Factors to take into account when choosing, reviewing and changing medicines.
Rescue therapy:
For symptomatic hyperglycaemia, consider insulin or a sulfonylurea and review when blood glucose control has been achieved.
Diet and lifestyle advice:
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At each point reinforce advice about diet and lifestyle.
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Background
Noncommunicable diseases are major contributors to morbidity and mortality worldwide. Modifying the risk factors for these conditions, such as physical inactivity, is thus essential. Addressing the context or circumstances in which physi...cal activity occurs may promote physical activity at a population level. We assessed the effects of infrastructure, policy or regulatory interventions for increasing physical activity.
Methods
We searched PubMed, Embase and clinicaltrials.gov to identify randomised controlled trials (RCTs), controlled before-after (CBAs) studies, and interrupted time series (ITS) studies assessing population-level infrastructure or policy and regulatory interventions to increase physical activity. We were interested in the effects of these interventions on physical activity, body weight and related measures, blood pressure, and CVD and type 2 diabetes morbidity and mortality, and on other secondary outcomes. Screening and data extraction was done in duplicate, with risk of bias was using an adapted Cochrane risk of bias tool. Due to high levels of heterogeneity, we synthesised the evidence based on effect direction.
Results
We included 33 studies, mostly conducted in high-income countries. Of these, 13 assessed infrastructure changes to green or other spaces to promote physical activity and 18 infrastructure changes to promote active transport. The effects of identified interventions on physical activity, body weight and blood pressure varied across studies (very low certainty evidence); thus, we remain very uncertain about the effects of these interventions. Two studies assessed the effects of policy and regulatory interventions; one provided free access to physical activity facilities and showed that it may have beneficial effects on physical activity (low certainty evidence). The other provided free bus travel for youth, with intervention effects varying across studies (very low certainty evidence).
Conclusions
Evidence from 33 studies assessing infrastructure, policy and regulatory interventions for increasing physical activity showed varying results. The certainty of the evidence was mostly very low, due to study designs included and inconsistent findings between studies. Despite this drawback, the evidence indicates that providing access to physical activity facilities may be beneficial; however this finding is based on only one study. Implementation of these interventions requires full consideration of contextual factors, especially in low resource settings.
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As a high-burden neglected tropical disease, soil-transmitted helminth (STH) infections remain a major problem in the world, especially among children under five years of age. Since young children are at high risk of being infected, STH infection can have a long-term negative impact on their life, i...ncluding impaired growth and development. Stunting, a form of malnutrition in young children, has been long assumed as one of the risk factors in acquiring the STH infections. However, the studies on STH infection in children under five with stunting have been lacking, resulting in poor identification of the risk. Accordingly, we collected and reviewed existing related research articles to provide an overview of STH infection in a susceptible population of stunted children under five years of age in terms of prevalence and risk factors. There were 17 studies included in this review related to infection with Ascaris lumbricoides, Trichuris trichiura, hookworm, and Strongyloides stercoralis from various countries. The prevalence of STH infection in stunted children ranged from 12.5% to 56.5%. Increased inflammatory markers and intestinal microbiota dysbiosis might have increased the intensity of STH infection in stunted children that caused impairment in the immune system. While the age from 2 to 5 years along with poor hygiene and sanitation has shown to be the most common risk factors of STH infections in stunted children; currently there are no studies that show direct results of stunting as a risk factor for STH infection. While stunting itself may affect the pathogenesis of STH infection, further research on stunting as a risk factor for STH infection is encouraged.
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Any individual that meets the suspected case definition of monkeypox should be offered testing in appropriately equipped laboratories by staff trained in the relevant technical and safety procedures. Confirmation of monkeypox virus infection is base...d on nucleic acid amplification testing (NAAT), using real-time or conventional polymerase chain reaction (PCR), for detection of unique sequences of viral DNA. PCR can be used alone, or in combination with sequencing. The recommended specimen type for laboratory confirmation of monkeypox is skin lesion material, including swabs of lesion surface and/or exudate, roofs from more than one lesion, or lesion crusts.
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From Individual to Collective healing: A trainer’s manual
The Participation Handbook for humanitarian field workers contains detailed practical advice on the participation of affected people in humanitarian action. It has three sections:
Developing a participatory approach (main issues, key factors,... building mutual respect, communication methods and advice on reviewing your approach);
Implementing your participatory approach at every stage of the project cycle (initial assessment, project design, implementation, monitoring and final evaluation);
A list of tools and additional resources (books, internet sites, etc.)
