The document summarizes the formation and goals of the Delta States Stroke Consortium (DSSC), which was established in 2002 to coordinate efforts to reduce the public health burden of stroke across five southern U.S. states. The DSSC identified two dimensions to guide interventions: 1) domains in the stroke process from risk factors to post-stroke care, and 2) arrays of activities that can be implemented. The domains included risk factor prevention/control, identifying stroke symptoms and encouraging rapid response, acute care transportation and treatment, secondary prevention, and recovery/rehabilitation. The activity arrays included public/professional education, advocacy, environmental modifications, and healthcare system changes. The DSSC aims to use this framework to structure interventions
Community stroke prevention_programs__an_overview.6สปสช นครสวรรค์
This document summarizes a journal article about community stroke prevention programs. It finds that while healthcare providers understand stroke risk factors, prevention and risk factor control remain poor. The general public also lacks knowledge about stroke warning signs and their own risk. The document reviews the human and economic costs of stroke and discusses disparities. It outlines modifiable risk factors like hypertension and the need to increase public awareness and reduce those risks through community programs.
This document analyzes cancer mortality rates between rural and urban counties in Wisconsin from 2003-2007. It finds that the smallest and most rural county (Menominee) had the highest cancer mortality rate and no local hospital, while more populous counties with multiple hospitals like Milwaukee, Brown, Dane and Waukesha had lower rates. Ensuring access to healthcare, especially in rural areas, through initiatives like comprehensive cancer control coalitions, could help reduce cancer deaths in Wisconsin.
Research done while in PwC Mexico. A short version was included as part of a PwC publication "Future of Pacific Alliance", that was presented at the presidental summit in Chile on July 2016.
This document summarizes information on falls in older adults, including risk factors, assessment, and physical therapy interventions. It discusses how 30% of community-dwelling older adults fall each year, with 10% resulting in injury. Falls are a leading cause of injury for older adults. The document reviews risk factors like history of falls, medications, mobility and sensory impairments. It provides guidelines for assessment and recommends multifactorial interventions that include balance, strength, and gait training exercises. Effective programs involve moderate to high balance challenges and last at least 12 weeks. The OTAGO exercise program is highlighted as an example of an effective home-based fall prevention program.
Empowering Healthcare Leaders: The Business Case for Language Access_10.3.14Douglas Green
Empowering Healthcare Leaders: The Business Case for Language Access provides a framework for calculating total potential encounters with limited English patients, the economic benefit and cost of not providing language access and a frame work to align the economic benefits with organizational goals under the Affordable Care Act.
Healthcare oligopoly is Affecting u.s. economy convertedRoyJMeidinger
The document provides an overview of rising healthcare costs and declining outcomes in the United States compared to other developed nations. It notes that while the US spends much more per capita on healthcare, it has lower life expectancy and rates of preventable deaths than peers. The high costs are driven by administrative waste, high prices, and lack of cost control. The document argues that healthcare costs are a major burden on the US economy and individuals, and that reforms are needed to reduce costs while improving access and outcomes for all Americans.
The Economics Of Language Services In Healthcare FinalDouglas Green
The initial presentation of the Economics of Language Access. For an updated version with new research please do not hesitate to contact Douglas Green through the website. Thank you.
This study investigated the relationship between demographic characteristics and the systemic inflammatory response syndrome (SIRS) score after trauma. The researchers conducted a retrospective chart review of 246 trauma patients admitted to the intensive care unit. They found that compared to white patients, African American patients had fewer occurrences of SIRS and a lower white blood cell count on admission. Demographic differences exist in SIRS scores after trauma, indicating that factors like race and socioeconomic status may influence the body's inflammatory response to injury. Additional research is needed to understand the potential mechanisms driving these differences.
Community stroke prevention_programs__an_overview.6สปสช นครสวรรค์
This document summarizes a journal article about community stroke prevention programs. It finds that while healthcare providers understand stroke risk factors, prevention and risk factor control remain poor. The general public also lacks knowledge about stroke warning signs and their own risk. The document reviews the human and economic costs of stroke and discusses disparities. It outlines modifiable risk factors like hypertension and the need to increase public awareness and reduce those risks through community programs.
This document analyzes cancer mortality rates between rural and urban counties in Wisconsin from 2003-2007. It finds that the smallest and most rural county (Menominee) had the highest cancer mortality rate and no local hospital, while more populous counties with multiple hospitals like Milwaukee, Brown, Dane and Waukesha had lower rates. Ensuring access to healthcare, especially in rural areas, through initiatives like comprehensive cancer control coalitions, could help reduce cancer deaths in Wisconsin.
Research done while in PwC Mexico. A short version was included as part of a PwC publication "Future of Pacific Alliance", that was presented at the presidental summit in Chile on July 2016.
This document summarizes information on falls in older adults, including risk factors, assessment, and physical therapy interventions. It discusses how 30% of community-dwelling older adults fall each year, with 10% resulting in injury. Falls are a leading cause of injury for older adults. The document reviews risk factors like history of falls, medications, mobility and sensory impairments. It provides guidelines for assessment and recommends multifactorial interventions that include balance, strength, and gait training exercises. Effective programs involve moderate to high balance challenges and last at least 12 weeks. The OTAGO exercise program is highlighted as an example of an effective home-based fall prevention program.
Empowering Healthcare Leaders: The Business Case for Language Access_10.3.14Douglas Green
Empowering Healthcare Leaders: The Business Case for Language Access provides a framework for calculating total potential encounters with limited English patients, the economic benefit and cost of not providing language access and a frame work to align the economic benefits with organizational goals under the Affordable Care Act.
Healthcare oligopoly is Affecting u.s. economy convertedRoyJMeidinger
The document provides an overview of rising healthcare costs and declining outcomes in the United States compared to other developed nations. It notes that while the US spends much more per capita on healthcare, it has lower life expectancy and rates of preventable deaths than peers. The high costs are driven by administrative waste, high prices, and lack of cost control. The document argues that healthcare costs are a major burden on the US economy and individuals, and that reforms are needed to reduce costs while improving access and outcomes for all Americans.
The Economics Of Language Services In Healthcare FinalDouglas Green
The initial presentation of the Economics of Language Access. For an updated version with new research please do not hesitate to contact Douglas Green through the website. Thank you.
This study investigated the relationship between demographic characteristics and the systemic inflammatory response syndrome (SIRS) score after trauma. The researchers conducted a retrospective chart review of 246 trauma patients admitted to the intensive care unit. They found that compared to white patients, African American patients had fewer occurrences of SIRS and a lower white blood cell count on admission. Demographic differences exist in SIRS scores after trauma, indicating that factors like race and socioeconomic status may influence the body's inflammatory response to injury. Additional research is needed to understand the potential mechanisms driving these differences.
