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- Beaney, Thomas, et al.
(författare)
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May Measurement Month 2017 : an analysis of blood pressure screening results worldwide
- 2018
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Ingår i: The Lancet Global Health. - 2214-109X. ; 6:7, s. 736-743
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Tidskriftsartikel (refereegranskat)abstract
- Background: Increased blood pressure is the biggest contributor to the global burden of disease and mortality. Data suggest that less than half of the population with hypertension is aware of it. May Measurement Month was initiated to raise awareness of the importance of blood pressure and as a pragmatic interim solution to the shortfall in screening programmes. Methods: This cross-sectional survey included volunteer adults (≥18 years) who ideally had not had their blood pressures measured in the past year. Each participant had their blood pressure measured three times and received a a questionnaire about demographic, lifestyle, and environmental factors. The primary objective was to raise awareness of blood pressure, measured by number of countries involved, number of people screened, and number of people who have untreated or inadequately treated hypertension (defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or both, or on the basis of receiving antihypertensive medication). Multiple imputation was used to estimate the mean of the second and third blood pressure readings if these were not recorded. Measures of association were analysed using linear mixed models. Findings: Data were collected from 1 201 570 individuals in 80 countries. After imputation, of the 1 128 635 individuals for whom a mean of the second and third readings was available, 393 924 (34·9%) individuals had hypertension. 153 905 (17·3%) of 888 616 individuals who were not receiving antihypertensive treatment were hypertensive, and 105 456 (46·3%) of the 227 721 individuals receiving treatment did not have controlled blood pressure. Significant differences in adjusted blood pressures and hypertension prevalence were apparent between regions. Adjusted blood pressure was higher in association with antihypertensive medication, diabetes, cerebrovascular disease, smoking, and alcohol consumption. Blood pressure was higher when measured on the right arm than on the left arm, and blood pressure was highest on Saturdays. Interpretation: Inexpensive global screening of blood pressure is achievable using volunteers and convenience sampling. Pending the set-up of systematic surveillance systems worldwide, MMM will be repeated annually to raise awareness of blood pressure. Funding: International Society of Hypertension, Centers for Disease Control and Prevention, Servier Pharmaceutical Co.
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- Chao, Tiffany E., et al.
(författare)
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Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis
- 2014
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Ingår i: The Lancet Global Health. - 2214-109X. ; 2:6, s. 334-345
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Forskningsöversikt (refereegranskat)abstract
- Background The perception of surgery as expensive and complex might be a barrier to its widespread acceptance in global health efforts. We did a systematic review and analysis of cost-effectiveness studies that assess surgical interventions in low-income and middle-income countries to help quantify the potential value of surgery. Methods We searched Medline for all relevant articles published between Jan 1, 1996 and Jan 31, 2013, and searched the reference lists of retrieved articles. We converted all results to 2012 US$. We extracted cost-effectiveness ratios (CERs) and appraised economic assessments for their methodological quality using the 10-point Drummond checklist. Findings Of the 584 identified studies, 26 met full inclusion criteria. Together, these studies gave 121 independent CERs in seven categories of surgical interventions. The median CER of circumcision ($13.78 per disability-adjusted life year [DALY]) was similar to that of standard vaccinations ($12.96-25.93 per DALY) and bednets for malaria prevention ($6.48-22.04 per DALY). Median CERs of cleft lip or palate repair ($47.74 per DALY), general surgery ($82.32 per DALY), hydrocephalus surgery ($108.74 per DALY), and ophthalmic surgery ($136 per DALY) were similar to that of the BCG vaccine ($51.86-220.39 per DALY). Median CERs of caesarean sections ($315.12 per DALY) and orthopaedic surgery ($381.15 per DALY) are more favourable than those of medical treatment for ischaemic heart disease ($500.41-706.54 per DALY) and HIV treatment with multidrug antiretroviral therapy ($453.74-648.20 per DALY). Interpretation Our findings suggest that many essential surgical interventions are cost-effective or very cost-effective in resource-poor countries. Quantification of the economic value of surgery provides a strong argument for the expansion of global surgery's role in the global health movement. However, economic value should not be the only argument for resource allocation-other organisational, ethical, and political arguments can also be made for its inclusion. Funding Massachusetts General Hospital Department of Surgery, Boston Children's Hospital, and Stanford University Department of Surgery. Copyright (C) Chao et al. Open Access article distributed under the terms of CC BY.