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In order to better understand the contributing factors of undernutrition in LIFT program areas and the links between child nutritional status and independent variables of programmatic importance to LIFT (such as income, livelihoods, food security, a...nd water, sanitation and hygiene [WASH]), LEARN commissioned a secondary analysis of nutrition-related data from the 2013 LIFT Household Survey. The purpose of this report is to present the findings of this analysis.
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Limited research has examined factors associated with psychological distress following natural
disasters among non-Western child populations. Conditions associated with trauma-related symptoms following the 2004 tsunami in a sample of 265 Sri Lanka...n child survivors (53.6% female, aged 3 to 17) were examined retrospectively. Multivariate regression analyses identified pre-traumatic conditions (female gender, prior health) and peritraumatic conditions (loss of family, complete property loss) as being associated with increased trauma-related symptoms. Findings can be applied to the identification of children most at risk of developing trauma-related symptoms following a natural disaster from a non-Western population to aid development of culturally-appropriate interventions.
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Stigma toward individuals with mental disorders has been studied extensively. In the case of
Latin America and the Caribbean, the past decade has been marked by a significant increase in
information on stigma toward mental illness, but these findi...ngs have yet to be applied to mental health services in Latin America. The objective of this study was to conduct a systematic review of studies relating to stigma toward mental illness in Latin America and the Caribbean. The authors specifically considered differences in this region as compared with manifestations reported in Western European countries
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The socioeconomic factors and public health inadequacies that facilitated the rapid spread of this infection continue to exist. As it is a new and emerging disease it has not received sufficient coverage yet in the medical curricula of Member States.... Specific treatment is not available, and there is no vaccine for the prevention of chikungunya fever. It has therefore become imperative to develop guidelines, based on the limited clinical experience gathered from managing patients so far, for appropriate management of patients in communities and in health facilities. Experts engaged in managing patients with chikungunya fever in the Region were brought together by the WHO Regional Office for South-East Asia to outline guidelines for managing various situations and stages of the disease.
The socioeconomic factors and public health inadequacies that facilitated the rapid spread of this infection continue to exist. As it is a new and emerging disease it has not received sufficient coverage yet in the medical curricula of Member States. Specific treatment is not available, and there is no vaccine for the prevention of chikungunya fever. It has therefore become imperative to develop guidelines, based on the limited clinical experience gathered from managing patients so far, for appropriate management of patients in communities and in health facilities. Experts engaged in managing patients with chikungunya fever in the Region were brought together by the WHO Regional Office for South-East Asia to outline guidelines for managing various situations and stages of the disease. This publication is the end result of that exercise and is intended to assist health-care providers in planning and implementing appropriate care to patients with chikungunya fever according to their actual clinical conditions
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The study sought to understand the factors that facilitate women to adhere to treatment and return to health facilities for routine care from their own perspective. The researchers focused on Malawi, Uganda and Zambia, early adopters of the global g...uidance to provide lifelong treatment for pregnant women living with HIV (Option B+) and spoke to women living with HIV, healthcare workers and programme managers to discover which factors and practices show promise in supporting women to initiate and remain in care.
This study found that women living with HIV who access these services to prevent vertical transmission have a strong sense and understanding of what factors support their retention and how health facilities, the wider community and their friends and relations can best support them. This report shares their words to describe how it feels to walk in their shoes on the path of life long treatment.
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Objective: This study examined the experiential factors and interacting vulnerabilities that contribute to the development of posttraumatic stress disorder (PTSD) in children and adolescents
Am J Psychiatry 2000; 157:1229–1235)
Addressing comorbidities and risk factors for TB is a crucial component of Pillar one of the End TB Strategy, which focuses on integrated patient-centred care and prevention, including action on TB and comorbidities. The Framework for collaborative ...action on TB and comorbidities aims to support countries in the evidence-informed introduction and scale-up of holistic people-centred services for TB, comorbidities and health-related risk factors, with the goal of comprehensively addressing TB and other co-existing health conditions. It should be used in conjunction with relevant WHO guidelines. The Framework is intended for use by people working in ministries of health, other relevant line-ministries, policymakers, international technical and funding organizations, researchers, nongovernmental and civil society organizations, as well as primary care workers, specialist health practitioners, and community health workers who support the response to TB and comorbidities in both the public and private sectors.