The document discusses the history and rationale for eliminating extra billing and user fees in Canada's health care system. It describes how extra billing proliferated in the 1980s due to funding cuts, undermining the principles of accessibility and universality. Several reports from this time recommended banning extra billing, leading to the Canadian Health Act of 1984 which eliminated the practices nationwide. The document argues that extra billing and user fees should continue to be banned, as they pose economic and ethical issues that could erode the social values underlying Canada's universal health care system. Allowing their re-introduction could risk accessibility for those unable to pay and higher overall costs.
Acs0008 Health Care Economics The Broader Contextmedbookonline
1) US healthcare spending is very high at over $2 trillion annually, yet health outcomes are mixed compared to other developed nations.
2) There is debate around whether rising healthcare costs represent an economic risk, with some arguing costs crowd out other spending while others say spending is acceptable if the value of health is high.
3) A key factor driving higher US costs with no clear improvement in outcomes is the market-based healthcare system, which differs from other countries. Features of healthcare markets like supplier-induced demand and moral hazard may contribute to rising costs.
This document discusses medical tourism, which is defined as traveling from one country to another for medical treatment. It notes that estimates of the number of US patients traveling abroad for care vary widely, from 60,000-85,000 per year according to one study to over 750,000 according to another. Several factors are driving growth in medical tourism, including rapidly rising healthcare costs in the US, a decrease in the percentage of Americans with health insurance, and significantly lower costs for care abroad. If US health plans covered medical travel, one study estimated the number of outbound medical tourists could grow to 500,000-700,000 patients annually.
The document discusses the dual cost and quality crises facing the American healthcare system. It argues that the root causes are a dysfunctional medical decision-making process and a financing system that relies too heavily on for-profit private insurance. The author proposes transitioning to a universal healthcare system financed by taxpayers and administered through non-profit third parties to reduce costs by an estimated $1 trillion annually. New electronic health records and medical AI tools could help improve decision-making quality if designed properly. Overall, the crises require understanding decision flaws and adopting evidence-based reforms rather than blaming any single group.
The United States health care system is a multi-payer system with both private and public insurance plans. About 62% of Americans receive health insurance through their employers, while 18% are uninsured. Major public programs include Medicare for the elderly and disabled, Medicaid for low-income individuals, and the State Children's Health Insurance Program. These programs are financed through taxes and premiums paid by individuals, businesses, and various levels of government. While the U.S. spends more on health care than any other country, many Americans remain uninsured, costs are very high, and the system ranked 37th globally in 2000. Recent health reform aims to expand coverage and regulate insurers.
The document discusses care considerations for older adults and pregnant patients. It notes that the aging population is growing rapidly and will be more ethnically diverse. Nurses must adapt care to address the specific needs of older patients, including common chronic illnesses. When triaging pregnant patients, nurses should consider red flags, choose the appropriate pregnancy protocol, and understand the difference between true and false labor. Safety is a top priority, and medications should only be recommended if on the patient's approved list.
Health Care and Medicare Corporate Culture and the Three-Legged StoolLillian Rosenthal
This document discusses the history and current state of Medicare spending in the United States. It notes that while Medicare was originally intended to provide healthcare access for seniors, costs have risen significantly due to an aging population living longer and advancing medical technology. The document analyzes newly released data on payments made to individual physicians by the Centers for Medicare and Medicaid Services to determine if and how healthcare providers may respond to financial incentives.
This study analyzed traffic fatality data from 2003-2012 in Georgia to determine how access to medical services influences crash outcomes. The researchers found that rural motorists had to travel further (over 30 miles in some areas) to reach hospitals. A 40-mile stretch of I-20 between Atlanta and Augusta was 18-30 miles from the nearest hospital and had a high fatality rate. Response times were consistently higher for crashes in rural areas compared to urban ones. Areas like rural I-20 and southeast Georgia highlighted locations where lack of access to prompt medical care could increase crash fatalities. The researchers conclude more study is needed at regional and national scales.
A single-payer healthcare system would cause further inefficiencies and be an economic burden for the United States. While increasing access to care, a single-payer system would lead to longer wait times like in Canada where 27% of people wait over 4 months for procedures compared to only 5% in the US. It would also decrease quality of care as seen in Canada where doctors are overworked and underpaid. Implementing such a system would require a tax increase of over 150% which would cripple the US economy, as seen when Vermont explored a single-payer plan. Competition in healthcare markets leads to lower costs and higher quality unlike a single-payer system, making it a step backwards for US healthcare.
The document summarizes the current state of universal health insurance in the United States. It discusses the fragmented nature of today's health care system and statistics on the uninsured. Research studies show that a universal single-payer system could cover all Americans for less money by reducing administrative costs. The document also briefly reviews universal health care systems in other countries like the UK, Germany, Japan, and Canada. It concludes by suggesting a universal system may be more achievable in the US than commonly believed.
The World’s Health Care Crisis: From the Laboratory Bench to the Patient’s Be...Elsevier
Ibis Sánchez-Serrano, founder and CEO of The Core Model Corp., a corporate strategy and policy think tank, talks about the role of pharma in the World’s Health Care Crisis at the New York Public Library on Aug. 29, 2013. He says the major problem is lack of access to better, safer and more affordable medicines. This issue is present not only in the United States and the developing world but also in countries with socialized health care systems. This illustrated talk will provide a comparative analysis of healthcare systems throughout the world and address major issues within biotechnology and pharmaceutical industries.
Used for Medical Grand Rounds at several hospitals, this is data based comprehensive review of the shortcomings of the American Medical System and dysfunctional political attempts at reform. Single payer, Medicare for all, with elimination of for profit insurance companies is the best answer.
Diagnosis of Early Risks, Management of Risks, and Reduction of Vascular Dise...asclepiuspdfs
In a recent issue of the Journal of Circulation, American Heart Association has published a scientific statement, related to the excess heart disease and acute vascular events in South Asians living in the USA. The same group of experts, also have published a complementary article in Circulation titled, “call to action: Cardiovascular disease (CVD) in Asian Americans.”I being a South Asian immigrant living in the USA, have always wondered as to why we do not have the same benefits as the other resident Americans in terms of the advantages of living in a highly advanced country? According to a study done in 2013, cardiovascular mortality has declined and diabetes mortality has increased in high-income countries. The study done in 26 industrialized nations, estimated the potential role of trends in population, for body mass index, systolic blood pressure, serum total cholesterol, and smoking, the modifiable risk factors identified as the promoters of CVD, and acute vascular events, by the Framingham Heart Study (FHS) group.
