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OBJECTIVE: To conduct a landscape assessment of public knowledge of cardiovascular disease risk factors and acute myocardial infarction symptoms, cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) awareness and training in three underserved communities in Brazil. METHODS: A cross-sectional, population-based survey of non-institutionalised adults age 30 or greater was conducted in three municipalities in Eastern Brazil. Data were analysed as survey-weighted percentages of the sampled populations. RESULTS: 3035 surveys were completed. Overall, one-third of respondents was unable to identify at least one cardiovascular disease risk factor and 25% unable to identify at least one myocardial infarction symptom. A minority of respondents had received training in CPR or were able to identify an AED. Low levels of education and low socioeconomic status were consistent predictors of lower knowledge levels of cardiovascular disease risk factors, acute coronary syndrome symptoms and CPR and AED use. CONCLUSIONS: In three municipalities in Eastern Brazil, overall public knowledge of cardiovascular disease risk factors and symptoms, as well as knowledge of appropriate CPR and AED use was low. Our findings indicate the need for interventions to improve public knowledge and response to acute cardiovascular events in Brazil as a first step towards improving health outcomes in this population. Significant heterogeneity in knowledge seen across sites and socioeconomic strata indicates a need to appropriately target such interventions.
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Reanimação Cardiopulmonar , Doenças Cardiovasculares/terapia , Cardioversão Elétrica , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Brasil/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Cidades , Estudos Transversais , Desfibriladores , Cardioversão Elétrica/instrumentação , Feminino , Pesquisas sobre Atenção à Saúde , Letramento em Saúde , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: As non-communicable disease (NCD) burden rises worldwide, community-based programmes are a promising strategy to bridge gaps in NCD care. The HealthRise programme sought to improve hypertension and diabetes management for underserved communities in nine sites across Brazil, India, South Africa and the USA between 2016 and 2018. This study presents findings from the programme's endline evaluation. METHODS: The evaluation utilises a mixed-methods quasi-experimental design. Process indicators assess programme implementation; quantitative data examine patients' biometric measures and qualitative data characterise programme successes and challenges. Programme impact was assessed using the percentage of patients meeting blood pressure and A1c treatment targets and tracking changes in these measures over time. RESULTS: Almost 60 000 screenings, most of them in India, resulted in 1464 new hypertension and 295 new diabetes cases across sites. In Brazil, patients exhibited statistically significant reductions in blood pressure and A1c. In Shimla, India, and in South Africa, country with the shortest implementation period, there were no differences between patients served by facilities in HealthRise areas relative to comparison areas. Among participating patients with diabetes in Hennepin and Ramsey counties and hypertension patients in Hennepin County, the percentage of HealthRise patients meeting treatment targets at endline was significantly higher relative to comparison group patients. Qualitative analysis identified linking different providers, services, communities and information systems as positive HealthRise attributes. Gaps in health system capacities and sociodemographic factors, including poverty, low levels of health education and limited access to nutritious food, are remaining challenges. CONCLUSIONS: Findings from Brazil and the USA indicate that the HealthRise model has the potential to improve patient outcomes. Short implementation periods and strong emphasis on screening may have contributed to the lack of detectable differences in other sites. Community-based care cannot deliver its full potential if sociodemographic and health system barriers are not addressed in tandem.
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Diabetes Mellitus , Hipertensão , Brasil/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/terapia , Índia/epidemiologia , África do Sul/epidemiologiaRESUMO
OBJECTIVE: To assess the changes in patient outcome prediction and hospital performance ranking when incorporating diagnoses as risk adjusters rather than comorbidity indices. DATA SOURCES: Healthcare Cost and Utilization Project State Inpatient Databases for New York State, 2005-2009. STUDY DESIGN: Conducted tree-based classification for mortality and readmission by incorporating discrete patient diagnoses as predictors, comparing with traditional comorbidity indices such as those used for Centers for Medicare and Medicaid Services (CMS) outcome models. PRINCIPAL FINDINGS: Diagnosis codes as predictors increased predictive accuracy 5.6 percent (95% CI: 4.5-6.9 percent) relative to CMS condition categories for heart failure 30-day mortality. Most other outcomes exhibited statistically significant accuracy gains and facility ranking shifts. Sensitivity analysis showed improvements even when predictors were limited to only the diagnoses included in CMS models. CONCLUSIONS: Discretizing patient severity information beyond the levels of traditional comorbidity indices improves patient outcome predictions and substantially shifts facility rankings.
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Benchmarking/métodos , Risco Ajustado/métodos , Fatores Etários , Centers for Medicare and Medicaid Services, U.S./estatística & dados numéricos , Comorbidade , Insuficiência Cardíaca/mortalidade , Humanos , Modelos Logísticos , Aprendizado de Máquina , Readmissão do Paciente/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Resultado do Tratamento , Estados UnidosRESUMO
Medical diplomacy is a complex, yet increasingly important strategy of the U.S. government. In this article, we present a unique program that was jointly developed by the U.S. Army Reserves 807 th Medical Deployment Support Command and the Trinidad Ministry of Health to address the large backlog of untreated cataracts in Trinidad and Tobago. This partnership evolved over time, but began with a commitment to help address a critical public health issue as determined by the host country, with investment in both local capacity and attention towards sustainability. The 807 th Medical Deployment Support Command utilized its connection to the military and civilian worlds, bringing in outside expertise and a long-term university partner allowing for sustainability without protracted U.S. government support. This program resulted in multiple positive outcomes, including building a strong partnership with a key U.S. interest; enhancing the legitimacy of the Trinidadian government through the development of a sustainable cataract program; and providing a platform for the United States to be seen by the Trinidadian public in a very positive light. This new model for medical diplomacy may have significant benefit for both the host country and U.S. government, and deserves further evaluation in other contexts.
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Extração de Catarata/educação , Cooperação Internacional , Militares , Órgãos Governamentais , Humanos , Avaliação de Programas e Projetos de Saúde , Trinidad e Tobago , Estados UnidosRESUMO
BACKGROUND: Dengue fever, a tropical disease once confined mostly to endemic areas in developing countries, is becoming more prevalent. Globalization has led to an increased incidence of the virus both in foreign travelers returning home and local outbreaks in traditionally nonendemic areas, such as the southern United States and southern Europe. Advances in diagnostic tests, therapies, and vaccines for dengue virus have been limited, but research is ongoing. OBJECTIVES: To review the current literature regarding the diagnosis and management of dengue fever. CASE REPORT: This case report describes a young woman returning from Central America with many of the common signs and symptoms who was misdiagnosed both abroad and at home. We explore the epidemiology, disease course, complications, and treatment of dengue fever. CONCLUSION: Emergency physicians should consider dengue fever in patients with acute febrile illnesses, especially among those with recent travel.