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Prevention of stroke and transient ischemic attack includes both conventional approaches to vascular risk factor management (blood pressure lowering, cholesterol reduction with statins, smoking cessation and antiplatelet therapy)
and more specific interventions, such as carotid revascularization or
...
anticoagulation for atrial fibrillation. The objective of this review is to discuss effective interventions for optimal primary and secondary stroke prevention.
more
ABSTRACT
More than 500 million people worldwide live with cardiovascular disease (CVD). Health systems today face fundamental challenges in delivering optimal care due to ageing populations, healthcare workforce constraints, financing, availability and affordability of CVD medicine, and service del
...
ivery.
Digital health technologies can help address these challenges. They may be a tool
to reach Sustainable Development Goal 3.4 and reduce premature mortality from
non-communicable diseases (NCDs) by a third by 2030. Yet, a range of fundamental barriers prevents implementation and access to such technologies. Health system governance, health provider, patient and technological factors can prevent or distort their implementation.
World Heart Federation (WHF) roadmaps aim to identify essential roadblocks on the pathway to effective prevention, detection, and treatment of CVD. Further, they aim to provide actionable solutions and implementation frameworks for local adaptation. This WHF Roadmap for digital health in cardiology identifies barriers to implementing digital health technologies for CVD and provides recommendations for overcoming them.
more
Atherosclerotic lower-extremity peripheral artery disease (PAD) is increasingly recognized as an important cause of cardiovascular morbidity and mortality that affects more than 230 million people worldwide. Traditional cardiovascular risk factors, including advanced age, smoking, and diabetes, are
...
strongly linked to an increase risk of PAD. Although PAD has been historically underappreciated compared to coronary artery disease and stroke, greater attention on PAD in recent years has led to important new epidemiologic insights in the areas of thrombosis, inflammation, dyslipidemia, and microvascular disease. In addition, the concept of polyvascular disease, or clinically-evident atherosclerosis in multiple arterial beds, is increasingly identified as a particularly malignant cardiovascular disease worthy of special clinical attention and further study. It is noteworthy that PAD may increase the risk of adverse outcomes in similar or even greater magnitude than coronary disease or stroke. In this review, we highlight important new advances in the epidemiology of PAD with a particular focus on polyvascular disease, emerging biomarkers, and differential risk pathways for PAD compared to other atherosclerotic diseases.
more
The 2019-2023 Strategy for UNU-IIGH, developed in
2018, built on UNU-IIGH’s strategic advantage and
position vis-à-vis the UN and global health ecosystem.
The Strategy set a goal to advance evidencebased policy on key issues related to sustainable
development and health and shifted the Instit
...
ute’s
body of work from investigator-driven global health
projects to three priority-driven, policy-relevant pillars
of work, each reflecting UNU-IIGH’s unique value
position.
When the COVID-19 pandemic hit in 2020, the
Institute adapted and reprioritised its areas of work
while continuing to deliver on the main strategic
objectives of translating evidence to policy, generating
policy-relevant analyses on gender and health, and
strengthening capacity for local decision making
especially in the Global South.
The new strategic plan encompasses four work packages:
1. Gender Equality and Intersectionality: through this work, we will aim to improve the quality of health care through a human-centred approach, by ensuring the health system is responsive to the needs of structurally excluded individuals and communities; and by advancing a positive and enabling environment for the frontline health workforce—e.g. addressing the experience of gender-based violence.
2. Power and Accountability: through this work, we will catalyse equitable shifts in power and address key accountability deficits that prevent the equitable and effective functioning of the global health system and prevent adequate responsiveness to the needs of states and populations in the Global South.
3. Digital Health Governance: through this work, we will address the colonial legacies and power asymmetries that negatively impact robust digital health governance, identify ways to strengthen health data governance with a particular focus on SRHR and promote diversity in technology design and development.
4. Climate Justice and Determinants of Health: through this work we will leverage UNU-IIGH's position within the UN and network of UNU institutes, network experts, practitioners, policy-makers, and academics to advance evidence-based policy on the different dimensions of the climate emergency and its impact on health.
