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2.
J Neurol ; 271(5): 2258-2273, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38367046

RESUMO

Neurological conditions are the leading cause of disability and mortality combined, demanding innovative, scalable, and sustainable solutions. Brain health has become a global priority with adoption of the World Health Organization's Intersectoral Global Action Plan in 2022. Simultaneously, rapid advancements in artificial intelligence (AI) are revolutionizing neurological research and practice. This scoping review of 66 original articles explores the value of AI in neurology and brain health, systematizing the landscape for emergent clinical opportunities and future trends across the care trajectory: prevention, risk stratification, early detection, diagnosis, management, and rehabilitation. AI's potential to advance personalized precision neurology and global brain health directives hinges on resolving core challenges across four pillars-models, data, feasibility/equity, and regulation/innovation-through concerted pursuit of targeted recommendations. Paramount actions include swift, ethical, equity-focused integration of novel technologies into clinical workflows, mitigating data-related issues, counteracting digital inequity gaps, and establishing robust governance frameworks balancing safety and innovation.


Assuntos
Inteligência Artificial , Neurologia , Humanos , Neurologia/métodos , Política de Saúde , Doenças do Sistema Nervoso/terapia , Doenças do Sistema Nervoso/diagnóstico
3.
Hypertension ; 80(12): 2581-2590, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37830199

RESUMO

BACKGROUND: This study aimed to develop a risk-scoring model for hypertension among Africans. METHODS: In this study, 4413 stroke-free controls were used to develop the risk-scoring model for hypertension. Logistic regression models were applied to 13 risk factors. We randomly split the dataset into training and testing data at a ratio of 80:20. Constant and standardized weights were assigned to factors significantly associated with hypertension in the regression model to develop a probability risk score on a scale of 0 to 1 using a logistic regression model. The model accuracy was assessed to estimate the cutoff score for discriminating hypertensives. RESULTS: Mean age was 59.9±13.3 years, 56.0% were hypertensives, and 8 factors, including diabetes, age ≥65 years, higher waist circumference, (BMI) ≥30 kg/m2, lack of formal education, living in urban residence, family history of cardiovascular diseases, and dyslipidemia use were associated with hypertension. Cohen κ was maximal at ≥0.28, and a total probability risk score of ≥0.60 was adopted for both statistical weighting for risk quantification of hypertension in both datasets. The probability risk score presented a good performance-receiver operating characteristic: 64% (95% CI, 61.0-68.0), a sensitivity of 55.1%, specificity of 71.5%, positive predicted value of 70.9%, and negative predicted value of 55.8%, in the test dataset. Similarly, decision tree had a predictive accuracy of 67.7% (95% CI, 66.1-69.3) for the training set and 64.6% (95% CI, 61.0-68.0) for the testing dataset. CONCLUSIONS: The novel risk-scoring model discriminated hypertensives with good accuracy and will be helpful in the early identification of community-based Africans vulnerable to hypertension for its primary prevention.


Assuntos
Doenças Cardiovasculares , Hipertensão , Humanos , Pessoa de Meia-Idade , Idoso , População Africana , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Fatores de Risco , Medição de Risco
4.
J Headache Pain ; 24(1): 140, 2023 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-37884869

RESUMO

The 2030 Agenda for Sustainable Development sets out, through 17 Sustainable Development Goals (SDGs), a path for the prosperity of people and the planet. SDG 3 in particular aims to ensure healthy lives and promote well-being for all at all ages and includes several targets to enhance health. This review presents a "headache-tailored" perspective on how to achieve SDG 3 by focusing on six specific actions: targeting chronic headaches; reducing the overuse of acute pain-relieving medications; promoting the education of healthcare professionals; granting access to medication in low- and middle-income countries (LMIC); implementing training and educational opportunities for healthcare professionals in low and middle income countries; building a global alliance against headache disorders. Addressing the burden of headache disorders directly impacts on populations' health, as well as on the possibility to improve the productivity of people aged below 50, women in particular. Our analysis pointed out several elements, and included: moving forward from frequency-based parameters to define headache severity; recognizing and managing comorbid diseases and risk factors; implementing a disease management multi-modal management model that incorporates pharmacological and non-pharmacological treatments; early recognizing and managing the overuse of acute pain-relieving medications; promoting undergraduate, postgraduate, and continuing medical education of healthcare professionals with specific training on headache; and promoting a culture that favors the recognition of headaches as diseases with a neurobiological basis, where this is not yet recognized. Making headache care more sustainable is an achievable objective, which will require multi-stakeholder collaborations across all sectors of society, both health-related and not health-related. Robust investments will be needed; however, considering the high prevalence of headache disorders and the associated disability, these investments will surely improve multiple health outcomes and lift development and well-being globally.


