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TitlePrevention of stroke: a global perspective.
AuthorsPandian, JD; Gall, SL; Kate, MP; Silva, GS; Akinyemi, RO; Ovbiagele, BI; Lavados, PM; Gandhi, DBC; Thrift, AG
JournalLancet (London, England)
Publication Date6 Oct 2018
Date Added to PubMed16 Oct 2018
AbstractAlong with the rising global burden of disability attributed to stroke, costs of stroke care are rising, providing the impetus to direct our research focus towards effective measures of stroke prevention. In this Series paper, we discuss strategies for reducing the risk of the emergence of disease (primordial prevention), preventing the onset of disease (primary prevention), and preventing the recurrence of disease (secondary prevention). Our focus includes global strategies and campaigns, and measurements of the effectiveness of worldwide preventive interventions, with an emphasis on low-income and middle-income countries. Our findings reveal that effective tobacco control, adequate nutrition, and development of healthy cities are important strategies for primordial prevention, whereas polypill strategies, use of mobile technology (mHealth), along with salt reduction and other dietary interventions, are effective in the primary prevention of stroke. An effective collaboration between various health-care sectors, government policies, and campaigns can successfully implement secondary prevention strategies, through surveillance and registries, such as the WHO's non-communicable diseases programmes, across high-income and low-income countries.
Linkhttp://doi.org/10.1016/S0140-6736(18)31269-8
TitleUniversal health coverage in Indonesia: concept, progress, and challenges.
AuthorsAgustina, R; Dartanto, T; Sitompul, R; Susiloretni, KA; Suparmi, EL; Taher, A; Wirawan, F; Sungkar, S; Sudarmono, P; Shankar, AH; Thabrany, H; Agustina, R; Dartanto, T; Sitompul, R; Susiloretni, KA; Suparmi, EL; Taher, A; Wirawan, F; Sungkar, S; Sudarmono, P; Shankar, AH; Thabrany, H; Soewondo, P; Ahmad, SA; Kurniawan, M; Hidayat, B; Pardede, D; Mundiharno, EJ; Lupita, O; Setyawan, E; Nurwahyuni, A; Martiningsih, D; Khusun, H
JournalLancet (London, England)
Publication Date5 Jan 2019
Date Added to PubMed24 Dec 2018
AbstractIndonesia is a rapidly growing middle-income country with 262 million inhabitants from more than 300 ethnic and 730 language groups spread over 17 744 islands, and presents unique challenges for health systems and universal health coverage (UHC). From 1960 to 2001, the centralised health system of Indonesia made gains as medical care infrastructure grew from virtually no primary health centres to 20 900 centres. Life expectancy improved from 48 to 69 years, infant mortality decreased from 76 deaths per 1000 livebirths to 23 per 1000, and the total fertility rate decreased from 5·61 to 2·11. However, gains across the country were starkly uneven with major health gaps, such as the stagnant maternal mortality of around 300 deaths per 100 000 livebirths, and minimal change in neonatal mortality. The centralised one size fits all approach did not address the complexity and diversity in population density and dispersion across islands, diets, diseases, local living styles, health beliefs, human development, and community participation. Decentralisation of governance to 354 districts in 2001, and currently 514 districts, further increased health system heterogeneity and exacerbated equity gaps. The novel UHC system introduced in 2014 focused on accommodating diversity with flexible and adaptive implementation features and quick evidence-driven decisions based on changing needs. The UHC system grew rapidly and covers 203 million people, the largest single-payer scheme in the world, and has improved health equity and service access. With early success, challenges have emerged, such as the so-called missing-middle group, a term used to designate the smaller number of people who have enrolled in UHC in wealth quintiles Q2-Q3 than in other quintiles, and the low UHC coverage of children from birth to age 4 years. Moreover, high costs for non-communicable diseases warrant new features for prevention and promotion of healthy lifestyles, and investment in a robust integrated digital health-information system for front-line health workers is crucial for impact and sustainability. This Review describes the innovative UHC initiative of Indonesia along with the future roadmap required to meet sustainable development goals by 2030.