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The cardiovascular disease continuum begins with risk factors such as diabetes mellitus (DM), progresses to vasculopathy and myocardial dysfunction, and finally ends with cardiovascular death. Diabetes is associated with a 2- to 4-fold increased risk for heart failure (HF). Moreover, HF patients wit
...
h DM have a worse prognosis than those without DM. Diabetes can cause myocardial ischemia via micro- and macrovasculopathy and can directly exert deleterious effects on the myocardium. Hyperglycemia, hyperinsulinemia, and insulin resistance can cause alterations in vascular homeostasis. Then, reduced nitric oxide and increased reactive oxygen species levels favor inflammation leading to atherothrombotic progression and myocardial dysfunction. The classification, diagnosis, and treatment of HF for a patient with and without DM remain the same. Until now, drugs targeting neurohumoral and metabolic pathways improved mortality and morbidity in HF with reduced ejection fraction (HFrEF). Therefore, all HFrEF patients should receive guideline-directed medical therapy. By contrast, drugs modulating neurohumoral activity did not improve survival in HF with preserved ejection fraction (HFpEF) patients. Trials investigating whether sodium-glucose cotransporter-2 inhibitors are effective in HFpEF are on-going. This review will summarize the epidemiology, pathophysiology, and treatment of HF in diabetes.
more
Sexual abuse perpetrated against children is one of the most significant crises of our time. Child sexual abuse is a significant risk factor for children, in common with other forms of child maltreatment. Sexual abuse can have severe short- and long-term consequences on the physical, mental, social,
...
emotional and economic well-being of children, families and communities. In emergencies, the threat of all forms of child abuse and gender-based violence (GBV), including child sexual abuse, is acute and widespread.
more
The Global Burden of Disease Study (GBD) began 30 years ago with the goal of providing timely, valid and relevant assessments of critical health outcomes. Over this period, the GBD has become progressively more granular. The latest iteration provides assessments of thousands of outcomes for diseases
...
, injuries and risk factors in more than 200 countries and territories and at the subnational level in more than 20 countries. The GBD is now produced by an active collaboration of over 8,000 scientists and analysts from more than 150 countries. With each GBD iteration, the data, data processing and methods used for data synthesis have evolved, with the goal of enhancing transparency and comparability of measurements and communicating various sources of uncertainty. The GBD has many limitations, but it remains a dynamic, iterative and rigorous attempt to provide meaningful health measurement to a wide range of stakeholders.
more
Non-communicable diseases (NCDs) are of increasing concern for society and national governments, as well as globally due to their high mortality rate. The main risk factors of NCDs can be classified into the categories of self-management, genetic factors, environmental factors, factors of medical co
...
nditions, and socio-demographic factors.
more
The document is part of the briefing package for Ethiopia's Water, Sanitation, and Hygiene (WASH) Cluster, which consists of resources that provide greater clarity and guidance to the cluster partners and other humanitarian actors.
The document is divided into four sections. Each section represen
...
ts the cluster’s coordination system (i) WASH Cluster coordination management, (ii) HPC process, (iii) Response monitoring, (iv) WASH response, and (v) Cluster meeting coordination.
Cluster Overview
The WASH Cluster in Ethiopia is part of and supports the Ministry of Water and Energy (MoWE). MoWE leads the WASH cluster emergency task force (ETF), which is co-led by the WASH Cluster secretariat hosted by UNICEF. In Ethiopia, the WASH Cluster was established with the activation of the cluster approach in 2006, and UNICEF, as the global Cluster Lead Agency, was assigned to appoint the WASH Cluster Coordinator.
The WASH Cluster aims to provide guidance and support to its partners to ensure well-coordinated, quality assistance reaches those in need in accordance with humanitarian standards and principles. Conflict, severe drought conditions, seasonal flooding, and Cholera remain the key drivers of WASH needs in Ethiopia.
