Cardiovascular diseases, principally ischemic heart disease (IHD), are the most important cause of death and disability in the majority of low- and lower-middle-income countries (LLMICs). In these countries, IHD mortality rates are significantly greater in individuals of a low socioeconomic status (...SES).
Three important focus areas for decreasing IHD mortality among those of low SES in LLMICs are (1) acute coronary care; (2) cardiac rehabilitation and secondary prevention; and (3) primary prevention. Greater mortality in low SES patients with acute coronary syndrome is due to lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, non-availability of thrombolysis and coronary revascularization, and the non-affordability of expensive medicines (statins, dual anti-platelets, renin-angiotensin system blockers). Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. A strong focus on the social determinants of health (low education, poverty, working and living conditions), greater healthcare financing, and efficient primary care is required. The quality of primary prevention needs to be improved with initiatives to eliminate tobacco and trans-fats and to reduce the consumption of alcohol, refined carbohydrates, and salt along with the promotion of healthy foods and physical activity. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. Task sharing with community health workers, electronic decision support systems, and use of fixed-dose combinations of blood pressure-lowering drugs and statins can substantially reduce risk factors and potentially lead to large reductions in IHD. Finally, training of physicians, nurses, and health workers in IHD prevention should be strengthened.
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Background
Noncommunicable diseases are major contributors to morbidity and mortality worldwide. Modifying the risk factors for these conditions, such as physical inactivity, is thus essential. Addressing the context or circumstances in which physical activity occurs may promote physical activity a...t a population level. We assessed the effects of infrastructure, policy or regulatory interventions for increasing physical activity.
Methods
We searched PubMed, Embase and clinicaltrials.gov to identify randomised controlled trials (RCTs), controlled before-after (CBAs) studies, and interrupted time series (ITS) studies assessing population-level infrastructure or policy and regulatory interventions to increase physical activity. We were interested in the effects of these interventions on physical activity, body weight and related measures, blood pressure, and CVD and type 2 diabetes morbidity and mortality, and on other secondary outcomes. Screening and data extraction was done in duplicate, with risk of bias was using an adapted Cochrane risk of bias tool. Due to high levels of heterogeneity, we synthesised the evidence based on effect direction.
Results
We included 33 studies, mostly conducted in high-income countries. Of these, 13 assessed infrastructure changes to green or other spaces to promote physical activity and 18 infrastructure changes to promote active transport. The effects of identified interventions on physical activity, body weight and blood pressure varied across studies (very low certainty evidence); thus, we remain very uncertain about the effects of these interventions. Two studies assessed the effects of policy and regulatory interventions; one provided free access to physical activity facilities and showed that it may have beneficial effects on physical activity (low certainty evidence). The other provided free bus travel for youth, with intervention effects varying across studies (very low certainty evidence).
Conclusions
Evidence from 33 studies assessing infrastructure, policy and regulatory interventions for increasing physical activity showed varying results. The certainty of the evidence was mostly very low, due to study designs included and inconsistent findings between studies. Despite this drawback, the evidence indicates that providing access to physical activity facilities may be beneficial; however this finding is based on only one study. Implementation of these interventions requires full consideration of contextual factors, especially in low resource settings.
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Bajo el tema La equidad, el corazón de la salud, este plan procura catalizar los esfuerzos en los Estados Miembros para reducir las inequidades en materia de salud entre los países y los territorios y dentro de ellos, a fin de mejorar los resultados en materia de salud. En el plan se señalan medi...das específicas para abordar la desigualdad en la salud, incluidas las recomendadas de la Comisión sobre Equidad y Desigualdades en Salud en las Américas, y se sigue la orientación de la Comisión de Alto Nivel para la Salud Universal. El enfoque que se adopta en este plan para abordar los determinantes de la salud incluye cuatro temas transversales clave: la equidad, el género, la etnicidad y los derechos humanos
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Women have less access to the development services and support – such as adequate healthcare, education and
modern technology – that make people more resilient to climate change and other shocks and stressors.2
Women’s unequal access to resources, their disproportionate responsibility for ca...re of dependents (typically unpaid),
and the insecurity and precariousness of their paid labour all contribute to the feminisation of poverty and women’s
heightened vulnerability to climate hazards. Climate change is a multiplier of existing vulnerabilities and threatens to
reverse hard-earned development gains for all people, and particularly for women.