Linkhttp://doi.org/10.1016/S0140-6736(18)31647-7
TitleFacilitators and Barriers to Chronic Disease Self-Management and Mobile Health Interventions for People Living With Diabetes and Hypertension in Cambodia: Qualitative Study.
AuthorsSteinman, L; Heang, H; van Pelt, M; Ide, N; Cui, H; Rao, M; LoGerfo, J; Fitzpatrick, A
JournalJMIR mHealth and uHealth
Publication Date24 Apr 2020
Date Added to PubMed25 Apr 2020
AbstractIn many low- and middle-income countries (LMICs), heart disease and stroke are the leading causes of death as cardiovascular risk factors such as diabetes and hypertension rapidly increase. The Cambodian nongovernmental organization, MoPoTsyo, trains local residents with diabetes to be peer educators (PEs) to deliver chronic disease self-management training and medications to 14,000 people with hypertension and/or diabetes in Cambodia. We collaborated with MoPoTsyo to develop a mobile-based messaging intervention (mobile health; mHealth) to link MoPoTsyo's database, PEs, pharmacies, clinics, and people living with diabetes and/or hypertension to improve adherence to evidence-based treatment guidelines. This study aimed to understand the facilitators and barriers to chronic disease management and the acceptability, appropriateness, and feasibility of mHealth to support chronic disease management and strengthen community-clinical linkages to existing services. We conducted an exploratory qualitative study using semistructured interviews and focus groups with PEs and people living with diabetes and/or hypertension. Interviews were recorded and conducted in Khmer script, transcribed and translated into the English language, and uploaded into Atlas.ti for analysis. We used a thematic analysis to identify key facilitators and barriers to disease management and opportunities for mHealth content and format. The information-motivation-behavioral model was used to guide data collection, analysis, and message development. We conducted six focus groups (N=59) and 11 interviews in one urban municipality and five rural operating districts from three provinces in October 2016. PE network participants desired mHealth to address barriers to chronic disease management through reminders about medications, laboratory tests and doctor's consultations, education on how to incorporate self-management into their daily lives, and support for obstacles to disease management. Participants preferred mobile-based voice messages to arrive at dinnertime for improved phone access and family support. They desired voice messages over texts to communicate trust and increase accessibility for persons with limited literacy, vision, and smartphone access. PEs shared similar views and perceived mHealth as acceptable and feasible for supporting their work. We developed 34 educational, supportive, and reminder mHealth messages based on these findings. These mHealth messages are currently being tested in a cluster randomized controlled trial (#1R21TW010160) to improve diabetes and hypertension control in Cambodia. This study has implications for practice and policies in Cambodia and other LMICs and low-resource US settings that are working to engage PEs and build community-clinical linkages to facilitate chronic disease management.
Linkhttp://doi.org/10.2196/13536
TitleFactors Influencing Adherence to mHealth Apps for Prevention or Management of Noncommunicable Diseases: Systematic Review.
AuthorsJakob, R; Harperink, S; Rudolf, AM; Fleisch, E; Haug, S; Mair, JL; Salamanca-Sanabria, A; Kowatsch, T
JournalJournal of medical Internet research
Publication Date25 May 2022
Date Added to PubMed26 May 2022