In 2024, the WASH Cluster aims to work with 79 partners to preserve life, well-being, and dignity and reduce the risk of WASH-related disease through timely interventions to vulnerable populations and preparedness to respond to shocks. Significant humanitarian WASH needs in 2024 are projected with a rigorous HPC process in Ethiopia.
The Humanitarian Program Cycle
The humanitarian program cycle (HPC) is a coordinated series of actions to help prepare for, manage, and deliver humanitarian response. It consists of five coordinated elements, each step logically building on the previous and leading to the next. Successful implementation of the HPC depends on effective emergency preparedness, effective coordination with national/local authorities and humanitarian actors, and information management. Affected people are central to the response; preparedness, coordination, and information management processes continually occur.
more
The World Food Programme (WFP) has taken important steps to progress disability inclusion across its programming and operations. In late 2022, WFP commissioned the Nossal Institute, University of Melbourne in partnership with the Faculty of Psychology, Universitas Gadjah Mada, Indonesia to identify
...
pathways for increasing disability inclusion in WFP’s emergency preparedness and response (EPR) programming.
The study explored WFP’s programming in Indonesia and the Philippines, including WFP’s advisory, technical assistance and service provision roles to government and partners and informed the development of this guide (see appendix 2). As general guidance on disability inclusion is increasingly available, the purpose of this guide is to contextualize disability inclusion in WFP’s emergency preparedness and response programming. The guide builds on core reference materials, such as the Inter-Agency Standing Committee (IASC) Guidelines on Inclusion of Persons with Disabilities in Humanitarian Action, 2019. While of wider relevance, this guide is directed at WFP’s EPR programming in Asia and the Pacific.
more
Disease epidemiology has a deeper relationship with the dynamic nature of culture. Health behaviors in general are largely shaped by the cultural norms and customs in a society. A mere identification of a behavior could be only a layer on the outer sphere of a particular disease epidemiology and the
...
interventional efforts to counteract such behaviors through for example public health measures could be futile and volatile, unless the deeper cultural factors are addressed.
more
The mounting burden of type 2 diabetes is a major concern in healthcare systems worldwide. The purpose of this study is to investigate the trend of type 2 diabetes from 1990 to 2019 in Asia.
This is an update (third edition) of the BACPR Standards & Core Components and represents current evidence-based best practice and a pragmatic overview of the structure and function of Cardiovascular Prevention and Rehabilitation Programmes (CPRPs) in the UK. The previously described seven standards
...
have now been reduced to six but without sacrificing any of the key elements and with a greater emphasis placed on measurable clinical outcomes, audit and certification. Similarly, the second edition provided an overview of seven core components felt to be essential for the delivery of quality prevention and rehabilitation, and this too has been reduced to six. The interplay between cardio-protective therapies and medical risk factors is almost impossible to disentangle for the vast majority of patients and even if specific drug therapies are deployed exclusively for risk factor modulation, the indirect effect will also be cardio-protective. Thus, these have been combined into a single core component – medical risk management.
more
Diabetes is a significant public health issue that affects approximately one in 10 adults globally, with type 2 diabetes accounting for 90–95% of cases. This chronic condition causes considerable morbidity and mortality and is growing in impact, with cases projected to rise from 537 million in 202
...
1 to 784 million by 2045.1 As cases rise, it is imperative to ensure the healthcare workforce is prepared to care for affected individuals. However, there is a growing global shortage of healthcare workers, which was estimated, pre pandemic, to reach 15 million by 2030.2 Therefore, all of the healthcare workforce will need to be utilised to their fullest potential in order to address the growing global burden of diabetes. Pharmacists will continue to be essential in this endeavour.
more
Unmet mental health needs in the Region of the Americas are a leading source of morbidity and mortality, which result in tremendous health, social, and economic consequences. The COVID-19 pandemic has exacerbated the mental health crisis in the Region, necessitating urgent action at the highest leve
...