Examination of the incidence of heart disease in the US. A multivariate logis...AJHSSR Journal
ABSTRACT:Heart disease is a condition that affects the human heart and blood vessels. Heart disease affects
about half of American adults, and it also played a role in the high death rate in the rest of the world. The data
extracted from National Center for Health Statistics (NCHS) span from December 2019 to December 2021. The
only goal of this study is to look at the risk factors that affect the incidence of heart disease. After that, it will
estimate a Youden index to find the best cut-off point and measure how well the multivariate logistic regression
model's diagnostic test performed, adding to the body of knowledge. The application of logistic regression
yielded the finding that socioeconomic and health risk variables strongly influence the incidence of heart
disease. According to the Youden index, the ideal cutoff value is around 52%. Consequently, it is crucial for
American adults to monitor their lifestyle, have their BMI, blood pressure, diabetes, and other risk factors for
heart disease diagnosed, and then make sure they are receiving adequate treatment to prevent the tendency to
develop heart disease, which in turn will lower the death rate brought on by heart disease.
KEYWORDS: Heart disease, Multivariate logistic regression, Youden index, Health risk factors,
socioeconomic factors.
Interheart risk modifiable factors in micardio infraction 2004Medicina
This document summarizes the objectives and methods of the INTERHEART study, a large international case-control study designed to assess the importance of cardiovascular risk factors worldwide. The study aimed to enroll approximately 15,000 cases of acute myocardial infarction and a similar number of controls from 52 countries representing all inhabited continents. The study investigated the association between nine modifiable risk factors (smoking, lipids, hypertension, diabetes, obesity, diet, physical activity, alcohol consumption, psychosocial factors) and the risk of myocardial infarction. Standardized questionnaires and physical examinations were used to collect information from all participants. Blood samples were also collected to analyze lipid levels. The results of this large, global study could help determine if cardiovascular risk factors have similar or
This document discusses chronic diseases and their control. It notes that chronic diseases have replaced infectious diseases as the leading causes of death in the United States. Chronic diseases are characterized by uncertain causes, multiple risk factors, long development periods, and disability rather than cure. The document outlines the continuum of chronic disease from upstream social determinants to behavioral risks to conditions to diseases to impairment. It provides examples of how chronic diseases and their risk factors are interrelated and complex. Effective control requires addressing many determinants and preventing progression along the continuum.
This document presents a systematic literature review of cardiovascular disease (CVD) in Latin American patients with rheumatoid arthritis (RA). The review identified 16 relevant articles. The prevalence of CVD in Latin American RA patients was found to be 35.3%. Non-traditional risk factors for CVD in this population included genetic factors, autoantibodies, chronic inflammation, long RA duration, steroid use, familial autoimmunity, and thrombogenic factors. The review concluded that there is limited data on CVD and RA in Latin America and called for further evaluation of cardiovascular risk factors and generation of public health policies to reduce morbidity and mortality rates.
This document discusses public health approaches to addressing small arms violence. It makes three key points:
1) Small arms violence causes hundreds of thousands of deaths and over a million injuries annually, creating a major global public health problem. However, data on its health impacts is limited, especially in low-income and conflict-affected areas.
2) Research is needed on the health effects of small arms, contributing risk factors, and impacts of interventions. Surveillance systems and studies in various settings can help identify trends and priorities.
3) A public health approach views small arms violence as preventable and addresses its root causes, like availability of weapons and human insecurity. Reducing access to firearms can lower both the frequency
15m people worldwide suffer a stroke every day. What can be done to combat the disease? This report, sponsored by AstraZeneca, assesses current developments and the economic burden of stroke across the regions of the world.
Aha guidelines for primary prevention of cardiovascular disease and strokeΑθανάσιος Παπαδόπουλος
The guidelines provide recommendations for comprehensive risk reduction for adult patients without cardiovascular disease:
1) Risk assessment should begin at age 20 and include regular screening and monitoring of risk factors.
2) All adults age 40 or older should have their 10-year risk of coronary heart disease assessed to determine their absolute risk level.
3) Recommendations are provided for lifestyle modifications and medical treatments to reduce risk and lower blood pressure, improve diet, encourage physical activity, and consider aspirin for those at higher risk. The goal is to match interventions to individual risk levels.
CDC Health Disparities and Inequalities Report — United StatMaximaSheffield592
CDC Health Disparities and Inequalities Report —
United States, 2013
Supplement / Vol. 62 / No. 3 November 22, 2013
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Morbidity and Mortality Weekly Report
Supplement
The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC),
U.S. Department of Health and Human Services, Atlanta, GA 30333.
Suggested Citation: Centers for Disease Control and Prevention. [Title]. MMWR 2013;62(Suppl 3):[inclusive page numbers].
Centers for Disease Control and Prevention
Thomas R. Frieden, MD, MPH, Director
Harold W. Jaffe, MD, MA, Associate Director for Science
Joanne Cono, MD, ScM, Acting Director, Office of Science Quality
Chesley L. Richards, MD, MPH, Deputy Director for Public Health Scientific Services
MMWR Editorial and Production Staff
Ronald L. Moolenaar, MD, MPH, Editor, MMWR Series
Christine G. Casey, MD, Deputy Editor, MMWR Series
Teresa F. Rutledge, Managing Editor, MMWR Series
David C. Johnson, Lead Technical Writer-Editor
Jeffrey D. Sokolow, MA, Catherine B. Lansdowne, MS,
Denise Williams, MBA, Project Editors
Martha F. Boyd, Lead Visual Information Specialist
Maureen A. Leahy, Julia C. Martinroe,
Stephen R. Spriggs, Terraye M. Starr
Visual Information Specialists
Quang M. Doan, MBA, Phyllis H. King
Information Technology Specialists
MMWR Editorial Board
William L. Roper, MD, MPH, Chapel Hill, NC, Chairman
Matthew L. Boulton, MD, MPH, Ann Arbor, MI
Virginia A. Caine, MD, Indianapolis, IN
Barbara A. Ellis, PhD, MS, Atlanta, GA
Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA
David W. Fleming, MD, Seattle, WA
William E. Halperin, MD, DrPH, MPH, Newark, NJ
King K. Holmes, MD, PhD, Seattle, WA
Timothy F. Jones, MD, Nashville, TN
Rima F. Khabbaz, MD, Atlanta, GA
Dennis G. Maki, MD, Madison, WI
Patricia Quinlisk, MD, MPH, Des Moines, IA
Patrick L. Remington, MD, MPH, Madison, WI
William Schaffner, MD, Nashville, TN
Asthma Attacks Among Persons with Current Asthma —
United States, 2001–2010 .......................................................................... 93
Diabetes — United States, 2006 and 2010 ............................................ 99
Health-Related Quality of Life — United States, 2006 and 2010 .... 105
HIV Infection — United States, 2008 and 2010 .................................. 112
Obesity — United States, 1999–2010 .................................................... 120
Periodontitis Among Adults Aged ≥30 Years —
United States, 2009–2010 ........................................................................ 129
Preterm Births — United States, 2006 and 2010 ............................... 136
Potentially Preventable Hospitalizations — United States,
2001–2009 .................................................................................................... 139
Prevalence of Hypertension and Contr ...