AbstractMobile health (mHealth) apps show vast potential in supporting patients and health care systems with the increasing prevalence and economic costs of noncommunicable diseases (NCDs) worldwide. However, despite the availability of evidence-based mHealth apps, a substantial proportion of users do not adhere to them as intended and may consequently not receive treatment. Therefore, understanding the factors that act as barriers to or facilitators of adherence is a fundamental concern in preventing intervention dropouts and increasing the effectiveness of digital health interventions. This review aimed to help stakeholders develop more effective digital health interventions by identifying factors influencing the continued use of mHealth apps targeting NCDs. We further derived quantified adherence scores for various health domains to validate the qualitative findings and explore adherence benchmarks. A comprehensive systematic literature search (January 2007 to December 2020) was conducted on MEDLINE, Embase, Web of Science, Scopus, and ACM Digital Library. Data on intended use, actual use, and factors influencing adherence were extracted. Intervention-related and patient-related factors with a positive or negative influence on adherence are presented separately for the health domains of NCD self-management, mental health, substance use, nutrition, physical activity, weight loss, multicomponent lifestyle interventions, mindfulness, and other NCDs. Quantified adherence measures, calculated as the ratio between the estimated intended use and actual use, were derived for each study and compared with the qualitative findings. The literature search yielded 2862 potentially relevant articles, of which 99 (3.46%) were included as part of the inclusion criteria. A total of 4 intervention-related factors indicated positive effects on adherence across all health domains: personalization or tailoring of the content of mHealth apps to the individual needs of the user, reminders in the form of individualized push notifications, user-friendly and technically stable app design, and personal support complementary to the digital intervention. Social and gamification features were also identified as drivers of app adherence across several health domains. A wide variety of patient-related factors such as user characteristics or recruitment channels further affects adherence. The derived adherence scores of the included mHealth apps averaged 56.0% (SD 24.4%). This study contributes to the scarce scientific evidence on factors that positively or negatively influence adherence to mHealth apps and is the first to quantitatively compare adherence relative to the intended use of various health domains. As underlying studies mostly have a pilot character with short study durations, research on factors influencing adherence to mHealth apps is still limited. To facilitate future research on mHealth app adherence, researchers should clearly outline and justify the app's intended use; report objective data on actual use relative to the intended use; and, ideally, provide long-term use and retention data.
Linkhttp://doi.org/10.2196/35371
Title[Synthesis of evidence and recommendations: guidelines for cervical cancer screening, detection, and treatmentSíntese de evidências e recomendações: diretrizes para rastreamento, detecção e tratamento do câncer do colo do útero].
Authors
JournalRevista panamericana de salud publica = Pan American journal of public health
Publication Date1 Dec 2023
Date Added to PubMed24 Apr 2023
AbstractSynthesize the recommendations developed by the World Health Organization (WHO) for the screening and treatment of women with pre-cancerous lesions for cervical cancer prevention, with a view to improving the quality of care and health outcomes. The guidelines prepared by WHO follow the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) method for the preparation of guidelines, as set forth in the WHO Handbook for Guideline Development. A synthesis of the recommendations of two WHO guidelines was carried out. Additionally, a systematic search was conducted in PubMed, Lilacs, Mhealth Systems Evidence, Epistemonikos and gray literature of studies developed in the Americas to identify barriers, facilitators, implementation strategies, and indicators. A total of 19 recommendations and ten good practices were formulated for screening pre-cancerous lesions of the cervix and treating cervical cancer. Implementation barriers and facilitators were identified, and indicators were created for assessing adherence and outcomes. The recommendations provide guidance for the screening and treatment of women with pre-cancerous lesions for cervical cancer prevention, with a view to improving the quality of care and health outcomes. Implementation in Latin America and the