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Epidemiology of hepatitis C virus infection among injection drug users in China: Systematic review and meta-analysis buy generic viagra extra dosage 120 mg on line. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www order viagra extra dosage with a mastercard. Surveillance data are used to estimate the magnitude of a health problem purchase on line viagra extra dosage, to describe the natural history of a disease, to detect epidemics, to document the distribution and spread of a health event or disease, to evaluate control and prevention measures, and to aid in public-health planning (Thacker, 2000). Public-health surveillance requires standardized, systematic, continuing collection and management of data. Through those steps, federal agencies and state and local health depart- ments are able to inform stakeholders by providing reliable information that can be used to reduce morbidity and mortality through public policy, appropriate resource distribution, and programmatic and educational inter- ventions. This chapter describes how surveillance data are used or could be used to determine the focus and scope of viral hepatitis prevention and control efforts. The committee reviewed the weaknesses of the current surveillance system for hepatitis B and hepatitis C, including the timeliness, accuracy, and completeness of data collection, analysis, and dissemination. It found that there were few published sources of information about viral hepatitis surveillance. To obtain a clearer picture of the activities that were taking place at state and local levels, the committee gathered information from Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Identify chronic cases of hepatitis B and C and measure prevalence • Develop accurate estimates of the burden of chronic disease in United States • Prevent secondary cases o Hepatitis B: Education, vaccination, and screening o Hepatitis C: Education, harm reduction, and screening 3. Its fndings are based on its review of the literature and on information gathered through surveys of and direct contact with profes- sionals working in this feld. Although the cooperative agreements do not include funds for viral-hepatitis surveillance, the coordinators are good sources of information about surveillance activities being conducted in each jurisdiction. As part of a national assessment of viral-hepatitis surveillance initiatives, the National Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Core surveillance means those activities in which all jurisdic- tions must engage to provide accurate, complete, and timely information to monitor incidence, prevalence, and trends in disease diagnoses. Data from other activities, such as targeted surveillance, supplement information from core surveillance, and are necessary to provide accurate incidence estimates, given the challenges of conducting hepatitis B and C surveillance, as de- tailed in this chapter. The recommendations also include guidance regarding the interpretation and dissemination of surveillance data. Federal and state health-department surveillance systems provide population-based information that can be used to improve the public’s health. They also offer an opportunity for public-health interven- tion at the individual level by linking infected people to appropriate care and support services (Klevens et al. Public health surveillance generally involves name-based reporting of cases of specifed diseases to state and local health departments. As such, it requires the gathering of information that some people consider private. Public health offcials and state legislatures have weighed the costs and benefts of public health surveillance and have required name-based report- ing of specifc diseases with confdentiality safeguards in place to protect private information (Fairchild et al. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The data can assist in recognizing and addressing breaches in in- fection control, and they can help to mitigate the size of outbreaks. Research on those outbreaks has shown that they typically occurred in dialysis units, medical wards, nursing homes, surgery wards, and outpatient clinics and resulted from breaches in infection control (Lanini et al. In a 2009 study, researchers found evidence of 33 outbreaks in nonhospital health-care settings in the United States in the last 10 years. Transmission was primarily patient to patient and was caused by lapses in infection control and aseptic techniques that allowed contamination of shared medical devices, such as dialysis machines. The authors stated that successful outbreak control depended on systematic case identifcation and investigation, but most health departments did not have the time, funds, personnel resources, or legal authority to investigate health-care–associated outbreaks (Thompson et al. