, and 55% presented on ART. Overall, 60.5% (509/842) were diagnosed with first-episode cryptococcal meningitis and 7.4% (62/842) with second episode. Definite/probable TB meningitis was the primary diagnosis in 6.9% (58/842); 5.3% (n = 45) had microbiologically confirmed (definite) TB meningitis. An additional 7.8% (66/842) did not meet the diagnostic threshold for definite/probable TBM but received empiric TBM therapy. Bacterial and viral meningitis were diagnosed in 1.3% (11/842) and 0.7% (6/842), respectively. The adoption of a cost-effective stepwise diagnostic algorithm allowed 79% (661/842) to have a confirmed microbiological diagnosis at an average cost of $44 per person. Conclusions Despite widespread ART availability, Cryptococcus remains the leading cause of HIV-associated meningitis. The second most common etiology was TB meningitis, treated in 14.7% overall. The increased proportion of microbiologically confirmed TBM cases reflects the impact of new improved molecular diagnostics.

scholarly journals Evaluation of the diagnostic accuracy and cost of different methods for the assessment of severe  anaemia in hospitalised children in Eastern Uganda

2018 ◽  
Vol 3 ◽  
pp. 130 ◽  
Author(s):  
Peter Olupot-Olupot ◽  
Natalie Prevatt ◽  
Charles Engoru ◽  
Julius Nteziyaremye ◽  
Denis Amorut ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Gold Standard ◽  
Public Health Problem ◽  
Cost Effective ◽  
Severe Anaemia ◽  
Observer Agreement ◽  
Major Public Health Problem ◽  
Kappa Score ◽  
Short Supply ◽  
Referral Hospitals

Background: Severe anaemia in children requiring hospital admission is a major public health problem in malaria-endemic Africa. Affordable methods for the assessment of haemoglobin have not been validated against gold standard measures for identifying those with severe anaemia requiring a blood transfusion, despite this resource being in short supply. Methods: We conducted a prospective descriptive study of hospitalized children aged 2 months – 12 years at Mbale and Soroti Regional Referral Hospitals, assessed to have pallor at triage by a nurse and two clinicians. Haemoglobin levels were measured using the HemoCue® Hb 301 system (gold standard); the Haemoglobin Colour Scale; calorimetric and Sahli’s methods. We report clinical assessments of the degree of pallor, clinicians’ intention to transfuse, inter-observer agreement, limits of agreement using the Bland-Altman method, and the sensitivity and specificity of each method in comparison to HemoCue® Results: We recruited 322 children assessed by the admitting nurse as having severe (164; 51.0%), moderate (99; 30.7%) or mild (57; 17.7%) pallor. Agreement between the clinicians and the nurse were good: Clinician A Kappa=0.68 (0.60–0.76) and Clinician B Kappa=0.62 (0.53–0.71) respectively (P<0.0001 for both). The nurse, clinicians A and B indicated that of 94/116 (81.0%), 83/121 (68.6%) and 93/120 (77.5%) respectively required transfusion. HemoCue® readings indicated anaemia as mild (Hb10.0–11.9g/dl) in 8/292 (2.7%), moderate (Hb5.0–9.9g/dl) in 132/292 (45.2%) and severe (Hb<5.0g/dl) in 152/292 (52.1%). Comparing to HemoCue® the Sahli’s method performed best in estimation of severe anaemia, with sensitivity 84.0% and specificity 87.9% and a Kappa score of  0.70 (0.64–0.80). Conclusions: Clinical assessment of severe pallor results has a low specificity for the diagnosis of severe anaemia. To target blood transfusion Hb measurement by either Hemocue® or Sahli’s method for the cost of USD 4 or and USD 0.25 per test, respectively would be more cost-effective.

scholarly journals Principles and Practice of Conservative Adhesive Restorations: A brief review

2020 ◽  
Vol 5 (2) ◽  
pp. 110-116
Author(s):  
Somya Jain ◽  
◽  
Raju U Pati ◽  
Priya Diwan ◽  
Shikha Rajput ◽  
...  
Keyword(s):  
Dental Caries ◽  
Effective Means ◽  
Age Groups ◽  
Public Health Problem ◽  
Cost Effective ◽  
Permanent Teeth ◽  
Major Public Health Problem ◽  
Promising Tool ◽  
Equivalent Effect ◽  
Occlusal Surfaces

Dental caries has been recognised as a major public health problem globally which has an equivalent effect on all age groups. Caries predominantly affects the occlusal surfaces of erupting molars and premolars and thus accounts for nearly 80-90% of pit and fissure caries in permanent teeth. Apart from regular measures for management of dental caries preventive measures involving sealing of the cavitated and non cavitated pits and fissures can be promising tool for cost effective caries prevention. Conservative Adhesive restorations (CAR) have proven to be one such effective means in prevention and treatment of pit and fissure caries. This article reviews complete application technique of CAR along with its indications, contraindications, advantages, disadvantages. Also, literature-based review of the success rate has been reported. An insight of its application in children and advancements that can help in further improving the efficacy have also been reviewed. From this review and after discussion of recently published studies, it is evident that prophylactic techniques like CAR can be both preventive as well as therapeutic measure for preventing progression of incipient caries.

scholarly journals Hematological Profile of Women in Pregnancy in a Hilly District of Himachal Pradesh

2020 ◽  
Vol 32 (3) ◽  
pp. 506-511
Author(s):  
Anuj Sharma ◽  
Jai Gopal Vohra ◽  
Manisha Behal ◽  
Sneha Bansal
Keyword(s):  
Early Recognition ◽  
Hematological Parameters ◽  
Public Health Problem ◽  
Cost Effective ◽  
Complete Characterization ◽  
Himachal Pradesh ◽  
Major Public Health Problem ◽  
Pregnant Females ◽  
Anemia During Pregnancy ◽  
Prevalence Of Anemia

Introduction: Anemia during pregnancy is a major public health problem throughout the world, especially in the developing countries. Anemia during pregnancy can lead to morbidity and mortality in mother as well as fetus. Anemia cannot be diagnosed only clinically, several blood tests are required for complete characterization. Aim of the present study was to know the prevalence of anemia during pregnancy in District Solan of Himachal Pradesh, classify its types and determine the effect of pregnancy on hematological parameters in Anemia. Material and Methods:In the present study Hematological parameters of 150 pregnant females in advanced pregnancy (of gestational age 32 to40 weeks) were analyzed and the results were compared with 90 age matched control cases. Results: The pregnant study group exhibited statistically significant lower values of haemoglobin, PCV, MCV, MCHC and lymphocyte and platelets while neutrophil and total WBC counts were significantly elevated. Conclusion: Hematological parameters are a simple and cost effective investigation which can aid in early recognition of anemia during pregnancyand thereby improve the outcome of pregnancy.

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