Assuntos
Dor Aguda , Transtornos da Cefaleia , Humanos , Feminino , Idoso , Desenvolvimento Sustentável , Saúde Pública , Cefaleia/diagnóstico , Cefaleia/terapia , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/epidemiologia , Transtornos da Cefaleia/terapia , Saúde Global
5.
J Stroke Cerebrovasc Dis ; 32(9): 107265, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37487320

RESUMO

OBJECTIVES: To assess the knowledge of community dwelling adults on stroke risk and their willingness to use mobile health (mHealth) technology in assessing their stroke risk. MATERIALS AND METHODS: A cross-sectional study was conducted among adults (≥18 years old) using survey questionnaires designed by neurologists and health promotion experts and administered by trained study staff. Logistic regression models were used to assess factors associated with receptivity toward knowing individual stroke risk score and willingness to use a mobile application (App) to assess stroke risk. RESULTS: The survey was administered to 486 participants in Nigeria, with a mean age of 47.4 ± 15.5 years, comprising 53.5% females. Up to 84% of participants wanted to know their risk for developing stroke but only 29.6% of respondents had ever previously had their stroke risk assessed. Factors associated with willingness to know stroke risk were age [aOR (95% CI): 0.97 (0.95 - 0.99)], and Hausa tribe [16.68 (2.16 - 128.92)]. Up to 66% of participants wanted to know their immediate risk of stroke, compared with 6.6% and 2.1% who wanted to know their 5-year or 10-year future stroke risks respectively. Regarding locations, participants preferred stroke risk assessment to be performed at a health facility, at home by health professional, on their own using mHealth (stroke risk calculator application), or at communal gatherings (decreasing order). About 70% specifically wished to learn about their stroke risk via an mHealth application. CONCLUSIONS: Community dwelling Nigerians wanted to know their immediate risk of stroke using digital platforms, such as a mobile phone stroke risk calculator application. Clinical trials are needed to assess the effectiveness of such a strategy for primary prevention of stroke in sub-Saharan African communities.


Assuntos
Acidente Vascular Cerebral , Telemedicina , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adolescente , Masculino , Estudos Transversais , Nigéria/epidemiologia , Medição de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle
6.
Eur J Neurol ; 30(8): 2141-2143, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37163274

RESUMO

Stroke, dementia and ischemic heart disease are a triple threat which combined are the leading causes of death and disability globally. Fortunately, the three diseases share similar risk factors along the vascular cascade which can be targeted for primordial and primary prevention. In Norway, during 1990-2019, the age-standardised incidence rates decreased significantly for dementia by -5.4%, ischemic heart disease by -30.0%, and stroke by -35.3%. This was possible because Norway ensured equitable income for her citizens, and committed sufficient funds to universal health coverage while implementing a semi-decentralized and responsive health system with robust primary health care. This included monitoring the burden of the triple threat and their cardinal risk factors; ensuring primordial, primary and secondary preventive interventions; implementing acute care for ischemic heart disease and stroke; and ensuring interdisciplinary rehabilitation and chronic care for the triple threat. Overall, all countries will need to develop national strategies for combating the triple threat within the context of sustainable development goals with adequate allocation and utilization of resources.


Assuntos
Demência , Isquemia Miocárdica , Acidente Vascular Cerebral , Feminino , Humanos , Carga Global da Doença , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Encéfalo , Demência/epidemiologia , Demência/terapia
7.
Nat Rev Neurol ; 19(6): 371-383, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37208496

RESUMO

The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.