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. For example, estimates of disease burden are commonly used to provide guidance to policy-makers on the level of funding required for disease-related programs. If surveillance data are not available or understate the disease burden, legislators and public-health offcials will not allocate suffcient resources to mount an appropriate public-health response. Information on disease burden is only one factor that guides policy- makers in allocating public-health resources. Therefore, it is im- portant to communicate surveillance trends and disease burden clearly to policy-makers and community advocates. Programmatic Design and Evaluation Public-health organizations use surveillance data to design programs that target appropriate populations. Surveillance data can also be used to evaluate systems for delivery of prevention and care service. Linking Patients to Care For some diseases, it is desirable to have a surveillance system closely involved in ensuring the linkage of persons who have new diagnoses to health-care services, often called case management (Fleming et al. For viral-hepatitis surveillance, linking patients who have recent diagnoses to comprehensive viral-hepatitis programs may be indicated to ensure ac- cess to appropriate services, including clinical evaluation, regular followup Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Chapter 5 will provide more detail on issues related to screening and identifcation. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Therefore, in investigating acute symptomatic infections, it is important to identify outbreaks so that preventive measures can be undertaken and, in the case of hepatitis B, to identify and screen close contacts who might beneft from the hepatitis B vaccine. Such information is needed if surveil- lance staff is to determine which cases are newly diagnosed, the result of recent exposure, or chronic (Fleming et al. Classifying acute cases of hepatitis B and hepatitis C requires a complex integration of clinical data, positive and negative laboratory data, and prior or repeat testing (see Boxes 2-2 and 2-3). Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Because auxiliary test results are not systematically reported to health departments, surveillance staff must actively follow up with health-care providers to obtain them and other clinical indicators of acute disease. If the data cannot be obtained, either because the proper tests were not ordered or because there is insuffcient staff to conduct followup, cases will be classifed ambiguously as nonacute infections. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Most important, when applying the most sensitive algorithm (the algorithm that detected the greatest number of cases of acute hepatitis B), the study found that only four of the eight cases of acute hepatitis B were in the state’s surveillance system and only one of the four was correctly classifed as acute; this suggests that 88% of acute hepatitis B cases may be missed if current reporting algorithms are used (Klompas et al.

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They enable the » reallocation of financial and human resources to facilitate organization of patient information purchase viagra extra dosage visa, tracking implementation of these services generic 200mg viagra extra dosage visa. Multidisciplinary health-care teams safe viagra extra dosage 130 mg, centred on primary The Secretariat of Health of Mexico health care, are an effective means in all settings of achieving this has launched a “crusade for the goal and of improving health-care outcomes (37 ). It is possible, however, to provide some the implementation of a structured of the core skills from these disciplines in other ways (by training diabetes education programme. It may be possible to provide core trained to adopt a quality improve- aspects of effective health care that in more resourced settings ment methodology. Among the inno- would be provided by health professionals from several different vations in primary health centres disciplines. The while among those receiving usual production of an evidence-based guideline is a resource-intensive care the proportion only increased and time consuming process. Documented foot lines are available for many chronic diseases (see, for example, care education increased to 76% of http://www. For example, simply providing information about the guideline is likely to have little impact, but linking the guideline to workshops or outreach training sessions and providing prompts within medical records are much more likely to change practice (41). Inter- A chronic disease self-management programme was developed in Shanghai from 1999 to 2001. The ventions that aim to improve the ability of patients and their programme was conducted by trained volunteer lay carers to manage conditions can be highly effective and leaders and included exercise, the use of cognitive are an essential component of chronic disease care (46). In some conditions, communities and six districts of Shanghai, and is being notably after myocardial infarction, rehabilitation reduces replicated in other cities (43). Multidisciplinary and intensive rehabilitation programmes, common in high income countries, are typically not feasible in low and middle income countries. This included mobil- » Multidisciplinary rehabilitation services in patients with chronic ity training and training to perform normal low back pain can reduce pain and improve function (48). Quality of life improved for » Cardiac rehabilitation (following myocardial infarction), with a some 95% of participants (44). In many from targeted communities (villages and low and middle income countries, this rehabilitation approach is not slum areas) were taught to identify and feasible owing to shortages of health workers and other resource train people with disabilities. Review of effective interventions In these situations, community-based rehabilitation is a viable alter- native, using and building on the community’s resources as well as those offered at district, provincial and central levels. Community-based