The document discusses the history and rationale for eliminating extra billing and user fees in Canada's health care system. It describes how extra billing proliferated in the 1980s due to funding cuts, undermining the principles of accessibility and universality. Several reports from this time recommended banning extra billing, leading to the Canadian Health Act of 1984 which eliminated the practices nationwide. The document argues that extra billing and user fees should continue to be banned, as they pose economic and ethical issues that could erode the social values underlying Canada's universal health care system. Allowing their re-introduction could risk accessibility for those unable to pay and higher overall costs.
Acs0008 Health Care Economics The Broader Contextmedbookonline
1) US healthcare spending is very high at over $2 trillion annually, yet health outcomes are mixed compared to other developed nations.
2) There is debate around whether rising healthcare costs represent an economic risk, with some arguing costs crowd out other spending while others say spending is acceptable if the value of health is high.
3) A key factor driving higher US costs with no clear improvement in outcomes is the market-based healthcare system, which differs from other countries. Features of healthcare markets like supplier-induced demand and moral hazard may contribute to rising costs.
This document discusses medical tourism, which is defined as traveling from one country to another for medical treatment. It notes that estimates of the number of US patients traveling abroad for care vary widely, from 60,000-85,000 per year according to one study to over 750,000 according to another. Several factors are driving growth in medical tourism, including rapidly rising healthcare costs in the US, a decrease in the percentage of Americans with health insurance, and significantly lower costs for care abroad. If US health plans covered medical travel, one study estimated the number of outbound medical tourists could grow to 500,000-700,000 patients annually.
The document discusses the dual cost and quality crises facing the American healthcare system. It argues that the root causes are a dysfunctional medical decision-making process and a financing system that relies too heavily on for-profit private insurance. The author proposes transitioning to a universal healthcare system financed by taxpayers and administered through non-profit third parties to reduce costs by an estimated $1 trillion annually. New electronic health records and medical AI tools could help improve decision-making quality if designed properly. Overall, the crises require understanding decision flaws and adopting evidence-based reforms rather than blaming any single group.
The United States health care system is a multi-payer system with both private and public insurance plans. About 62% of Americans receive health insurance through their employers, while 18% are uninsured. Major public programs include Medicare for the elderly and disabled, Medicaid for low-income individuals, and the State Children's Health Insurance Program. These programs are financed through taxes and premiums paid by individuals, businesses, and various levels of government. While the U.S. spends more on health care than any other country, many Americans remain uninsured, costs are very high, and the system ranked 37th globally in 2000. Recent health reform aims to expand coverage and regulate insurers.
The document discusses care considerations for older adults and pregnant patients. It notes that the aging population is growing rapidly and will be more ethnically diverse. Nurses must adapt care to address the specific needs of older patients, including common chronic illnesses. When triaging pregnant patients, nurses should consider red flags, choose the appropriate pregnancy protocol, and understand the difference between true and false labor. Safety is a top priority, and medications should only be recommended if on the patient's approved list.
Health Care and Medicare Corporate Culture and the Three-Legged StoolLillian Rosenthal
This document discusses the history and current state of Medicare spending in the United States. It notes that while Medicare was originally intended to provide healthcare access for seniors, costs have risen significantly due to an aging population living longer and advancing medical technology. The document analyzes newly released data on payments made to individual physicians by the Centers for Medicare and Medicaid Services to determine if and how healthcare providers may respond to financial incentives.
This study analyzed traffic fatality data from 2003-2012 in Georgia to determine how access to medical services influences crash outcomes. The researchers found that rural motorists had to travel further (over 30 miles in some areas) to reach hospitals. A 40-mile stretch of I-20 between Atlanta and Augusta was 18-30 miles from the nearest hospital and had a high fatality rate. Response times were consistently higher for crashes in rural areas compared to urban ones. Areas like rural I-20 and southeast Georgia highlighted locations where lack of access to prompt medical care could increase crash fatalities. The researchers conclude more study is needed at regional and national scales.
A single-payer healthcare system would cause further inefficiencies and be an economic burden for the United States. While increasing access to care, a single-payer system would lead to longer wait times like in Canada where 27% of people wait over 4 months for procedures compared to only 5% in the US. It would also decrease quality of care as seen in Canada where doctors are overworked and underpaid. Implementing such a system would require a tax increase of over 150% which would cripple the US economy, as seen when Vermont explored a single-payer plan. Competition in healthcare markets leads to lower costs and higher quality unlike a single-payer system, making it a step backwards for US healthcare.
The document summarizes the current state of universal health insurance in the United States. It discusses the fragmented nature of today's health care system and statistics on the uninsured. Research studies show that a universal single-payer system could cover all Americans for less money by reducing administrative costs. The document also briefly reviews universal health care systems in other countries like the UK, Germany, Japan, and Canada. It concludes by suggesting a universal system may be more achievable in the US than commonly believed.
The World’s Health Care Crisis: From the Laboratory Bench to the Patient’s Be...Elsevier
Ibis Sánchez-Serrano, founder and CEO of The Core Model Corp., a corporate strategy and policy think tank, talks about the role of pharma in the World’s Health Care Crisis at the New York Public Library on Aug. 29, 2013. He says the major problem is lack of access to better, safer and more affordable medicines. This issue is present not only in the United States and the developing world but also in countries with socialized health care systems. This illustrated talk will provide a comparative analysis of healthcare systems throughout the world and address major issues within biotechnology and pharmaceutical industries.
Used for Medical Grand Rounds at several hospitals, this is data based comprehensive review of the shortcomings of the American Medical System and dysfunctional political attempts at reform. Single payer, Medicare for all, with elimination of for profit insurance companies is the best answer.
