Interventions used to improve control of blood pressure in patients with hypertension.

BACKGROUND: It is well recognized that patients with high blood pressure (hypertension) in the community frequently fail to meet treatment goals - a condition labeled as "uncontrolled" hypertension. The optimal way in which to organize and deliver care to patients who have hypertension so that they reach treatment goals has not been clearly identified. OBJECTIVES: To determine the effectiveness of interventions to improve control of blood pressure in patients with hypertension. To evaluate the effectiveness of reminders on improving the follow-up of patients with hypertension. SEARCH STRATEGY: All-language search of all articles (any year) in the Cochrane Controlled Trials Register (CCTR), Medline and Embase from June 2000. SELECTION CRITERIA: Randomized controlled trials (RCTs) of patients with hypertension that evaluated the following interventions: (1) self-monitoring (2) educational interventions directed to the patient (3) educational interventions directed to the health professional (4) health professional (nurse or pharmacist) led care (5) organisational interventions that aimed to improve the delivery of care (6) appointment reminder systems. Outcomes assessed were: (1) mean systolic and diastolic blood pressure( 2) control of blood pressure (3) proportion of patients followed up at clinic. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently and in duplicate and assessed each study according to the criteria outlined by the Cochrane Collaboration Handbook. MAIN RESULTS: 56 RCTs met our inclusion criteria. The methodological quality of included studies was variable. An organized system of regular review allied to vigorous antihypertensive drug therapy was shown to reduce blood pressure (weighted mean difference -8.2/-4.2 mmHg, -11.7/-6.5 mmHg, -10.6/-7.6 mmHg for 3 strata of entry blood pressure) and all-cause mortality at five years follow-up (6.4% versus 7.8%, difference 1.4%) in a single large RCT- the Hypertension Detection and Follow-Up study. Other interventions had variable effects. Self-monitoring was associated with moderate net reduction in diastolic blood pressure (weighted mean difference (WMD): -2.0 mmHg, 95%CI: -2.7 to -1.4 mmHg, respectively. Appointment reminders increased the proportion of individuals who attended for follow-up. RCTs of educational interventions directed at patients or health professionals were heterogeneous but appeared unlikely to be associated with large net reductions in blood pressure by themselves. Health professional (nurse or pharmacist) led care may be a promising way of delivering care, with the majority of RCTs being associated with improved blood pressure control, but requires further evaluation. AUTHORS' CONCLUSIONS: Family practices and community-based clinics need to have an organized system of regular follow-up and review of their hypertensive patients. Antihypertensive drug therapy should be implemented by means of a vigorous stepped care approach when patients do not reach target blood pressure levels

Tuberculosis infection among homeless persons and caregivers in a high-tuberculosis-prevalence area in Japan: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Tuberculosis (TB) is a major public health problem. The Airin district of Osaka City has a large population of homeless persons and caregivers and is estimated to be the largest TB-endemic area in the intermediate-prevalence country, Japan. However, there have been few studies of homeless persons and caregivers. The objective of this study is to detect active TB and to assess the prevalence and risk factors for latent TB infection among homeless persons and caregivers.</p> <p>Methods</p> <p>We conducted a cross-sectional study for screening TB infection (active and latent TB infections) using questionnaire, chest X-ray (CXR), newly available assay for latent TB infection (QuantiFERON-TB Gold In-Tube; QFT) and clinical evaluation by physicians at the Osaka Socio-Medical Center Hospital between July 2007 and March 2008. Homeless persons and caregivers, aged 30-74 years old, who had not received CXR examination within one year, were recruited. As for risk factors of latent TB infection, the odds ratios (OR) and 95% confidence intervals (95% CI) for QFT-positivity were calculated using logistic regression model.</p> <p>Results</p> <p>Complete responses were available from 436 individuals (263 homeless persons and 173 caregivers). Four active TB cases (1.5%) among homeless persons were found, while there were no cases among caregivers. Out of these four, three had positive QFT results. One hundred and thirty-three (50.6%) homeless persons and 42 (24.3%) caregivers had positive QFT results. In multivariate analysis, QFT-positivity was independently associated with a long time spent in the Airin district: ≥10 years versus <10 years for homeless (OR = 2.53; 95% CI, 1.39-4.61) and for caregivers (OR = 2.32; 95% CI, 1.05-5.13), and the past exposure to TB patients for caregivers (OR = 3.21; 95% CI, 1.30-7.91) but not for homeless persons (OR = 1.51; 95% CI, 0.71-3.21).</p> <p>Conclusions</p> <p>Although no active TB was found for caregivers, one-quarter of them had latent TB infection. In addition to homeless persons, caregivers need examinations for latent TB infection as well as active TB and careful follow-up, especially when they have spent a long time in a TB-endemic area and/or have been exposed to TB patients.</p