Caribbean is considered. Organización Panamericana de la SaludspaCase ReportsEnglish AbstractJournal ArticleSíntesis de evidencia y recomendaciones: directriz para el tamizaje, la detección y el tratamiento del cáncer de cuello uterino.20230421United StatesRev Panam Salud Publica97054001020-4989Sintetizar las recomendaciones desarrolladas por la Organización Mundial de la Salud (OMS) con el fin de mejorar la calidad del cuidado y los desenlaces en salud sobre el tamizaje y tratamiento de las mujeres con lesiones precancerosas para la prevención del cáncer de cuello uterino. Las directrices elaboradas por la OMS siguen los métodos de elaboración de la directriz GRADE (Grading of Recommendations Assessment Development and Evaluation) del Manual para el desarrollo de directrices de la OMS. Se llevó a cabo una síntesis de las recomendaciones de dos directrices de OMS. Adicionalmente, se realizó una búsqueda sistemática en PubMed, Lilacs, Health Systems Evidence, Epistemonikos y literatura gris de estudios desarrollados en las Américas con el fin de identificar barreras, facilitadores, estrategias de implementación e indicadores. Se formularon 19 recomendaciones y 10 puntos de buena práctica para el tamizaje de lesiones precancerosas del cuello del útero y el tratamiento del cáncer de cuello uterino. Se identificaron barreras y facilitadores para la implementación y se crearon indicadores de adherencia y resultado. Las recomendaciones formuladas proveen orientación para mejorar la calidad del cuidado y los desenlaces en salud sobre el tamizaje y tratamiento de las mujeres con lesiones precancerosas para la prevención del cáncer de cuello uterino, con consideraciones para su implementación en América Latina y el Caribe. Apresentar de forma resumida as recomendações desenvolvidas pela Organização Mundial da Saúde (OMS) para melhorar a qualidade da atenção e os desfechos de saúde relacionados ao rastreamento e ao tratamento de mulheres com lesões pré-cancerosas para a prevenção do câncer do colo do útero. As diretrizes elaboradas pela OMS seguem o método GRADE (Grading of Recommendations Assessment, Development and Evaluation) do manual de desenvolvimento de diretrizes da OMS. Fez-se uma síntese das recomendações de duas diretrizes da OMS. Além disso, realizou-se uma busca sistemática nos bancos de dados PubMed, Lilacs, mHealth Systems Evidence e Epistemonikos e na literatura cinzenta por estudos realizados nas Américas, a fim de identificar barreiras, facilitadores, estratégias de implementação e indicadores. Foram formuladas 19 recomendações e 10 pontos de boas práticas para o rastreamento de lesões pré-cancerosas do colo do útero e o tratamento do câncer do colo do útero. Identificaram-se facilitadores e barreiras para implementação e foram criados indicadores de adesão e de resultados. As recomendações apresentadas fornecem orientações para melhorar a qualidade da atenção e os desfechos de saúde no rastreamento e no tratamento de mulheres com lesões pré-cancerosas para a prevenção do câncer do colo do útero, com considerações para sua implementação na América Latina e no Caribe.
Linkhttp://doi.org/10.26633/RPSP.2023.72
TitleMobile Health Technology to Improve Care for Patients With Atrial Fibrillation.
AuthorsGuo, Y; Lane, DA; Wang, L; Zhang, H; Wang, H; Zhang, W; Wen, J; Xing, Y; Wu, F; Xia, Y; Liu, T; Wu, F; Liang, Z; Liu, F; Zhao, Y; Li, R; Li, X; Zhang, L; Guo, J; Burnside, G; Chen, Y; Lip, GYH; Guo, Y; Lip, GYH; Lane, DA; Chen, Y; Wang, L; Eckstein, J; Thomas, GN; Tong, L; Mei, F; Xuejun, L; Xiaoming, L; Zhaoliang, S; Xiangming, S; Wei, Z; Yunli, X; Jing, W; Fan, W; Sitong, Y; Xiaoqing, J; Bo, Y; Xiaojuan, B; Yuting, J; Yangxia, L; Yingying, S; Zhongju, T; Li, Y; Tianzhu, L; Chunfeng, N; Lili, Z; Shuyan, L; Zulu, W; Bing, X; Liming, L; Yuanzhe, J; Yunlong, X; Xiaohong, C; Fang, W; Lina, Z; Yihong, S; Shujie, J; Jing, L; Nan, L; Shijun, L; Huixia, L; Rong, L; Fan, L; Qingfeng, G; Tianyun, G; Yuan, W; Xin, L; Yan, R; Xiaoping, C; Ronghua, C; Yun, S; Yulan, Z; Haili, S; Yujie, Z; Quanchun, W; Weidong, S; Lin, W; Chan, E; Guangliang, S; Chen, Y; Wei, Z; Dandi, C; Xiang, H; Anding, X; Xiaohan, F; Ziqiang, Y; Xiang, G; Fulin, G
JournalJournal of the American College of Cardiology