Assuntos
Encéfalo , Saúde Global , Cooperação Internacional , Doenças do Sistema Nervoso , Neurologia , Humanos , Pesquisa Biomédica , Política Ambiental , Saúde Global/tendências , Objetivos , Saúde Holística , Saúde Mental , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/prevenção & controle , Doenças do Sistema Nervoso/reabilitação , Doenças do Sistema Nervoso/terapia , Neurologia/métodos , Neurologia/tendências , Espiritualismo , Participação dos Interessados , Desenvolvimento Sustentável , Organização Mundial da Saúde
8.
Stroke ; 53(3): 680-688, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35105185

RESUMO

Stroke exerts a tremendous burden on individuals, families, communities, and health systems globally. Even more troublesome are the striking disparities faced across diverse populations. These disparities are further exacerbated by the COVID-19 pandemic. Despite efforts to advance stroke research, substantial gaps remain in understanding factors that contribute to stroke disparities, including the Social Determinants of Health. Strategically designed studies and tailored interventions are needed to bridge the inequities high-risk populations face and to meet their specific needs. Community-based participatory research offers an approach to equitably partner with community members to understand and work collaboratively to address community-specific health priorities. In this focused update, we highlight the main processes of community-based participatory research studies and share exemplars from our team's work in stroke research and from the literature. As we continue to face an increasing prevalence of stroke, compounded by the COVID-19 pandemic and ongoing implications of the Social Determinants of Health, partnering with communities to address community-driven health priorities can inform interventions targeted to overcome the disparities faced by certain populations.


Assuntos
COVID-19/epidemiologia , Pesquisa Participativa Baseada na Comunidade , Disparidades nos Níveis de Saúde , Pandemias , Saúde Pública , SARS-CoV-2 , Acidente Vascular Cerebral/epidemiologia , COVID-19/prevenção & controle , Humanos
9.
Lancet Public Health ; 7(1): e74-e85, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34756176

RESUMO

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course.


Assuntos
Acidente Vascular Cerebral/prevenção & controle , Custos e Análise de Custo , Países em Desenvolvimento , Saúde Global , Política de Saúde , Humanos , Acidente Vascular Cerebral/economia
10.
J Stroke Cerebrovasc Dis ; 30(10): 106003, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34332227

RESUMO

BACKGROUND: Stroke risk can be quantified using risk factors whose effect sizes vary by geography and race. No stroke risk assessment tool exists to estimate aggregate stroke risk for indigenous African. OBJECTIVES: To develop Afrocentric risk-scoring models for stroke occurrence. MATERIALS AND METHODS: We evaluated 3533 radiologically confirmed West African stroke cases paired 1:1 with age-, and sex-matched stroke-free controls in the SIREN study. The 7,066 subjects were randomly split into a training and testing set at the ratio of 85:15. Conditional logistic regression models were constructed by including 17 putative factors linked to stroke occurrence using the training set. Significant risk factors were assigned constant and standardized statistical weights based on regression coefficients (ß) to develop an additive risk scoring system on a scale of 0-100%. Using the testing set, Receiver Operating Characteristics (ROC) curves were constructed to obtain a total score to serve as cut-off to discriminate between cases and controls. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at this cut-off. RESULTS: For stroke occurrence, we identified 15 traditional vascular factors. Cohen's kappa for validity was maximal at a total risk score of 56% using both statistical weighting approaches to risk quantification and in both datasets. The risk score had a predictive accuracy of 76% (95%CI: 74-79%), sensitivity of 80.3%, specificity of 63.0%, PPV of 68.5% and NPV of 76.2% in the test dataset. For ischemic strokes, 12 risk factors had predictive accuracy of 78% (95%CI: 74-81%). For hemorrhagic strokes, 7 factors had a predictive accuracy of 79% (95%CI: 73-84%). CONCLUSIONS: The SIREN models quantify aggregate stroke risk in indigenous West Africans with good accuracy. Prospective studies are needed to validate this instrument for stroke prevention.


