The cardiovascular disease continuum begins with risk factors such as diabetes mellitus (DM), progresses to vasculopathy and myocardial dysfunction, and finally ends with cardiovascular death. Diabetes is associated with a 2- to 4-fold increased risk for heart failure (HF). Moreover, HF patients wit...h DM have a worse prognosis than those without DM. Diabetes can cause myocardial ischemia via micro- and macrovasculopathy and can directly exert deleterious effects on the myocardium. Hyperglycemia, hyperinsulinemia, and insulin resistance can cause alterations in vascular homeostasis. Then, reduced nitric oxide and increased reactive oxygen species levels favor inflammation leading to atherothrombotic progression and myocardial dysfunction. The classification, diagnosis, and treatment of HF for a patient with and without DM remain the same. Until now, drugs targeting neurohumoral and metabolic pathways improved mortality and morbidity in HF with reduced ejection fraction (HFrEF). Therefore, all HFrEF patients should receive guideline-directed medical therapy. By contrast, drugs modulating neurohumoral activity did not improve survival in HF with preserved ejection fraction (HFpEF) patients. Trials investigating whether sodium-glucose cotransporter-2 inhibitors are effective in HFpEF are on-going. This review will summarize the epidemiology, pathophysiology, and treatment of HF in diabetes.
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The purpose of this manual is to provide guidance in the design, implementation and evaluation of a course that aims to build and strengthen the capacity of health personnel to manage eye patients at primary-level health facilities in the African Region. The course falls within the remit of continuo...us professional development in its broadest sense. Its content focuses on simple evidence-based practice that can be easily carried out in primary-level health facilities all over Africa.
This manual is intended for use by course directors and facilitators. Its intended audience includes all persons who wish to commission, support or offer a course serving the above aims, including pre-service training. This manual sets out the requisite steps for the preparation and organization of such a course.
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Volume 1 covers emergency triage assessment and treatment, and acute care for a severely ill or acutely injured patient for approximately the first 24 hours of care. It describes the clinical procedures commonly used in emergency and acute care, and gives a summary of the medicines used and the step...s necessary for infection control.
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UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance
Les pays progressent vers la réalisation de l’objectif mondial tendant à ce que, d’ici 2025, 95 pour cent des personnes qui vivent avec le VIH connaissent leur statut sérologique. Cependant, en 2020, on estimait encore à 6 millions le nombre de personnes séropositives non diagnostiquées da...ns le monde. Les hommes vivant dans des lieux où la prévalence du VIH est élevée et les hommes appartenant aux populations clés, tous lieux confondus, ont moins de chances de connaître leur séropositivité que les femmes. Ainsi, au niveau mondial, 78 pour cent des hommes de plus de 15 ans connaissent leur statut sérologique, contre 86 pour cent chez les femmes de cette même tranche d’âge.
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Submission by the WHO Collaborating Centre on training and policy on opioid availability and WHO collaborating Centre for community participation in palliative care and long term care To the Indian Nursing Council for consideration to be included in the Undergraduate Nursing education curriculum
Research in Brief.
The international community’s predominant response to the Venezuelan migration crisis remains focused on humanitarian relief. This is important, for two populations: a) the over 50,000 ‘pendular’ migrants who go back and forth across the border every day in order to access ...food and basic services; b) those who seek residency in Colombia or another country, and require immediate support in terms of food, shelter, and medical access. However, Betts states, for the over 1.2 million migrants who have settled in Colombia, a longer-term vision is needed, which must be based on seeing Venezuelan migration as a development opportunity that can benefit both migrants and citizens
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Manual for use in primary care.
This manual explains the theoretical basis and evidence for the effectiveness of brief interventions and assists primary health care workers in conducting a simple brief intervention for clients whose substance use is putting them at risk.
DHS Working Papers No. 101
Women’s empowerment, HIV testing, birth in past five years, Tanzania
Malnutrition in childhood and pregnancy has many adverse consequences for child survival and long-term well-being. It
also has far-reaching consequences for human capital, economic productivity, and national development overall. The
consequences of malnutrition should be a significant concern for ...policy makers in Burkina Faso, since around 672,000
children under 5 years (21 percent) suffer from chronic malnutrition (stunting or low height-for-age) and 10 percent
suffer from acute malnutrition (wasting or low weight-for-height) (Ministère de la Santé [MOH] et al. 2018).
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Background: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expan...ding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).
Methods: We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.
Findings: The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (−0.8 percentage points (pp) (95% credible interval: −2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: −0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (−0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (−0.6 per 1000 (95% CI −2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges.
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Men lag behind women regarding use of HIV services and represent the majority of individuals living with uncontrolled HIV, advanced HIV, and who experience HIV-related mortality. Men (15+) globally are less likely than women (15+) to know their HIV status (83% for men vs 91% for women), be on antire...troviral treatment (ART) (72% for men vs 83% for women) and reach viral suppression (67% for men vs 78% for women).
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