Cohort monitoring of persons with diabetes mellitus in a primary healthcare clinic for Palestine refugees in Jordan.

Objective  To illustrate the method of cohort reporting of persons with diabetes mellitus (DM) in a primary healthcare clinic in Amman, Jordan, serving Palestine refugees with the aim of improving quality of DM care services. Method  A descriptive study using quarterly and cumulative case findings, as well as cumulative and 12-month analyses of cohort outcomes collected through E-Health in UNRWA Nuzha Primary Health Care Clinic. Results  There were 55 newly registered patients with DM in quarter 1, 2012, and a total of 2851 patients with DM ever registered on E-Health because this was established in 2009. By 31 March 2012, 70% of 2851 patients were alive in care, 18% had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow-up. Cumulative and 12-month cohort outcome analysis indicated deficiencies in several components of clinical care: measurement of blood pressure, annual assessments for foot care and blood tests for glucose, cholesterol and renal function. 10-20% of patients with DM in the different cohorts had serious late complications such as blindness, stroke, cardiovascular disease and amputations. Conclusion  Cohort analysis provides data about incidence and prevalence of DM at the clinic level, clinical management performance and prevalence of serious morbidity. It needs to be more widely applied for the monitoring and management of non-communicable chronic diseases

Comparing Strategies to Prevent Stroke and Ischemic Heart Disease in the Tunisian Population: Markov Modeling Approach Using a Comprehensive Sensitivity Analysis Algorithm.

Background. Mathematical models offer the potential to analyze and compare the effectiveness of very different interventions to prevent future cardiovascular disease. We developed a comprehensive Markov model to assess the impact of three interventions to reduce ischemic heart diseases (IHD) and stroke deaths: (i) improved medical treatments in acute phase, (ii) secondary prevention by increasing the uptake of statins, (iii) primary prevention using health promotion to reduce dietary salt consumption. Methods. We developed and validated a Markov model for the Tunisian population aged 35–94 years old over a 20-year time horizon. We compared the impact of specific treatments for stroke, lifestyle, and primary prevention on both IHD and stroke deaths. We then undertook extensive sensitivity analyses using both a probabilistic multivariate approach and simple linear regression (metamodeling). Results. The model forecast a dramatic mortality rise, with 111,134 IHD and stroke deaths (95% CI 106567 to 115048) predicted in 2025 in Tunisia. The salt reduction offered the potentially most powerful preventive intervention that might reduce IHD and stroke deaths by 27% (−30240 [−30580 to −29900]) compared with 1% for medical strategies and 3% for secondary prevention. The metamodeling highlighted that the initial development of a minor stroke substantially increased the subsequent probability of a fatal stroke or IHD death. Conclusions. The primary prevention of cardiovascular disease via a reduction in dietary salt consumption appeared much more effective than secondary or tertiary prevention approaches. Our simple but comprehensive model offers a potentially attractive methodological approach that might now be extended and replicated in other contexts and populations

Südame- ja veresoonkonnahaiguste riskiga patsientide eluviis ning tervisedendus esmatasandil

Eesmärk. Selgitada südame-veresoonkonnahaiguste (SVH) suure riskiga (SCORE ≥ 5%) patsientide informeeritust neil esinevatest riskiteguritest ja nende seostest eluviisi ja toitumisega ning rakendatud meetmeid eluviisi tervislikumaks muutmiseks. Uurimismaterjal ja -meetodid. Korraldati registreeritud suurenenud SVH-riskiga inimeste ankeetküsitlus, millele vastas 63 isikut (27 meest, 36 naist) vanuses 40–60 aastat. Tulemused. 84% küsitletutest oli teadlik oma terviseriskist ja 89% eluviisi osast selle kujunemisel. 52% vastanutest hindas oma eluviisi pigem tervislikuks ning 57% oli SVH ennetusprojektis osalemise järel oma eluviisi muutnud, eelkõige oli korrigeeritud toiduvalikut ja seda olid teinud sagedamini naised; kehalist aktiivsust suurendasid pooled küsitletutest. Tervist edendavat teavet oli pereõe vastuvõtul saanud 45% uuritutest. Kõrgema haridustasemega patsiendid olid subjektiivselt parema tervisega ning rakendasid pereõe soovitusi enam kui madalama haridustasemega vastanud. Patsiendid soovivad perearstilt ja -õelt rohkem infot oma tervise kohta, sh regulaarset uuringutele suunamist ja eluviisinõustamist; rohkem patsiendikeskset lähenemist eluviisi muutuste elluviimisel ja empaatilist suhtlemist. Eesti Arst 2012; 91(2):69–7

