A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries.

BACKGROUND: Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. METHODS AND FINDINGS: Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia;$39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and$1,3000,000,000 and 378439 LYG in Turkey. CONCLUSION: Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives

Reducing Emergency Department Nurse to Patient Ratios to Reduce Preventable Deaths

Background: Staffing shortages, exacerbated by high turnover rates from staff burnout, have created an unsafe environment for nurses and patients alike, by creating an intensive imbalance in RN-to-patient ratio allocation. Inadequate RN-to-patient ratios have shown an increase in adverse events as well as the length of stay in units, such as the emergency department. Objectives: To analyze and synthesize current evidence of the relationship between the patient-nurse staff ratio and patient mortality rates in the emergency department. Methods: Using relevant keywords, we extensively searched the Cochrane Database, PubMed, Google Scholar, JSTOR, and EBSCO electronic databases for studies published in English between (2010-2022), which focused on RN-to-patient ratio allocation and the subsequent impact on patients\u27 outcomes. A quality assessment of the reviewed studies was conducted. Results: In this review, a total of ten studies were included which consisted of five mixed-methods studies, four quantitative studies, and one qualitative study. Nurse-to-patient ratios positively influence various factors for both registered nurses and patients alike. A ratio of 1 RN to 3 patients showed a marked reduction in mortality rates among patients, as well as a reduction of the overall workload of registered nurses. Conclusions: Implementing appropriate nurse-to-patient ratios in Emergency Departments could decrease poor health outcomes and subsequent mortality rates

Patients’ perceptions of access to care for cardiovascular diseases and diabetes mellitus in Ramallah: a qualitative assessment

Background Cardiovascular diseases and diabetes mellitus present an increasing challenge for health care in the occupied Palestinian territory (oPt). Effective access to health care is a core prerequisite to the effective management of the two diseases. A main goal for policy makers is to improve access for patients to the services they need. However, improvement of access needs a thorough understanding of the barriers to health care encountered by patients. The aim in this study was to show the main barriers to health-care access that are reported by patients with cardiovascular diseases and diabetes mellitus attending clinics in Ramallah, West Bank, oPt. Methods A qualitative method based on theory developed from data generated during field research was used to develop a framework of patients’ perceptions of access to health care and management of illness. Data were gathered as part of a larger project (Mediterranean Studies of Cardiovascular disease and Hyperglycaemia: Analytical Modelling of Population Socio-economic transitions) from four clinics selected to represent the main health-care providers in the oPt: an outpatient cardiology clinic (urban setting) and three primary health-care clinics (rural and refugee-camp settings). 40 patients had exit interviews and 16 had in-depth interviews; 12 in-depth interviews were done with patients’ family members, and eight in-depth interviews with the clinic staff. Findings Factors that are related to patients and systems interact to form barriers or facilitators to health care and effective illness management, and were noted in all three themes that became apparent from the interviews: availability (central physical location and distance from home, patient’s waiting time, availability of the needed drugs and laboratory tests, and the presence of specialist staff); affordability of drugs that were not provided at the local formulary and thus were not provided to patients free of charge, and needed laboratory tests that were not available at the centre; patients’ acceptability of or satisfaction with care (previous social ties between patients and providers; sense of belonging to or ownership of the centre; patients’ views of the importance of seeking care; and patients’ expectations of what providers should inform them about and how they should deal with their illness). The last theme became apparent differently between primary and secondary health-care centres—patients at the primary health-care centres expressed higher satisfaction than for secondary health care, determined by strong social ties and a sense of belonging to the providers and the health-care centre. Interpretation For patients, health services are not only places for the provision of health care, albeit varied, but they are also sites of social relations. Patients’ perceptions of their access to health care differ, dependent on their socioeconomic, political, and cultural influences, and should also be taken into serious consideration in future policy development

Experimental realization of atomically flat and AlO2-terminated LaAlO3(001) substrate surfaces

Oxide single-crystal substrates with atomically smooth and chemically uniform surfaces are indispensable for constructing sharp epitaxial heterointerfaces and investigating emergent interfacial physical phenomena. Here, we report a simple method to realize atomically flat and AlO2-terminated LaAlO3 (001) [LAO(001)] substrate surfaces. So far, the LAO(001) substrate has been utilized as a structural template for the epitaxial growth of a variety of oxide films. However, well-established methods for achieving atomically flat, singly terminated LAO(001) surfaces have rarely been reported. This is mainly due to the unstable charged surfaces of LaO+ or AlO2-, which hinders simultaneous stabilizations of atomic-scale smoothness and single termination. To overcome this problem, we combined thermal annealing and subsequent deionized water leaching to treat the LAO(001) surface. We used atomic force microscopy to investigate the evolution of the LAO(001) surface during the water leaching and confirmed the atomically flat surface of the 120-min-water-leached sample. We further demonstrated the uniform AlO2 termination of the LAO(001) surface via coaxial impact-collision ion scattering spectroscopy. Using the treated substrates, we are able to grow perovskite oxide films (i.e., SrRuO3) on the LAO(001) substrate with atomically sharp heterointerfaces. Our paper provides an effective means for controlling the surface and interface of transition-metal oxide heterostructures at the atomic scale. © 2019 American Physical Societ