Assuntos
População Negra , Técnicas de Apoio para a Decisão , Acidente Vascular Cerebral Hemorrágico/etnologia , AVC Isquêmico/etnologia , Fatores Etários , Estudos de Casos e Controles , Comorbidade , Feminino , Gana/epidemiologia , Acidente Vascular Cerebral Hemorrágico/diagnóstico por imagem , Humanos , AVC Isquêmico/diagnóstico por imagem , Estilo de Vida/etnologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Valor Preditivo dos Testes , Fatores Raciais , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Determinantes Sociais da Saúde , Fatores Socioeconômicos
11.
J Am Coll Cardiol ; 76(25): 2982-3021, 2020 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-33309175

RESUMO

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.


Assuntos
Doenças Cardiovasculares/mortalidade , Efeitos Psicossociais da Doença , Carga Global da Doença , Saúde Global , Saúde Global/estatística & dados numéricos , Saúde Global/tendências , Política de Saúde , Fatores de Risco de Doenças Cardíacas , Humanos , Saúde Pública
13.
Lancet Neurol ; 19(3): 255-265, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31813850

RESUMO

Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. In the past 30 years, the absolute numbers of deaths and people with disabilities owing to neurological diseases have risen substantially, particularly in low-income and middle-income countries, and further increases are expected globally as a result of population growth and ageing. This rise in absolute numbers of people affected suggests that advances in prevention and management of major neurological disorders are not sufficiently effective to counter global demographic changes. Urgent measures to reduce this burden are therefore needed. Because resources for health care and research are already overstretched, priorities need to be set to guide policy makers, governments, and funding organisations to develop and implement action plans for prevention, health care, and research to tackle the growing challenge of neurological disorders.


Assuntos
Carga Global da Doença/economia , Doenças do Sistema Nervoso/economia , Doenças do Sistema Nervoso/epidemiologia , Feminino , Carga Global da Doença/tendências , Saúde Global , Humanos , Expectativa de Vida , Masculino , Doenças do Sistema Nervoso/mortalidade , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Fatores Socioeconômicos
14.
BMJ Open ; 9(11): e031144, 2019 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727655

RESUMO

INTRODUCTION: Worldwide, 2 million patients aged 18-50 years suffer a stroke each year, and this number is increasing. Knowledge about global distribution of risk factors and aetiologies, and information about prognosis and optimal secondary prevention in young stroke patients are limited. This limits evidence-based treatment and hampers the provision of appropriate information regarding the causes of stroke, risk factors and prognosis of young stroke patients. METHODS AND ANALYSIS: The Global Outcome Assessment Life-long after stroke in young adults (GOAL) initiative aims to perform a global individual patient data meta-analysis with existing data from young stroke cohorts worldwide. All patients aged 18-50 years with ischaemic stroke or intracerebral haemorrhage will be included. Outcomes will be the distribution of stroke aetiology and (vascular) risk factors, functional outcome after stroke, risk of recurrent vascular events and death and finally the use of secondary prevention. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and climate of residence. ETHICS AND DISSEMINATION: Ethical approval for the GOAL study has already been obtained from the Medical Review Ethics Committee region Arnhem-Nijmegen. Additionally and when necessary, approval will also be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of worldwide differences in risk factors, causes and outcome of young stroke patients.


Assuntos
Isquemia Encefálica/epidemiologia , Hemorragia Cerebral/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Isquemia Encefálica/mortalidade , Isquemia Encefálica/fisiopatologia , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/fisiopatologia , Clima , Etnicidade , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Estações do Ano , Prevenção Secundária , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Adulto Jovem
16.
J Neurol Sci ; 400: 194-198, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-30991160

RESUMO

Stroke is a leading cause of global morbidity and mortality. Sub-Saharan Africa (SSA), where an unprecedented rise in stroke burden is currently raging, has the highest age-standardized stroke incidence, stroke prevalence, and stroke mortality rates. This is in sharp contrast to the relative decline in stroke incidence in high-income countries over the past four decades through better awareness and control of vascular risk factors. Compared to other groups, Africans tend to have a higher risk of stroke, higher percentage of the hemorrhagic type and much poorer outcomes. Indeed, stroke levies a heavy toll on the developing SSA economy by affecting a relatively younger age group. In this commentary, we examine the disproportionately high burden of stroke in the setting of grossly inadequate resources and evidence-based interventions. We propose an annual pan-regional stroke conference (starting in 2020) to harness global resources and local talent with the goal of galvanizing action to tackle this escalating burden. We anticipate that a successful conference series could become a rallying point for the eventual establishment of an African Stroke Organization.