Publication Date7 Apr 2020
Date Added to PubMed4 Apr 2020
AbstractCurrent management of patients with atrial fibrillation (AF) is limited by low detection of AF, non-adherence to guidelines, and lack of consideration of patients' preferences, thus highlighting the need for a more holistic and integrated approach to AF management. The objective of this study was to determine whether a mobile health (mHealth) technology-supported AF integrated management strategy would reduce AF-related adverse events, compared with usual care. This is a cluster randomized trial of patients with AF older than 18 years of age who were enrolled in 40 cities in China. Recruitment began on June 1, 2018 and follow-up ended on August 16, 2019. Patients with AF were randomized to receive usual care, or integrated care based on a mobile AF Application (mAFA) incorporating the ABC (Atrial Fibrillation Better Care) Pathway: A, Avoid stroke; B, Better symptom management; and C, Cardiovascular and other comorbidity risk reduction. The primary composite outcome was a composite of stroke/thromboembolism, all-cause death, and rehospitalization. Rehospitalization alone was a secondary outcome. Cardiovascular events were assessed using Cox proportional hazard modeling after adjusting for baseline risk. There were 1,646 patients allocated to mAFA intervention (mean age, 67.0 years; 38.0% female) with mean follow-up of 262 days, whereas 1,678 patients were allocated to usual care (mean age, 70.0 years; 38.0% female) with mean follow-up of 291 days. Rates of the composite outcome of 'ischemic stroke/systemic thromboembolism, death, and rehospitalization' were lower with the mAFA intervention compared with usual care (1.9% vs. 6.0%; hazard ratio [HR]: 0.39; 95% confidence interval [CI]: 0.22 to 0.67; p < 0.001). Rates of rehospitalization were lower with the mAFA intervention (1.2% vs. 4.5%; HR: 0.32; 95% CI: 0.17 to 0.60; p < 0.001). Subgroup analyses by sex, age, AF type, risk score, and comorbidities demonstrated consistently lower HRs for the composite outcome for patients receiving the mAFA intervention compared with usual care (all p < 0.05). An integrated care approach to holistic AF care, supported by mHealth technology, reduces the risks of rehospitalization and clinical adverse events. (Mobile Health [mHealth] technology integrating atrial fibrillation screening and ABC management approach trial; ChiCTR-OOC-17014138).
Linkhttp://doi.org/10.1016/j.jacc.2020.01.052
TitleAddressing disparities in the global epidemiology of stroke.
AuthorsPrust, ML; Forman, R; Ovbiagele, B
JournalNature reviews. Neurology
Publication Date1 Apr 2024
Date Added to PubMed17 Jan 2024
AbstractStroke is the second leading cause of death and the third leading cause of disability worldwide. Though the burden of stroke worldwide seems to have declined in the past three decades, much of this effect reflects decreases in high-income countries (HICs). By contrast, the burden of stroke has grown rapidly in low-income and middle-income countries (LMICs), where epidemiological, socioeconomic and demographic shifts have increased the incidence of stroke and other non-communicable diseases. Furthermore, even in HICs, disparities in stroke epidemiology exist along racial, ethnic, socioeconomic and geographical lines. In this Review, we highlight the under-acknowledged disparities in the burden of stroke. We emphasize the shifting global landscape of stroke risk factors, critical gaps in stroke service delivery, and the need for a more granular analysis of the burden of stroke within and between LMICs and HICs to guide context-appropriate capacity-building. Finally, we review strategies for addressing key inequalities in stroke epidemiology, including improvements in epidemiological surveillance and context-specific research efforts in under-resourced regions, development of the global workforce of stroke care providers, expansion of access to preventive and treatment services through mobile and telehealth platforms, and scaling up of evidence-based strategies and policies that target local, national, regional and global stroke disparities.
Linkhttp://doi.org/10.1038/s41582-023-00921-z
TitleEstonia: Health System Review.
