Browsing by Subject "Secondary Prevention"
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Item Secondary Prevention: A Cost-Effective Yet Underutilized Strategy for Reducing the Stroke Burden in Resource-Limited Settings(2015-03-25) Rimmer, Kathryn; Gebreyohanns, MehariBACKGROUND: Over two-thirds of global stroke occur in low- and middle-income countries (LMIC), where the populations are affected on average 15 years younger. Those who survive potentially lose their livelihood and are financially vulnerable to health care expenses. On a national level, stroke DALYs rob the developing economy of its workforce. Cost-effective prevention strategies and interventions could help reduce the stroke burden in LMIC. Primary prevention is considered the top priority, but it necessitates sufficient infrastructure and human resources for successful campaigns. In resource-limited health systems, the population at greatest risk for stroke are likely not receiving regular health maintenance. OBJECTIVE: Secondary prevention targets the cohort seeking medical attention for an incident stroke. It is hypothesized to be a more feasible strategy of improving stroke rates in LMIC by reducing recurrence in high-risk populations. The objectives of this study are to compare stroke risk and secondary prevention practices across four different countries of varying income level, and to determine which secondary prevention drug regimen would be optimal for resource-limited settings. METHODS: Current economic and health indicator data were collected from the World Bank and the World Health Organization (WHO) on the United States, France, Vietnam, and Peru. Death and disability-adjusted life-years (DALYs) rates along with risk factor prevalences for each country were accessed from the WHO. Literature reviews on secondary prevention of recurrent stroke and healthcare-utilization in the developing world were conducted on MEDLINE and Pubmed databases using the following key words: stroke, epidemiology, risk factors, stroke burden, secondary prevention, secondary prevention drugs, cost-effectiveness, healthcare-utilization, resource-limited settings, developing world, developing countries, and LMIC. Articles that addressed thesis objectives were selected for review. Additionally, the latest country-specific guidelines for secondary prevention of stroke were retrieved online from the relevant national stroke organizations. RESULTS: Vietnam experienced the highest death (109) and DALY (729) rates for both genders despite having a young population. Peru has the next highest incidence of death (45.8) and DALYs (385) from stroke. There was a trend of increasing stroke burden with decreasing country GNI per capita among the four countries. Each country had a signature risk factor profile; the United States with raised total cholesterol and obesity; France with hypertension, raised total cholesterol, and smoking; Vietnam with the greatest risk of hypertension and the highest prevalence of smoking among men; and Peru with risk of high BMI. Regarding clinical practice, both the United States and France have an established national guidelines on secondary prevention of stroke. Vietnam recently established its own quality standards based on the Royal College of Physicians' recommendations. Peru does not have its own clinical guidelines for secondary prevention, and adherence to evidence-based recommendations is likely variable among Peruvian neurologists. CONCLUSION: In the absence of a health system that can adequately screen and monitor common risk factors in its population, most susceptible patients will go untreated until a cerebrovascular event brings them to medical attention. The opportunity to intervene in the high-risk population is at the moment of incident stroke. Secondary prevention is a cost-effective strategy that can be implemented in the interim while sufficient healthcare capacity develops to maximize primary prevention in the future. LMIC must economize according to the constraints of their resources. Therefore, it would be practical to initiate secondary prevention drug therapy according to the top one or two risk factors in the population.Item Slaying the hydra: recurrent Clostridioides difficile infections(2020-06-26) Tessier, JeffreyItem Systematic Review of the Global Literature on Uncomplicated Recurrent Urinary Tract Infections: Underscoring Major Heterogeneity(2024-01-30) Papp, Sara B.; Seyan, Zheyar; Khan, Zara; Kenee, Parker R.M.; Christie, Alana; Zimmern, Philippe E.INTRODUCTION: Urinary tract infections (UTI) are common infections affecting over 60% of women and often become recurrent (rUTI). Despite their prevalence, research on rUTIs is limited and results are heterogenous due to varying definitions and populations. This systematic review examines global literature on uncomplicated rUTI and assesses differences in data based on geographic region. METHODS: Databases PubMed, Embase, WHO Global Index Medicus, and SciELO were searched for the keywords and/or MESH terms for recurrent and UTI, 2000- 2023. Studies were restricted to females ≥18 with uncomplicated rUTIs. Studies were excluded if they did not provide a definition for rUTI or did not cite/report an estimate for rUTI prevalence. The review was registered in PROSPERO and conformed to PRISMA. RESULTS: The search yielded 2,947 studies of which 124 were included (Table 1). Most studies were conducted in Europe (41%) or North America (39%), were prospective (52%), at tertiary centers (49%) and included all age groups (60%). Public institutions were the most common in North America (67%) while multi-center and public institutions were equally frequent in Europe (39% each). The most common definition for rUTI was 2 UTI/6m or 3 UTI/1y (62%). Regardless of study location, most studies cited prevalence estimates for rUTI from U.S.-based populations. Convenience samples were used for 91% of studies and sample sizes were: 30% n<50, 29% n=50-99, 22% n=100-199, 36% n≥200. CONCLUSIONS: This study represents the first formal investigation of the global literature base on uncomplicated rUTI. Studies on rUTIs are globally of small scale and definitions used for rUTI are heterogeneous. More studies are needed to ascertain the true prevalence of rUTI outside of North America and Europe.