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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Tune into Kids | UNICEF |
United and proud for the next generation
EBioMedicine. 2016 Jun 16. pii: S2352-3964(16)30276-6. doi: 10.1016/j.ebiom.2016.06.020. Open Access
PLoS Med 10(1): e1001366. https://doi.org/10.1371/journal.pmed.1001366
Published: January 8, 2013
nContraception and Reproductive Medicine (2017) 2:26 DOI 10.1186/s40834-017-0053-6
Young women in Burkina Faso and Mali are increasingly using modern contraceptives for family planning; however, the LAPM contraceptive prevalence rate remains low. Our analysis indicates that social norms around idea...l family size for both men and women continue to drive young women’s choices around family planning and impede use of LAPMs. To increase modern contraceptive use and curb fertility rates, local governments and development organizations should focus on women’s empowerment and include male partners.
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Over the past few months, battles between the Myanmar military and the Arakan Army (AA) have increased in Rakhine and Chin states. Initially during the Union Solidarity and Development Party (USDP) administration, and now during the National League for Democracy (NLD) administration, ethnic armed or...ganizations (EAOs) that once had limited numbers and military capabilities have gained in strength by allying with more powerful EAOs, posing a challenge to the peace process. The continued insistence by the government and military that all EAOs sign the Nationwide Ceasefire Agreement (NCA) before engaging in further substantive dialogue has only exacerbated the many armed conflicts in the country.
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The United Nations Children's Fund (UNICEF), the International Organization for Migration (IOM), Georgetown University, and the United Nations University have today launched new guidelines to provide the first-ever global policy framework that will help protect, include, and empower children on the ...move in the context of climate change.
The Guiding Principles for Children on the Move in the Context of Climate Change provides a set of 9 principles that address the unique and layered vulnerabilities of children on the move both internally and across borders as a result of the adverse impacts of climate change. Currently, most child-related migration policies do not consider climate and environmental factors, while most climate change policies overlook the unique needs of children.
The guidelines note that climate change is intersecting with existing environmental, social, political, economic, and demographic conditions contributing to people’s decisions to move. In 2020 alone, nearly 10 million children were displaced in the aftermath of weather-related shocks. With around one billion children – nearly half of the world’s 2.2 billion children – living in 33 countries at high risk of the impacts of climate change, millions more children could be on the move in the coming years.
Developed in collaboration with young climate and migration activists, academics, experts, policymakers, practitioners, and UN agencies, the guiding principles are based on the globally ratified Convention on the Rights of the Child and are further informed by existing operational guidelines and frameworks.
Recommendations for safeguarding the rights and well-being of children regardless of their location or migration status.
The guiding principles provide national and local governments, international organizations and civil society groups with a foundation to build policies that protect children’s rights. The organizations and institutions are calling on governments, local and regional actors, international organizations, and civil society groups to embrace the guiding principles to help protect, include, and empower children on the move in the context of climate change.
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Eur Respir J. 2014 April ; 43(4): 1132–1141. doi:10.1183/09031936.00203613.
BMC Medicine201210:107
https://doi.org/10.1186/1741-7015-10-107© Katchanov and Birbeck; licensee BioMed Central Ltd. 2012
Received: 10 July 2012Accepted: 24 September 2012Published: 24 September 2012
In 2011, the World Health Organization’s (WHO) mental health Gap Action Programme (mhGAP) r...eleased evidence-based epilepsy-care guidelines for use in low and middle income countries (LAMICs). From a
geographical, sociocultural, and political perspective, LAMICs represent a heterogenous group with significant differences in the epidemiology, etiology, and perceptions of epilepsy. Successful implementation of
the guidelines requires local adaptation for use within individual countries. For effective implementation and sustainability, the sense of ownership and empowerment must be transferred from the global health authorities to the local people. Sociocultural and financial barriers that impede the implementation of the guidelines should be
identified and ameliorated. Impact assessment and program revisions should be planned and a budget allocated to them. If effectively implemented, as intended, at the primary-care level, the mhGAP
guidelines have the potential to facilitate a substantial reduction in the epilepsy treatment gap and improve the quality of epilepsy care in resource-limited settings.
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Q8: For people with dementia, what is the role of a medical review (including comorbid physical and mental conditions and medication use)?
Guide de réadaptation à base communautaire (RBC)
En 2003, une Consultation internationale consacrée à l’examen de la réadaptation à base communautaire organisée à Helsinki a émis un certain nombre de recommandations essentielles. Par la suite, la RBC a été redéfinie, dans un document ...d’orientation conjoint de l’OIT, l’UNESCO et l’OMS, comme une stratégie faisant partie intégrante du développement communautaire général qui vise à assurer la réadaptation, l’égalité des chances et l’intégration sociale des personnes handicapées.
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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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Miscellaneous
Chapter J.3
Health Economics Review, 2016 6:7 -Published: 11 February 2016
Q11: 11a). In women with epilepsy, should antiepileptic therapy be prescribed as monotherapy or polytherapy to decrease the risk of fetal malformations?
11b). Does the use of folic acid preconceptually decrease the risk of foetal malformations in women with epilepsy?
11c). Do phenytoin, phenobarbi...tal, valproic acid or carbamazepine enter breast milk in quantities which are clinically significant to the baby?
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Ce manuel décrit les règles et les procédures mises en place pour assurer la qualité
des prestations faites par le service de Pharmacie de l’hôpital d’Aubenas.
Il s’applique à toutes les prestations faites par le service de Pharmacie à destination des
différents services de l’hôp...ital ainsi qu’aux patients en ambulatoire sollicitant la pharmacie.
Basé sur le modèle de la norme AFNOR ISO 9001 version 2000, sa finalité est d’accroître la
satisfaction des unités de soins et se conformer aux bonnes pratiques de pharmacie
hospitalière.
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