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This study aimed to estimate the proportion of Mozambicans eligible for pharmacological treatment for hypertension according to single risk factor and total cardiovascular risk approaches. It concluded that a total of 19.8% of 40–64-year-olds would be eligible for pharmacological treatment of hype...rtension according to the WHO guidelines, all of whom had SBP/DBP at least 160/100 mmHg.
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Los objetivos del presente documento serán:Ofrecer una atención domiciliaria segura y de calidad.Garantizarunos niveles adecuados de protección de los familiares,convivientes,trabajadores sanitarios y de la poblacióngeneralcon el fin de prevenir la transmisiónde la enfermedad.
Safe drinking-water management must consider drinking-water quality, acceptability and quantity in the context of public health protection. In this manual, the term “safety” encompasses these three elements. Although the principles in this manual can be broadly applied to all types of drinking-w...ater supplies, the guidance is primarily intended for piped water supplies that are professionally managed (by a water supplier or equivalent management entity).The guidance may be applied to existing drinking-water supplies, or adapted for water supplies that are in the planning stage before construction.
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Christian morality consists of living one’s life with guidance and inspiration from the Christian scriptures and traditions. Christian ethics as an academic discipline uses these scriptures and traditions in developing and critiquing ethical norms and theories and applying them to ethical issues.... Most Christian ethicists agree that the sources for doing ethics include revelation (scripture) and tradition, as well as human reason and experience.
accessed July 2020
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El objetivo de este artículo es analizar las condiciones de acceso a servicios de salud de las personas con tuberculosis en América
Latina y el Caribe (ALC), reflexionando desde la bioética sobre los aspectos de salud pública implicados. Se realizó una revisión
documental del contexto de la ...tuberculosis en ALC con base en datos epidemiológicos. Los resultados se analizaron a partir de su
relación con los determinantes sociales de la salud, los principios éticos que pautan la práctica médica y la responsabilidad social
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'Ethical Issues in Obstetrics and Gynecology' represents the results of carefully researched and considered discussion. The guidelines are intended to provide material for consideration and debate about ethical aspects of our discipline for member organisations and their constituent membership.
These country profiles present progress on implementation of policy recommendations of the Global Action Plan on Physical Activity (GAPPA) 2018-2030 in each country. They also present an estimate of the cost to health systems of not taking action to improve physical activity levels and reinforce th...e urgency to position physical activity as a shared, whole-of-government priority, and to strengthen coordination and partnerships to promote physical activity.
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Report of the Joint World Health Organization–Brien Holden Vision Institute Global Scientific Meeting on Myopia | University of New South Wales, Sydney, Australia 16–18 March 2015
In the post-colonial history of the Central African Republic, violence has often been the shortest way to presidential power. President Bozizé presented little deviation from this narrative after coming to power after a coup d’état in 2003. Whilst he faced armed opposition and a conflict-affecte...d northwest from the outset, it is not until the rise of the Séléka, that the CAR entered into an era of unprecedented violence.
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This report is documenting the global incidence of attacks and threats against health workers, facilities, and transport around the world. The report cites 806 incidents of violence against or obstruction of health care in 43 countries and territories in ongoing wars and violent conflicts in 2020, r...anging from the bombing of hospitals in Yemen to the abduction of doctors in Nigeria. Attacks -- including killings, kidnappings, and sexual assaults, as well as destruction and damage of health facilities and transports -- compounded the threats to health in every country as health systems struggled to prepare for and respond to the outbreak of the COVID-19 pandemic.
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