RESUMEN
The Third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program provides guidelines for managing dyslipidemia; however, studies from large centers find that most dyslipidemic patients fail to achieve management goals. Few data exist on lipid management in rural settings. To determine the proportion of rural dyslipidemic patients achieving ATP III goals, records of 461 patients were reviewed from 4 practices. Only 54% of the patients with dyslipidemia achieved ATP III goals. Patients with diabetes or with a family history of premature coronary heart disease were less likely to achieve ATP III goals (odds ratio 0.56; 95% confidence interval, 0.38-0.84 and odds ratio 0.42; 95% confidence interval, 0.25-0.71, respectively). Patients taking statins were more likely to achieve goals (odds ratio 3.23; 95% confidence interval, 2.13-4.89). These results indicate that a significant proportion of patients with dyslipidemia in rural practices do not achieve management goals. Strategies to improve lipid management in rural practices are needed.
Asunto(s)
Atención Ambulatoria , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Dislipidemias/sangre , Educación del Paciente como Asunto , Servicios de Salud Rural , Logro , Adulto , Anciano , Atención Ambulatoria/normas , Análisis de Varianza , Biomarcadores/sangre , Enfermedad Coronaria/sangre , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/etiología , Enfermedad Coronaria/prevención & control , Dislipidemias/complicaciones , Dislipidemias/tratamiento farmacológico , Dislipidemias/epidemiología , Femenino , Objetivos , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipolipemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/normas , Prevalencia , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Factores de Riesgo , Servicios de Salud Rural/normas , Resultado del Tratamiento , West Virginia/epidemiologíaAsunto(s)
Benzotiadiazinas , Hipersensibilidad a las Drogas/diagnóstico , Glomeruloesclerosis Focal y Segmentaria/diagnóstico , Vasculitis por IgA/diagnóstico , Infecciones del Sistema Respiratorio/complicaciones , Inhibidores de los Simportadores del Cloruro de Sodio/efectos adversos , Infecciones Estreptocócicas/complicaciones , Adulto , Biopsia , Diagnóstico Diferencial , Diuréticos , Femenino , Humanos , Vasculitis por IgA/inducido químicamente , Vasculitis por IgA/microbiología , Riñón/patologíaRESUMEN
BACKGROUND: The World Health Organization (WHO) Global Program to Eliminate Lymphatic Filariasis relies on mass drug administration (MDA) of two drugs annually for 4 to 6 years. The goal is to reduce the reservoir of microfilariae in the blood to a level insufficient to maintain transmission by the mosquito vector. In 2008, the international medical aid organization Médecins Sans Frontières (MSF) performed the first round of a MDA in the high-burden area of Asmat district, in Papua, Indonesia. We report the challenges faced in this MDA on a remote Indonesian island and propose solutions to overcome these hurdles in similar future contexts. RESULTS: During the MDA, we encountered difficult challenges in accessing as well as persuading the patient population to take the antifilarial drugs. Health promotion activities supporting treatment need to be adapted and repetitive, with adequate time and resources allocated for accessing and communicating with local, seminomadic populations. Distribution of bednets resulted in an increase in MDA coverage, but it was still below the 80-85% target. CONCLUSIONS: MDA for lymphatic filariasis is how the WHO has planned to eliminate the disease from endemic areas. Our programmatic experience will hopefully help inform future campaign planning in difficult-to-access, high-burden areas of the world to achieve target MDA coverage for elimination of lymphatic filariasis.