rehabilitation is implemented through the combined efforts of people with disabilities, their families, organizations and communities, as well as the relevant governmental and nongovernmental health, education, vocational, social and other services. Such efforts are being made in more than 90 (mostly low and middle income) countries. There have been As an overall approach, some important successes that might be applied nationally. For example, the Pain it has not been rigorously and Palliative Care Society in Kerala has developed a network of 33 palliative care evaluated but site-spe- clinics providing free care to those who need it, with an emphasis on home care. Palliative care ranges from which five countries – Botswana, Ethiopia, Uganda, United personal care and assistance in daily living to Republic of Tanzania and Zimbabwe – and the World counselling and pain management. The current evidence provides little guid- local nongovernmental organizations, particularly Hospice ance on whether one approach is superior to Africa Uganda, the Ministry of Health has included pain another and suggests that further studies would relief and palliative care in the home care package, based be useful (52–54). Services include essential drugs for pain and other symp- tom relief, food and family support. I was also having trou- ble remembering things and had to urinate a lot,” she recalls. After that, Zahida ignored her symptoms for eight long years before seeking medical care again, this time in Islamabad, 70 km from her home town. A second blood test finally established the nature of the problem and she started feeling much better almost immedi- ately after taking her first shot of insulin. One of her legs was amputated below the knee, as a result of an ulcer on her foot going untreated. Zahida holds her local hospital responsible for not having detected raised blood glucose in the first place, but admits that she should have reported the ulcer on her foot to her doctor much sooner. Now 65 years old, she is slowly recovering at home from the physical and emotional effects of surgery with the help of her son and daughter- in-law. Many of the complications of diabetes, such as leg 115 amputation, can be prevented with good health care. Chronic diseases are already the major cause of death in almost all countries, and the threat to people’s lives, their health and the economic development of their countries is growing fast. Yet, as this part of the report has shown, the knowledge exists to deal with this threat and to save millions of lives. Effective and cost-effective interventions, and the knowledge to implement them, have been shown to work in many countries. If existing interventions are used together as part of a comprehensive, integrated approach, the global goal for preventing chronic diseases can be achieved. The only question is how governments, the private sector and civil society can work together to put such approaches into practice. If they do so in the ways outlined in the next part of the report, the global goal for chronic disease prevention and control will be achieved and millions of lives will be saved. Reduction in the incidence of noncommunicable disease interventions: lessons from type 2 diabetes with lifestyle intervention or metformin. Changes in sodium intake and blood pressure in a mellitus by changes in lifestyle among subjects with impaired community-based intervention project in China. School-based health education quickly does reduction in serum cholesterol concentration lower programs can be maintained over time: results from the risk of ischaemic heart disease? Vartiainen E, Jousilahti P, Alfthan G, Sundvall J, Pietinen P, London, Food Standards Agency, Dairy Council, Health Puska P. Cardiovascular risk factor changes in Finland, 1972– Education Trust, 2004 (http://www. International workplace health promotion program conducted in Japan for Journal of Tuberculosis and Lung Disease, 2000, 4:1002–1008. Paper prepared for the Transportation Research screening for noncommunicable disease: World Health Board and the Institute of Medicine Committee on Physical Organization Consultation Group Report on methodology of Activity, Health, Transportation, and Land Use. The long-term impact of Johnson & Johnson’s Health los Andes, Corporation de Universidades Centro de Bogota, & Wellness Program on employee health risks. Journal of Occupational and Environmental and evaluation of the Agita Sao Paolo Program using the Medicine, 2002, 44:21–29. Implementing clinical for cervical cancer in low- and middle-income developing guidelines: current evidence and future implications. Bulletin of the World Health Organization, 2002, of Continuing Education in the Health Professions, 2004, 79:954–962. Effectiveness and costs of interventions Implementation and quantitative evaluation of chronic disease to lower systolic blood pressure and cholesterol: a global and self-management programme in Shanghai, China: randomized regional analysis on reduction of cardiovascular-disease risk. Hypertension management in a community-based rehabilitation in Punjab, Pakistan: I: Russian polyclinic. Therapy-based rehabilitation services for stroke patients at chronically ill seniors. Review: exercise-based cardiac rehabilitation reduces all- cause and cardiac mortality in coronary heart disease. The impact of different models of specialist palliative care on patients’ quality of life: a systematic literature review.

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