Diagnosis of Early Risks, Management of Risks, and Reduction of Vascular Dise...asclepiuspdfs
In a recent issue of the Journal of Circulation, American Heart Association has published a scientific statement, related to the excess heart disease and acute vascular events in South Asians living in the USA. The same group of experts, also have published a complementary article in Circulation titled, “call to action: Cardiovascular disease (CVD) in Asian Americans.”I being a South Asian immigrant living in the USA, have always wondered as to why we do not have the same benefits as the other resident Americans in terms of the advantages of living in a highly advanced country? According to a study done in 2013, cardiovascular mortality has declined and diabetes mortality has increased in high-income countries. The study done in 26 industrialized nations, estimated the potential role of trends in population, for body mass index, systolic blood pressure, serum total cholesterol, and smoking, the modifiable risk factors identified as the promoters of CVD, and acute vascular events, by the Framingham Heart Study (FHS) group.
Examination of the incidence of heart disease in the US. A multivariate logis...AJHSSR Journal
ABSTRACT:Heart disease is a condition that affects the human heart and blood vessels. Heart disease affects
about half of American adults, and it also played a role in the high death rate in the rest of the world. The data
extracted from National Center for Health Statistics (NCHS) span from December 2019 to December 2021. The
only goal of this study is to look at the risk factors that affect the incidence of heart disease. After that, it will
estimate a Youden index to find the best cut-off point and measure how well the multivariate logistic regression
model's diagnostic test performed, adding to the body of knowledge. The application of logistic regression
yielded the finding that socioeconomic and health risk variables strongly influence the incidence of heart
disease. According to the Youden index, the ideal cutoff value is around 52%. Consequently, it is crucial for
American adults to monitor their lifestyle, have their BMI, blood pressure, diabetes, and other risk factors for
heart disease diagnosed, and then make sure they are receiving adequate treatment to prevent the tendency to
develop heart disease, which in turn will lower the death rate brought on by heart disease.
KEYWORDS: Heart disease, Multivariate logistic regression, Youden index, Health risk factors,
socioeconomic factors.
Interheart risk modifiable factors in micardio infraction 2004Medicina
This document summarizes the objectives and methods of the INTERHEART study, a large international case-control study designed to assess the importance of cardiovascular risk factors worldwide. The study aimed to enroll approximately 15,000 cases of acute myocardial infarction and a similar number of controls from 52 countries representing all inhabited continents. The study investigated the association between nine modifiable risk factors (smoking, lipids, hypertension, diabetes, obesity, diet, physical activity, alcohol consumption, psychosocial factors) and the risk of myocardial infarction. Standardized questionnaires and physical examinations were used to collect information from all participants. Blood samples were also collected to analyze lipid levels. The results of this large, global study could help determine if cardiovascular risk factors have similar or
This document discusses chronic diseases and their control. It notes that chronic diseases have replaced infectious diseases as the leading causes of death in the United States. Chronic diseases are characterized by uncertain causes, multiple risk factors, long development periods, and disability rather than cure. The document outlines the continuum of chronic disease from upstream social determinants to behavioral risks to conditions to diseases to impairment. It provides examples of how chronic diseases and their risk factors are interrelated and complex. Effective control requires addressing many determinants and preventing progression along the continuum.
This document presents a systematic literature review of cardiovascular disease (CVD) in Latin American patients with rheumatoid arthritis (RA). The review identified 16 relevant articles. The prevalence of CVD in Latin American RA patients was found to be 35.3%. Non-traditional risk factors for CVD in this population included genetic factors, autoantibodies, chronic inflammation, long RA duration, steroid use, familial autoimmunity, and thrombogenic factors. The review concluded that there is limited data on CVD and RA in Latin America and called for further evaluation of cardiovascular risk factors and generation of public health policies to reduce morbidity and mortality rates.
This document discusses public health approaches to addressing small arms violence. It makes three key points:
1) Small arms violence causes hundreds of thousands of deaths and over a million injuries annually, creating a major global public health problem. However, data on its health impacts is limited, especially in low-income and conflict-affected areas.
2) Research is needed on the health effects of small arms, contributing risk factors, and impacts of interventions. Surveillance systems and studies in various settings can help identify trends and priorities.
3) A public health approach views small arms violence as preventable and addresses its root causes, like availability of weapons and human insecurity. Reducing access to firearms can lower both the frequency
15m people worldwide suffer a stroke every day. What can be done to combat the disease? This report, sponsored by AstraZeneca, assesses current developments and the economic burden of stroke across the regions of the world.
Aha guidelines for primary prevention of cardiovascular disease and strokeΑθανάσιος Παπαδόπουλος
The guidelines provide recommendations for comprehensive risk reduction for adult patients without cardiovascular disease:
1) Risk assessment should begin at age 20 and include regular screening and monitoring of risk factors.
2) All adults age 40 or older should have their 10-year risk of coronary heart disease assessed to determine their absolute risk level.
3) Recommendations are provided for lifestyle modifications and medical treatments to reduce risk and lower blood pressure, improve diet, encourage physical activity, and consider aspirin for those at higher risk. The goal is to match interventions to individual risk levels.
CDC Health Disparities and Inequalities Report — United StatMaximaSheffield592
CDC Health Disparities and Inequalities Report —
United States, 2013
Supplement / Vol. 62 / No. 3 November 22, 2013
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Morbidity and Mortality Weekly Report
Supplement
The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC),
U.S. Department of Health and Human Services, Atlanta, GA 30333.
Suggested Citation: Centers for Disease Control and Prevention. [Title]. MMWR 2013;62(Suppl 3):[inclusive page numbers].
Centers for Disease Control and Prevention
Thomas R. Frieden, MD, MPH, Director
Harold W. Jaffe, MD, MA, Associate Director for Science
Joanne Cono, MD, ScM, Acting Director, Office of Science Quality
Chesley L. Richards, MD, MPH, Deputy Director for Public Health Scientific Services
MMWR Editorial and Production Staff
Ronald L. Moolenaar, MD, MPH, Editor, MMWR Series
Christine G. Casey, MD, Deputy Editor, MMWR Series
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Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA
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Asthma Attacks Among Persons with Current Asthma —
United States, 2001–2010 .......................................................................... 93
Diabetes — United States, 2006 and 2010 ............................................ 99
Health-Related Quality of Life — United States, 2006 and 2010 .... 105
HIV Infection — United States, 2008 and 2010 .................................. 112
Obesity — United States, 1999–2010 .................................................... 120
Periodontitis Among Adults Aged ≥30 Years —
United States, 2009–2010 ........................................................................ 129
Preterm Births — United States, 2006 and 2010 ............................... 136
Potentially Preventable Hospitalizations — United States,
2001–2009 .................................................................................................... 139
Prevalence of Hypertension and Contr ...