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- Elbukhari Ibrahim, Maisoon, et al.
(författare)
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Short-term aid or long-term gains? : Harnessing Sudan's humanitarian response for the resilience of its health system
- 2024
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Ingår i: The Lancet Global Health. - 2214-109X. ; 12:7
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Tidskriftsartikel (refereegranskat)abstract
- The Sudan 2023 Humanitarian Response Plan was revised in May, 2023, due to the escalating violence in the country. This revision increased the scale of assistance and protection activities and suspended the funding allocated for access to livelihood, access to basic services, and for the implementation of resilience solutions. We call to rethink Sudan's current humanitarian response through a pro-resilience and people-centred approach. A pro-resilience approach prioritises investments in national systems and institutions capable of delivering aid and anticipates, prevents, mitigates, and manages imminent and simultaneous shocks. A people-centred humanitarian response involves meaningful engagement of communities and collaborations with civil society organisations, which continue to be the key responders to the ongoing conflict in Sudan. Finally, we propose approaches to effectively operationalise health system resilience to enhance immediate and long-term health outcomes.
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- Lin, Queran, et al.
(författare)
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Hypertension in stroke survivors and associations with national premature stroke mortality : data for 2·5 million participants from multinational screening campaigns
- 2022
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Ingår i: The Lancet Global Health. - 2214-109X. ; 10:8, s. 1141-1149
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Tidskriftsartikel (refereegranskat)abstract
- Background: Blood pressure control has a pivotal role in reducing the incidence and recurrence of stroke. May Measurement Month (MMM), which was initiated in 2017 by the International Society of Hypertension, is the largest global blood pressure screening campaign. We aim to compare MMM participants with and without a previous history of stroke and to investigate associations between national-level estimates of blood pressure management from MMM and premature stroke mortality. Methods: In this annual, global, cross-sectional survey, more than 2·5 million volunteers (≥18 years) from 92 countries were screened in May, 2017, and May, 2018. Three seated blood pressure readings and demographic, lifestyle, and cardiovascular disease data were collected. Associations between risk factors and stroke history were analysed with mixed-effects logistic regression, and associations between national-level estimates of blood pressure management and premature stroke mortality based on Global Burden of Disease data were investigated with linear regression. Findings: 2 222 399 (88·4%) of 2 515 365 participants had recorded data on a history of stroke, of whom 62 639 (2·8%) reported a previous stroke. Participants with a history of stroke had higher rates of hypertension (77·0% vs 32·9%, p<0·0001) and of treated (90·2% vs 57·0%, p<0·0001) and controlled (55·9% vs 32·4%, p<0·0001) hypertension than those without a history of stroke. A third of participants with a history of stroke had either untreated hypertension or treated but uncontrolled hypertension (blood pressure ≥140/90 mm Hg). Strong positive associations were found between national premature stroke mortality and mean systolic blood pressure (84·3 [95% CI 38·8 to 129·9] years of life lost [YLL] per 100 000 people per mm Hg increase) and the percentage of participants with raised blood pressure (49·1 [22·6 to 75·6] YLL per 100 000 people per 1% increase). Strong negative associations were found between national premature stroke mortality and the percentage of participants with hypertension on treatment (−21·0 [−33·0 to −8·9] YLL per 100 000 people per 1% increase) and with controlled blood pressure (−31·6 [−43·8 to −19·4] YLL per 100 000 people per 1% increase). Interpretation: Blood pressure control remains suboptimal worldwide among people with a history of stroke. National estimates of blood pressure management reflect national premature stroke mortality sufficiently to prompt policy makers to promote blood pressure screening and management. Funding: International Society of Hypertension and Servier Pharmaceuticals.
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- Pisani, Luigi, et al.
(författare)
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Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome : a pooled analysis of four observational studies
- 2022
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Ingår i: The Lancet Global Health. - 2214-109X. ; 10:2, s. 227-235
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Tidskriftsartikel (refereegranskat)abstract
- Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference –1·69 [–9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5–8] vs 6 [5–8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52–23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75–0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding.
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