The public health benefits of insulation retrofits in existing housing in the United States

BACKGROUND: Methodological limitations make it difficult to quantify the public health benefits of energy efficiency programs. To address this issue, we developed a risk-based model to estimate the health benefits associated with marginal energy usage reductions and applied the model to a hypothetical case study of insulation retrofits in single-family homes in the United States. METHODS: We modeled energy savings with a regression model that extrapolated findings from an energy simulation program. Reductions of fine particulate matter (PM(2.5)) emissions and particle precursors (SO(2 )and NOx) were quantified using fuel-specific emission factors and marginal electricity analyses. Estimates of population exposure per unit emissions, varying by location and source type, were extrapolated from past dispersion model runs. Concentration-response functions for morbidity and mortality from PM(2.5 )were derived from the epidemiological literature, and economic values were assigned to health outcomes based on willingness to pay studies. RESULTS: In total, the insulation retrofits would save 800 TBTU (8 × 10(14 )British Thermal Units) per year across 46 million homes, resulting in 3,100 fewer tons of PM(2.5), 100,000 fewer tons of NOx, and 190,000 fewer tons of SO(2 )per year. These emission reductions are associated with outcomes including 240 fewer deaths, 6,500 fewer asthma attacks, and 110,000 fewer restricted activity days per year. At a state level, the health benefits per unit energy savings vary by an order of magnitude, illustrating that multiple factors (including population patterns and energy sources) influence health benefit estimates. The health benefits correspond to $1.3 billion per year in externalities averted, compared with$5.9 billion per year in economic savings. CONCLUSION: In spite of significant uncertainties related to the interpretation of PM(2.5 )health effects and other dimensions of the model, our analysis demonstrates that a risk-based methodology is viable for national-level energy efficiency programs

Supporting an integrated transportation infrastructure and public space design: A coupled simulation method for evaluating traffic pollution and microclimate

Traditional urban and transport infrastructure planning that emphasized motorized transport has fractured public space systems and worsened environmental quality, leading to a decrease in active travel. A novel multiscale simulation method for supporting an integrated transportation infrastructure and public space design is presented in this paper. This method couples a mesoscale agent-based traffic prediction model, traffic-related emission calculation, microclimate simulations, and human thermal comfort assessment. In addition, the effects of five urban design strategies on traffic pollution and pedestrian level microclimate are evaluated (i.e., a “two-fold” evaluation). A case study in Beijing, China, is presented utilizing the proposed urban modeling-design framework to support the assessment of a series of transport infrastructure and public space scenarios, including the Baseline scenario, a System-Internal Integration scenario, and two External Integration scenarios. The results indicate that the most effective way of achieving an environmentally- and pedestrian- friendly urban design is to concentrate on both the integration within the transport infrastructure and public space system and the mitigation of the system externalities (e.g., air pollution and heat exhaustion). It also demonstrates that the integrated blue-green approach is a promising way of improving local air quality, micro-climatic conditions, and human comfort

Dietary reference values for potassium

Scientific opinion on Dietary Reference Values for potassium

Progress and prospects for event tourism research

This paper examines event tourism as a field of study and area of professional practice updating the previous review article published in 2008. In this substantially extended review, a deeper analysis of the field’s evolution and development is presented, charting the growth of the literature, focusing both chronologically and thematically. A framework for understanding and creating knowledge about events and tourism is presented, forming the basis which signposts established research themes and concepts and outlines future directions for research. In addition, the review article focuses on constraining and propelling forces, ontological advances, contributions from key journals, and emerging themes and issues. It also presents a roadmap for research activity in event tourism

Cyber risk assessment in cloud provider environments: Current models and future needs

Traditional frameworks for risk assessment do not work well for cloud computing. While recent work has often focussed on the risks faced by firms adopting or selecting cloud services, there has been little research on how cloud providers might assess their own services. In this paper, we use an in-depth review of the extant literature to highlight the weaknesses of traditional risk assessment frameworks for this task. Using examples, we then describe a new risk assessment model (CSCCRA) and compare this against three established approaches. For each approach, we consider its goals, the risk assessment process, decisions, the scope of the assessment and the way in which risk is conceptualised. This evaluation points to the need for dynamic models specifically designed to evaluate cloud risk. Our suggestions for future research are aimed at improving the identification, assessment, and mitigation of inter-dependent cloud risks inherent in a defined supply chain