The epidemiology is referred to the medicine branch which mainly deals with identifying prevalence, incidence, distribution and possible management of diseases and their associated factors regarding health.
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Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
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rvices. All analysis was carried out using SAS v9.1.
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1. VOLUME 1: NO. 4 OCTOBER 2004
An Approach to Coordinate Efforts to
Reduce the Public Health Burden of Stroke:
The Delta States Stroke Consortium
TOOLS & TECHNIQUES
Suggested citation for this article: Howard VJ, Acker J,
Gomez CR, Griffies AH, Magers W, Michael M III, et al, for
the Delta States Stroke Consortium. An approach to coor-
dinate efforts to reduce the public health burden of stroke:
the Delta States Stroke Consortium. Prev Chronic Dis
[serial online] 2004 Oct [date cited]. Available from: URL:
http://www.cdc.gov/pcd/issues/2004/oct/ 03_0037.htm
Abstract
Stroke is the third leading cause of death and a lead-
ing cause of disability in the United States, with a par-
ticularly high burden on the residents of the southeast-
ern states, a region dubbed the “Stroke Belt.” These five
states — Alabama, Arkansas, Louisiana, Mississippi,
and Tennessee — have formed the Delta States Stroke
Consortium to direct efforts to reduce this burden. The
consortium is proposing an approach to identify domains
where interventions may be instituted and an array of
activities that can be implemented in each of the
domains. Specific domains include 1) risk factor preven-
tion and control; 2) identification of stroke signs and
symptoms and encouragement of appropriate responses;
3) transportation, Emergency Medical Services care, and
acute care; 4) secondary prevention; and 5) recovery and
rehabilitation management. The array of activities
includes 1) education of lay public; 2) education of health
professionals; 3) general advocacy and legislative
actions; 4) modification of the general environment; and
5) modification of the health care environment. The
Delta States Stroke Consortium members propose that
together these domains and activities define a structure
to guide interventions to reduce the public health bur-
den of stroke in this region.
Introduction
Stroke is the third leading cause of death and a lead-
ing cause of disability in the United States (1).
Unfortunately, the burden of stroke does not fall propor-
tionately on the nation’s population. Residents of the
southeastern states, a region dubbed the “Stroke Belt,”
carry a particularly high burden. The Stroke Belt has
been defined on the basis of high rates of stroke mortal-
ity, but the causes of high stroke mortality are a matter
of debate and uncertainty (2,3). Although the boundaries
of the Stroke Belt are not distinct, eight southern states
are considered to compose its core: North Carolina,
South Carolina, Georgia, Tennessee, Alabama,
Mississippi, Arkansas, and Louisiana.
The magnitude of the public health burden imposed by
the Stroke Belt is overwhelming. Figure 1 shows the
number of deaths from stroke in the eight-state region
from 1968–1996. During this 29-year period, 780,385
total deaths resulted from stroke in this region. The
expected number of deaths from stroke can be calculat-
ed by applying the national stroke death rate to the pop-
ulation of the region, resulting in an expected 585,836
total deaths from stroke during 1968–1996. The differ-
ence of 194,549 deaths represents the “extra” stroke
deaths, or approximately 6708 extra deaths on average
annually. Although stroke incidence data are not avail-
able, the extra number of incident stroke events in the
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
www.cdc.gov/pcd/issues/2004/oct/03_0037.htm • Centers for Disease Control and Prevention 1
Virginia J. Howard, MSPH, Joe Acker, MPH, Camilo R. Gomez, MD, Ada H. Griffies, MPH, Wanda Magers, MPA,
Max Michael III, MD, Sean R. Orr, MD, Martha Phillips, PhD, James M. Raczynski, PhD, John E. Searcy, MD, Richard M.
Zweifler, MD, George Howard, DrPH; for the Delta States Stroke Consortium
2. VOLUME 1: NO. 4
OCTOBER 2004
region each year can be
approximated by divid-
ing the number of extra
deaths each year (6708)
by the case fatality rate
(approximately 30%),
resulting in 22,363 extra
stroke events each year.
The mean lifetime cost of
ischemic stroke in the
United States is estimat-
ed to be $140,048 (in
1999 dollars), which
includes inpatient care,
rehabilitation, and fol-
low-up care (4). These
data suggest that the
annual public health
burden imposed by the
Stroke Belt is more than
$3.1 billion dollars. (Note that this is not the burden of
stroke in the region, but rather the extra costs associat-
ed with the increased stroke risk in the region.)
The Centers for Disease Control and Prevention (CDC)
recently published A Public Health Action Plan to
Prevent Heart Disease and Stroke (5), a comprehensive
plan to reduce the burden of stroke and heart disease.
One of the five major components of the proposed strat-
egy is to encourage “engaging in regional and global
partnerships [to] multiply resources and capitaliz[e] on
shared experience” (5). The importance of developing
partnerships in the southeastern United States to
reduce the burden of stroke is evident, given the
immense public health burden of stroke in the region.
This need gave rise to the Tri-States Stroke Consortium,
established in 1997 to coordinate the efforts of North
Carolina, South Carolina, and Georgia (6). In 2002, the
Delta States Stroke Consortium (DSSC) was formed to
coordinate the efforts of the remaining five states in the
Stroke Belt — Tennessee, Alabama, Mississippi,
Arkansas, and Louisiana. This consortium includes rep-
resentatives of state health departments, academic sci-
entists, health care professionals, advocacy groups,
pharmaceutical and other industry representatives, and
stroke survivors. At the first meeting of the DSSC, held
March 13–14, 2003, a plan for organizing efforts to
reduce the burden of stroke in the region was developed
and is summarized in this report.
Identifying
Opportunities to
Reduce the Burden
of Stroke
The DSSC developed a
context for planning
interventions to reduce
the public health burden
of stroke based on a two-
dimensional model. The
first dimension is based
on the observation that
stroke is not an event,
but rather a process that
begins with developing
risk factors and contin-
ues through caring for
stroke survivors. The sec-
ond dimension represents the array of activities that can
be implemented to reduce the burden of stroke. Each of
these dimensions is summarized below.
Domains in the process of stroke
The public health burden of stroke results from a
process that begins in childhood (some would suggest
prior to childhood), continues to adulthood, continues to
the stroke event, and then to the subsequent care of the
stroke survivor. The DSSC has divided this process into
five domains. Within each domain, opportunities exist to
reduce the burden of stroke.