Factores de riesgo relacionados con la Crisis Hipertensiva en pacientes que asisten al área de shock del Hospital Alemán Nicaragüense, Managua, Nicaragua, segundo semestre 2016

La crisis hipertensiva constituye una causa de consulta frecuente en los servicios de urgencias por lo que se deriva de un alza de la presión arterial que obliga a un manejo eficiente rápido y vigilado de la misma. El presente estudio se realiza en el Hospital Alemán Nicaragüense, en el área de shock teniendo como objetivo analizar los factores de riesgos relacionados con la crisis Hipertensiva, la investigación tiene un diseño descriptivo, retrospectivo y de corte transversal. El universo en estudio está compuesto por 295 pacientes los cuales se pretende atender en el mes de Noviembre, del corriente año, De este universo de la muestra en estudio, se escogieron 73 pacientes los cuales llenaron los criterios de inclusión, como resultado se obtuvo lo siguiente el estado nutricional de los pacientes se encontró alterado, siendo estos (sobrepeso, obesidad grado I, obesidad grado II) por lo que podemos concluir que es un factor de riesgo en las crisis hipertensiva. Entre los alimentos que consumen podemos mencionar panes, los meneítos y el café, seguido de las gaseosas, frituras y bebidas enlatadas provocando esto un aumento de la crisis hipertensiva esto es debido a que estos alimentos se encuentran procesados, con grandes cantidades de sal y preservantes. El ejercicio es un factor determinante para reducir las crisis hipertensivas por lo tanto el caminar más de media hora cada día es un ejercicio muy adecuado para lograr reducir la presión arterial, por lo que se recomienda caminar 30 minutos aproximadamente. Una vez recopilada la información se procesan los datos por medio del software Ms-Excel y mostrar resultados en forma de tabla de distribución, de frecuencia y gráficos de barra y circular. Palabras claves: crisis hipertensiva, factores de riesgo, área de emergenci

The feminization of aging: How will this impact on health outcomes and services?

We conducted an integrative review to identify issues and challenges that face aging women and to distinguish areas for future research. We found that many older women continue to face inequities related to health and often are invisible within the discourse of aging policy. In this article we argue for a greater focus on the unique needs of women, a gendered approach to policy and intervention development, and promotion of the health of women across the life span. Policymakers, health care workers, and researchers need to consider the perspective of gender as well as age when implementing and evaluating effective interventions. © Taylor & Francis Group, LLC

Classification methodology of CVD with localized feature analysis using Phase Space Reconstruction targeting personalized remote health monitoring

2016 Computing in Cardiology Conference (CinC), 11-14 September 2016, Vancouver, BC, CanadaThis is the final version of the article. Available from the publisher via the DOI in this recordThis paper introduces the classification methodology of Cardiovascular Disease (CVD) with localized feature analysis using Phase Space Reconstruction (PSR) technique targeting personalized health care. The proposed classification methodology uses a few localized features (QRS interval and PR interval) of individual Electrocardiogram (ECG) beats from the Feature Extraction (FE) block and detects the desynchronization in the given intervals after applying the PSR technique. Considering the QRS interval, if any notch is present in the QRS complex, then the corresponding contour will appear and the variation in the box count indicating a notch in the QRS complex. Likewise, the contour and the disparity of box count due to the variation in the PR interval localized wave have been noticed using the proposed PSR technique. ECG database from the Physionet (MIT-BIH and PTBDB) has been used to verify the proposed analysis on localized features using proposed PSR and has enabled us to classify the various abnormalities like fragmented QRS complexes, myocardial infarction, ventricular arrhythmia and atrial fibrillation. The design have been successfully tested for diagnosing various disorders with 98% accuracy on all the specified abnormal databases.This work is partly supported by the Department of Electronics and Information and Technology (DeitY), India under the “Internet of Things (IoT) for Smarter Healthcare” under Grant No: 13(7)/2012-CC&BT, dated 25 Feb 2013. Naresh V is funded by Ministry of Human Resource Development (MHRD) PhD studentship through IIT Hyderabad