ls of government and across sectors to build back better mental health now and for the future. This landmark report is the result of the PAHO High-Level Commission on Mental Health and COVID-19. It provides an analysis of the mental health situation in the Region, followed by a series of recommendations and corresponding actions to support countries in the Americas to prioritize and advance mental health using human rights- and equity-based approaches.
more
Cardiovascular diseases (CVDs) are a growing public health problem in Ghana and other African countries. Strokes and other CVDs have become a leading cause of death due to increasing risk factors such as hypertension. According to the Global Burden of Disease study (GBD), ischaemic heart disease was
...
the fourth leading cause of death in Ghana in 2016. The prevalence of hyper-
tension, a major risk factor for CVDs, is increasing rapidly and ranges from 19% to 48%, according to the Ghana Health Service Annual Report, 2017, due to rising life expectancy and the increasing prevalence of contributing factors such as overweight/obesity. Early diagnosis and adequate management of the risk factors can reduce the fatal consequences of CVDs.
At the heart of improving risk assessment and management of CVDs are nationally approved guidelines, which facilitate standardisation of care approaches.
These guidelines developed by experts from all levels of health care and stakeholders capture all recommended approaches and necessary information for clinicians and other healthcare workers on CVDs. They also serve as a practical guide for assessing and managing the most important CVDs prevalent in Ghana and can be used at all levels of care namely health facilities without a doctor; with a general practitioner and with a physician specialist.
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Since 2016, the Pan American Health Organization (PAHO) has been promoting the implementation of the HEARTS Initiative in the Americas as a regional adaptation of the World Health Organization's Global HEARTS Initiative. During this time, 33 countries in the Region of the Americas have committed to
...
implementing HEARTS, and PAHO has developed many technical resources to support them. Most of these resources are clinical tools for primary healthcare teams and focus on quality improvement. This compendium aims to group all these clinical tools in a single document under a simple format that facilitates their practical implementation in daily clinical practice. The reader will notice that each tool is summarized on a single page and presented in a modular format. Therefore, each tool can be used together or separately as needed. In addition, at the bottom of each tool, the reader will find the references and hyperlinks to access full texts in case deeper knowledge is required.
more
Produced by UNICEF and IRC, with the support of the German Corporation for International Cooperation GmbH (GIZ) and the generous funding from the German Federal Ministry of Economic Cooperation and Development (BMZ), the Caring for Child Survivors of Sexual Abuse (CCS) Resource Package (Second Editi
...
on, 2023) is a revision of the original CCS Guidelines and associated Training (First Edition, 2012). The Second Edition offers an up-to-date global technical guidance on providing a model of quality care for children and families affected by sexual abuse in humanitarian settings. The new resources include both revised and content additions based on practitioner feedback, the most recent evidence and learning. In particular, the Guidelines aim to bring a stronger focus on gender inequality, intersectionality, as well as the connections between the best interests of the child and a survivor-centered approach.
more
The Kenya Health Policy 2014-2030 aims at attaining the highest possible standard of health in a manner responsive to the health needs of our population. One of the major policy directions towards realizing the intentions of this policy is to halt and reverse the
rising burden of non-communicable d
...
iseases.
more
Long Acting Muscarinic Antagonists (LAMA) such as tiotropium and glycopyrronium are used in the management of COPD1. They have been shown to improve lung function, quality of life and exercise tolerance. They have also been associated with reduced COPD-related exacerbations, associated hospitalisati
...
ons and duration of hospital stay. Both the South African Thoracic Society (SATS) and Global Initiative for Chronic Obstructive Lung Disease (GOLD), guidelines recommend the use of long acting anticholinergic drugs (or long acting beta agonists) in moderate to very severe disease as defined by lung function (FEV1). The most up to date guideline, utilizing the GRADE methodology (European Respiratory Society guidelines of 2017), confirms their superiority over long acting β agonists (LABA) as monotherapy for COPD in that LAMA's have demonstrated greater efficacy in terms of exacerbation reduction, with similar safety profile.2 These recommnedations are supported by published peer-reviewed
evidence including individual papers and Cochrane reviews.
more