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Noncommunicable diseases (NCDs) are responsible for 81% of all deaths in the region of the Americas, of which 34% befall prematurely in people between 30- 69 years old. The burden of theses diseases and their common risk factors jeopardize the healt...h systems to provide adequate management, as well as to implement customized policies and interventions. The PAHO/WHO STEPwise approach to NCD risk factor surveillance (STEPS) is a simple, sequential, standardized method for collecting, analyzing, and disseminating data on key NCD risk factors in countries in adults from 18 to 69 years old. This survey covers key modifiable risk factors: tobacco use, alcohol use, physical inactivity, and unhealthy diet, as well as key biological risk factors: overweight and obesity, raised blood pressure, raised blood glucose, and abnormal blood lipids. STEPS is a household survey that gathers information on the risk factors through a face-to-face interview (step 1), simple physical measurements (step 2), and collection of urine and blood samples for biochemical analysis (step 3). Every step has a core set of questions, measurements, and expanded sets depending on the countries' needs and interests. It also has optional modules. Implementing STEPS allows the comparability of data within and between countries due to its standardized data collection. It also helps health services plan public health priorities and monitors and evaluates population-wide interventions. It is designed to help countries build and strengthen their capacity to conduct surveillance. STEPS captures 11 of the 25 indicators outlined in the NCD Global Monitoring Framework relating to 7 of the nine global targets.
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A study set out to investigate the factors affecting the prevalence of the practice among cross-border communities in East Africa and the Horn of Africa and the extent to which people cross borders to practise or undergo FGM and the effects of the p...ractice on the women and girls in those communities. Changes were found in social norms in the cross-border communities investigated, indicating that the practice of female genital mutilation (FGM) can be eradicated. Effective interventions to end FGM need to be tailored to communities’ belief systems if they are to be “owned” by and mobilize the communities to change their culture. This report summarises the findings.
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The document provides Information on alcohol use (risk factors, evaluation alcohol use etc.) in a descriptive way.
Socioeconomic status is associated with differences in risk factors for cardiovascular disease incidence and outcomes, including mortality. However, it is unclear whether the associations between cardiovascular disease and common measures of socioec...onomic status—wealth and education—differ among high-income, middle-income, and low-income countries, and, if so, why these differences exist. We explored the association between education and household wealth and cardiovascular disease and mortality to assess which marker is the stronger predictor of outcomes, and examined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management.
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Cardiovascular diseases (CVDs) are a growing public health problem in Ghana and other African countries. Strokes and other CVDs have become a leading cause of death due to increasing risk factors such as hypertension. According to the Global Burden ...of Disease study (GBD), ischaemic heart disease was the fourth leading cause of death in Ghana in 2016. The prevalence of hyper-
tension, a major risk factor for CVDs, is increasing rapidly and ranges from 19% to 48%, according to the Ghana Health Service Annual Report, 2017, due to rising life expectancy and the increasing prevalence of contributing factors such as overweight/obesity. Early diagnosis and adequate management of the risk factors can reduce the fatal consequences of CVDs.
At the heart of improving risk assessment and management of CVDs are nationally approved guidelines, which facilitate standardisation of care approaches.
These guidelines developed by experts from all levels of health care and stakeholders capture all recommended approaches and necessary information for clinicians and other healthcare workers on CVDs. They also serve as a practical guide for assessing and managing the most important CVDs prevalent in Ghana and can be used at all levels of care namely health facilities without a doctor; with a general practitioner and with a physician specialist.
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To identify and to assess factors enhancing or hindering the delivery of breast and cervical cancer screening services in Malawi with regard to accessibility, uptake, acceptability and effectiveness.
Systematic review of published scientific eviden...ce. A search of six bibliographic databases and grey literature was executed to identify relevant studies conducted in Malawi in the English language, with no time or study design restrictions. Data extraction was conducted in Excel and evidence synthesis followed a thematic analysis approach to identify and compare emerging themes.
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Q5.SCOPING QUESTION: In individuals with psychotic disorders (including schizophrenia) who require long-term antipsychotic treatment, what is the safety and role of depot antipsychotic medication?