1. Risk factor prevention and control
Prevention of stroke, as well as of most chronic dis-
eases, has been shown to be the most cost-effective
approach for reducing the public health burden of dis-
ease (7). The broad field of prevention is increasingly
considered as being subdivided into two major
domains: 1) primordial risk factor prevention and 2)
risk factor control.
Primordial risk factor prevention, or preventing indi-
viduals from ever developing the risk factor, is clearly
the best way to control the risk factor (8). Many risk fac-
tors for stroke, such as hypertension, diabetes, and obe-
sity, have roots in childhood. Other risk factors, such as
smoking, have roots in late adolescence. The first oppor-
2 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2004/oct/03_0037.htm
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
Figure 1. Number of annual deaths from stroke in North Carolina, South Carolina,
Georgia, Tennessee, Alabama, Mississippi, Louisiana, and Arkansas, 1968–1996.
The darker portion shows the number of deaths from stroke that would have
occurred if the death rate from stroke were the same as for the remainder of the
nation, while the lighter area represents the “extra” deaths above national rates.
3. tunity to reduce the burden of stroke is to intervene to
reduce the development of risk factors.
There are, however, ample opportunities to reduce the
burden of stroke after risk factors develop by improving
the identification and control of those risk factors. For
example, hypertension is the risk factor with the largest
population-attributable risk: approximately 25% of
strokes are attributable to the risk factor hypertension
alone (9). While the number of hypertensive patients
receiving appropriate diagnosis and management has
improved dramatically, 31% of hypertensive patients are
still unaware of their hypertension, and 69% of diagnosed
hypertensive patients still do not control their condition
adequately (10). Furthermore, benefits could be gained by
better detection and control of other risk factors, including
diabetes, atrial fibrillation, cigarette smoking, and other
vascular risk factors (9,11,12).
2. Identification of stroke signs and symptoms and
encouragement of appropriate responses
While some consider tissue plasminogen activator (t-PA)
to be the only acute treatment for stroke, many other
approaches, including hydration and blood pressure con-
trol, can improve the outcome of stroke and thereby reduce
the subsequent burden of events. The effectiveness of
these alternatives is supported by evidence showing that
stroke patients have better outcomes when they receive
stroke-unit care rather than general hospital care (13).
However, the efficacy of these treatments is likely
increased by the ability to intervene early during the
stroke event. It is critical that the stroke is quickly identi-
fied and that it is perceived as a medical emergency that
should be managed by professionals; hence, the burden of
stroke can be reduced by improvements in the identifica-
tion of strokes and in the decision making by the stroke
victim and those witnessing the event. Specifically, it is
critical that the public recognize stroke as a 911 emer-
gency and that stroke victims be transported to the hospi-
tal as quickly as possible.
3. Transportation, Emergency Medical Services
(EMS) care, and acute care
After the stroke is identified and 911 is contacted, the
outcome of the stroke patient can be improved by prompt
transport to an appropriate medical facility and delivery
of appropriate care during the acute phase of the event.
Effective transport is related to, but not solely deter-
mined by, the transport time from initial 911 call to
emergency room delivery. Decisions must be made about
the facility to which the patient should be taken and the
kind of treatment that should be delivered during trans-
port. In addition, the burden of stroke can be reduced by
appropriate treatment after the patient arrives at the
medical facility.
4. Secondary prevention
Stroke has a high rate of recurrence. The recurrence rate
within 30 days for all cerebral infarcts in the Stroke Data
Bank is 3.3%, and the one-year cumulative rate of death or
recurrent infarction is 15.3% (14). Other studies have
found the risk of recurrent stroke to be 8% in the first year
and 12% after two years (15-17). Many first neurologic
events have transient effects or minor long-term deficits;
however, these patients are at elevated risk for subsequent
major stroke. Many proven treatments reduce the subse-
quent risk of stroke, including risk factor management
involving lifestyle changes, medical management, and sur-
gical interventions (12,18).
5. Recovery and rehabilitation management
After a stroke has occurred, rehabilitation therapies can
increase the stroke survivor’s independence and quality of
life, which have a direct impact on the quality of life of the
survivor’s family and caregivers and reduce the cost of
post-stroke care.
Array of activities to reduce the impact of stroke
The five domains discussed above provide opportunities
to intervene to reduce the burden of stroke through an
array of activities. The DSSC formed a working group for
each domain to ensure that all opportunities and activities
were considered. The Table shows a matrix that couples
examples of activities with a specific domain. Clearly, cer-
tain activities may be more or less appropriate for each
domain; however, use of this matrix ensures that all poten-
tial activities for each domain are considered.
A brief description of each general activity suggested by
the DSSC is provided below.
1. Education of lay public
Perhaps the most promising of all activities to reduce the
burden of stroke are efforts to educate the lay public.
Educating the general public raises awareness of 1)
lifestyle choices that lead to the development and control
of risk factors, 2) stroke signs and symptoms, and 3) appro-
VOLUME 1: NO. 4
OCTOBER 2004
www.cdc.gov/pcd/issues/2004/oct/03_0037.htm • Centers for Disease Control and Prevention 3
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
4. VOLUME 1: NO. 4
OCTOBER 2004
priate actions when signs and symptoms occur. Positive
changes in lifestyle choices are associated with risk reduc-
tion. Education of the public also emphasizes the impor-
tance of obtaining and complying with rehabilitation
efforts. The literature is rich with documentation of the lay
public’s lack of knowledge about the signs and symptoms
of stroke (19-21), and there is an equally disturbing lack of
knowledge in other domains such as risk factors (19,21),
EMS care (22,23), and recovery and rehabilitation (24).
2. Education of health care professionals
Not only does the lay public lack knowledge about
stroke prevention and care but health care professionals
also have gaps in knowledge about opportunities to
reduce the burden of stroke. Opportunities to improve the
knowledge and training of health care providers include
educating them about 1) lifestyle choices that prevent the
development of risk factors; 2) better controls for existing
risk factors; 3) appropriate guidance when initial signs
and symptoms are reported; 4) actions that reduce the
chances of subsequent strokes; and 5) potential gains
offered by rehabilitation.