AuthorsHabicht, T; Reinap, M; Kasekamp, K; Sikkut, R; Aaben, L; van Ginneken, E
JournalHealth systems in transition
Publication Date1 Mar 2018
Date Added to PubMed3 Oct 2018
AbstractThis analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In 2017, the Estonian government took the historic step of expanding the revenue base of the health system, which has been a longstanding challenge. However, in terms of percentage of GDP it remains a small increase and long-term financial sustainability could still pose a problem. That said, if these additional funds are invested wisely, they could play a positive role in further improving the health system. Indeed, although Estonia has made remarkable progress on many health indicators (e.g. the strongest gains in life expectancy of all EU countries, strongly falling amenable mortality rates), there are opportunities for improvements. They include overcoming the large health disparities between socioeconomic groups, improving population coverage, developing a comprehensive plan to tackle workforce shortages, better managing the growing number of people with (multiple) noncommunicable diseases and further reaping the benefits of the e-health system, especially for care integration and clinical decision-making. Also in terms of quality, large strides have been made but the picture is mixed. Avoidable hospital admissions are among the lowest in Europe for asthma and chronic obstructive pulmonary disease (COPD), about average for congestive heart failure and diabetes, but among the worst for hypertension. Moreover, the 30-day fatality rates for acute myocardial infarction and stroke are among the worst in the EU. These outcomes suggest substantial room to further improve service quality and care coordination. The new NHP, which is currently being revised will be play a crucial role in the success of future reform efforts.
Link
TitleThe Transformation of The Indian Healthcare System.
AuthorsKumar, A
JournalCureus
Publication Date1 May 2023
Date Added to PubMed28 Jun 2023
AbstractThe Indian healthcare system is a diverse and complex network of public and private sectors that provide a wide range of medical services to India's 1.4 billion inhabitants. Despite undergoing significant changes over the years, the system continues to face multiple challenges. These challenges include inadequate infrastructure, a shortage of healthcare professionals, urban-rural disparities, limited health insurance coverage, insufficient public healthcare funding, and a fragmented healthcare system. India is grappling with a growing burden of non-communicable diseases, which poses a significant challenge to its healthcare system. The Indian government has initiated multiple programs to improve the healthcare system. The National Health Mission improves the availability of medical equipment and supplies. This also promotes community participation and engagement in healthcare decision-making and service delivery. The Ayushman Bharat scheme is a health insurance program that provides coverage of up to INR 5 lakhs per family per year for secondary and tertiary care hospitalization. The Indian healthcare system is also witnessing multiple healthcare innovations, ranging from low-cost medical devices to innovative healthcare delivery models. The country's healthcare regulatory system is evolving to ensure patient safety, promote high-quality care, and control costs. Furthermore, India has emerged as a leading destination for medical tourism due to the relatively low cost of medical procedures, the availability of skilled doctors, and advanced technology. Factors such as cost-effective treatment, advanced technology, a wide range of specialities, alternative medicine, English language proficiency, and ease of travel have contributed to India's growing medical tourism industry. The Indian healthcare system has made significant progress in recent years. The positive transformation of the Indian healthcare system involves a range of changes and initiatives. Despite challenges, the continued investment in healthcare and innovation provides reasons to be optimistic about the future of healthcare in India.
Linkhttp://doi.org/10.7759/cureus.39079
TitleDigital health interventions for non-communicable disease management in primary health care in low-and middle-income countries.
AuthorsXiong, S; Lu, H; Peoples, N; Duman, EK; Najarro, A; Ni, Z; Gong, E; Yin, R; Ostbye, T; Palileo-Villanueva, LM; Doma, R; Kafle, S; Tian, M; Yan, LL
JournalNPJ digital medicine
Publication Date1 Feb 2023
Date Added to PubMed2 Feb 2023
AbstractCurrent evidence on digital health interventions is disproportionately concerned with high-income countries and hospital settings. This scoping review evaluates the extent of use and effectiveness of digital health interventions for non-communicable disease (NCD) management in primary healthcare settings of low- and middle-income countries (LMICs) and identifies factors influencing digital health interventions' uptake. We use PubMed, Embase, and Web of Science search results from January 2010 to 2021. Of 8866 results, 52 met eligibility criteria (31 reviews, 21 trials). Benchmarked against World Health Organization's digital health classifications, only 14 out of 28 digital health intervention categories are found, suggesting critical under-use and lagging innovation. Digital health interventions' effectiveness vary across outcomes: clinical (mixed), behavioral (positively inclined), and service implementation outcomes (clear effectiveness). We further identify multiple factors influencing digital health intervention uptake, including political commitment, interactivity, user-centered design, and integration with existing systems, which points to future research and practices to invigorate digital health interventions for NCD management in primary health care of LMICs.
Linkhttp://doi.org/10.1038/s41746-023-00764-4
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