3. General advocacy and legislative actions
Another mechanism for reducing the burden of stroke is
a highly focused effort for advocacy and legislative
changes. Primordial risk factor prevention activities could
include, for example, modification of public school lunches
and urban design to encourage physical activity. An activ-
ity to promote primary control of risk factors could include
public assistance for blood pressure medication. General
advocacy activities could include the recruitment of lay
opinion leaders to raise the awareness of stroke signs and
symptoms. Legislative actions with an impact on the acute
care of stroke patients should include encouraging the
establishment of stroke centers (25). Finally, advocacy and
legislative actions can reduce subsequent stroke and pro-
vide rehabilitation opportunities by ensuring access to
services following the stroke event.
4. Modification of the general environment
Modifying the general environment is a potentially pow-
erful tool in reducing the burden of stroke. Such activities
include development of employee education programs,
appropriate EMS signage, and home alterations to facili-
tate the return home of a stroke survivor.
5. Modification of the health care environment
Finally, there is the opportunity to modify the medical
environment, including EMS transport, which should be
designed to route stroke patients to hospitals equipped and
ready to provide acute care as well as access to computed
tomography (CT) imaging and rehabilitation services.
Conclusions
The DSSC is organized into five working groups, with
the emphasis of each group corresponding to one of the
domains described in this report. The goal in defining
these domains is to incorporate the entire spectrum of
the stroke process, which places such a heavy burden on
the United States, particularly in the southeastern
states. Each working group developed an array of activi-
ties that have the potential to impact the public health
burden of stroke.
Developing the list of potential activities in each of the
domains, however, is only the first step. Each activity will
be rated by a subcommittee both on its potential impact
and the feasibility of its implementation. Subsequently,
the DSSC aims to implement activities with a high poten-
tial impact and an acceptable feasibility in an ongoing
effort to reduce the burden of stroke.
Acknowledgments
The Delta States Stroke Consortium was initially sup-
ported through a grant from the Cardiovascular Health
Branch at the Centers for Disease Control and Prevention
(CDC) within the Community Health Promotion Program,
and is subsequently supported by the CDC under a grant
agreement with the Cardiovascular Health Branch of the
Alabama Department of Public Health.
Author Information
Corresponding author: Virginia J. Howard, MSPH,
Assistant Professor of Epidemiology, School of Public
Health, University of Alabama at Birmingham, 210F
Ryals Public Health Building, 1665 University Blvd,
Birmingham, AL 35294-0022. Telephone: 205-934-7197.
E-mail: vjhoward@uab.edu.
Author affiliations: Joe Acker, MPH, Birmingham
Regional Emergency Medical Services System,
4 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2004/oct/03_0037.htm
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
5. Birmingham, Ala; Camilo R. Gomez, MD, Sean R. Orr,
MD, Alabama Neurological Institute, Birmingham, Ala;
Ada H. Griffies, MPH, Max Michael III, MD, George
Howard, DrPH, School of Public Health, University of
Alabama at Birmingham, Birmingham, Ala; Wanda
Magers, MPA, Mississippi State Department of Health,
Jackson, Miss; Martha Phillips, PhD, James M.
Raczynski, PhD, University of Arkansas for Medical
Sciences, Little Rock, Ark; John E. Searcy, MD, Alabama
Medicaid Agency, Montgomery, Ala; Richard M. Zweifler,
MD, University of South Alabama, Mobile, Ala.
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VOLUME 1: NO. 4
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www.cdc.gov/pcd/issues/2004/oct/03_0037.htm • Centers for Disease Control and Prevention 5
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
6. VOLUME 1: NO. 4
OCTOBER 2004
KR, Hinn AR. Determinants of use of emergency med-
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Second Delay in Accessing Stroke Healthcare (DASH
II) Study. Stroke 2000;31(11):2591-6.
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6 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2004/oct/03_0037.htm
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
7. Table. Matrix of Opportunities to Reduce the Burden of Stroke by Applying Activities Within Each of Five Domains, Delta
States Stroke Consortium
VOLUME 1: NO. 4
OCTOBER 2004
www.cdc.gov/pcd/issues/2004/oct/03_0037.htm • Centers for Disease Control and Prevention 7
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
Potential Activities to Reduce Stroke Burden
Domains for
Interventions
to Reduce
the Burden
of Stroke
Primordial
and primary
risk factor
control
Identification
of signs and
symptoms,
with appropri-
ate actions
Stroke trans-
port and
acute care
Secondary
stroke
prevention
Rehabilitation
and recovery
Share resources
and develop
regional mes-
sages; partner
with other organi-
zations
Develop and dis-
seminate a
stroke first-aid
course to the
general public
Develop and dis-
seminate “Make
the right call”
and “Am I at
risk?” programs
Ensure that all
hospitalized
patients have
education in risk
factors for pre-
vention of second
strokes, signs
and symptoms of
stroke, and need
for monitoring
status
Design and
develop a
rehabilitation
awareness
course
Education of pri-
mary care
providers
Education of
primary care
physicians to
immediately
contact 911
Develop and gain
hospital adoption
of uniform emer-
gency room pro-
tocol for care of
acute stroke
Ensure that the
health care
providers have
adequate training
to formulate an
optimal second-
ary prevention
plan on type of
initial stroke or
transient
ischemic attacks
Design and
develop rehabili-
tation training
programs for
physicians and
allied health pro-
fessionals
Advocate to
provide
reimbursement
for provision of
preventive care
Recruit panel of
opinion leaders
to assist in
sending mes-
sages and rais-
ing awareness
Reduce barriers
to calling 911
and ensure that
costs will be
covered
Work at the
local and nation-
al levels to
increase aware-
ness, funding,
and quality con-
trol for second-
ary prevention
by using
AQAF/JCHCO
standards for
stroke centers
Push for stroke
recovery as a
quality indicator
(QI) for all feder-
al programs
Encourage
environment for
healthy lifestyle
choices includ-
ing walking
paths and
healthy snacks
Ensure com-
plete 911
coverage
Stress need for
clear residential
address identifi-
cation for EMS
Encourage
environment
that facilitates
control of risk
factors
Foster develop-
ment of patient
and caregiver
support groups
Encourage sys-
tems for preven-
tive care including
standard assess-
ments of lifestyle
choices and risk
factors
Train 911 opera-
tors on standard
stroke identifica-
tion and pre-
transport care.
Develop a format
and content for a
bidirectional
stroke transfer
protocol to include
type of transport,
level of transport,
and treatment
prior to hospital
arrival
Improve efforts to
provide quality
home health care;
improve educa-
tion, communica-
tions, and staffing
Utilize lifetime
health programs,
encourage con-
tracts with local
gymnasiums
Modification of
health care
environment
Modification
of general
environment
Advocacy and
legislative
actions
Education of
health care
providers
Education of
lay public