Assuntos
Congressos como Assunto/tendências , Efeitos Psicossociais da Doença , Acidente Vascular Cerebral/epidemiologia , África Subsaariana/epidemiologia , Pesquisa Biomédica/tendências , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
17.
PLoS One ; 14(4): e0214454, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30958868

RESUMO

INTRODUCTION: Understanding context and how this can be systematically assessed and incorporated is crucial to successful implementation. We describe how context has been assessed (including exploration or evaluation) in Global Alliance for Chronic Diseases (GACD) implementation research projects focused on improving health in people with or at risk of chronic disease and how contextual lessons were incorporated into the intervention or the implementation process. METHODS: Using a web-based semi-structured questionnaire, we conducted a cross-sectional survey to collect quantitative and qualitative data across GACD projects (n = 20) focusing on hypertension, diabetes and lung diseases. The use of context-specific data from project planning to evaluation was analyzed using mixed methods and a multi-layered context framework across five levels; 1) individual and family, 2) community, 3) healthcare setting, 4) local or district level, and 5) state or national level. RESULTS: Project teams used both qualitative and mixed methods to assess multiple levels of context (avg. = 4). Methodological approaches to assess context were identified as formal and informal assessments, engagement of stakeholders, use of locally adapted resources and materials, and use of diverse data sources. Contextual lessons were incorporated directly into the intervention by informing or adapting the intervention, improving intervention participation or improving communication with participants/stakeholders. Provision of services, equipment or information, continuous engagement with stakeholders, feedback for personnel to address gaps, and promoting institutionalization were themes identified to describe how contextual lessons are incorporated into the implementation process. CONCLUSIONS: Context is regarded as critical and influenced the design and implementation of the GACD funded chronic disease interventions. There are different approaches to assess and incorporate context as demonstrated by this study and further research is required to systematically evaluate contextual approaches in terms of how they contribute to effectiveness or implementation outcomes.


Assuntos
Doença Crônica/terapia , Doenças não Transmissíveis/terapia , Projetos de Pesquisa , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Atenção à Saúde , Diabetes Mellitus/terapia , Feminino , Geografia , Promoção da Saúde/métodos , Humanos , Hipertensão/terapia , Cooperação Internacional , Internet , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Pobreza , Pesquisa Qualitativa , Participação dos Interessados , Resultado do Tratamento
19.
Diabetes Care ; 41(5): 1097-1105, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29678866

RESUMO

OBJECTIVE: The extent to which diabetes (DM) practice guidelines, often based on evidence from high-income countries (HIC), can be implemented to improve outcomes in low- and middle-income countries (LMIC) is a critical challenge. We carried out a systematic review to compare type 2 DM guidelines in individual LMIC versus HIC over the past decade to identify aspects that could be improved to facilitate implementation. RESEARCH DESIGN AND METHODS: Eligible guidelines were sought from online databases and websites of diabetes associations and ministries of health. Type 2 DM guidelines published between 2006 and 2016 with accessible full publications were included. Each of the 54 eligible guidelines was assessed for compliance with the Institute of Medicine (IOM) standards, coverage of the cardiovascular quadrangle (epidemiologic surveillance, prevention, acute care, and rehabilitation), translatability, and its target audiences. RESULTS: Most LMIC guidelines were inadequate in terms of applicability, clarity, and dissemination plan as well as socioeconomic and ethical-legal contextualization. LMIC guidelines targeted mainly health care providers, with only a few including patients (7%), payers (11%), and policy makers (18%) as their target audiences. Compared with HIC guidelines, the spectrum of DM clinical care addressed by LMIC guidelines was narrow. Most guidelines from the LMIC complied with less than half of the IOM standards, with 12% of the LMIC guidelines satisfying at least four IOM criteria as opposed to 60% of the HIC guidelines (P < 0.001). CONCLUSIONS: A new approach to the contextualization, content development, and delivery of LMIC guidelines is needed to improve outcomes.


Assuntos
Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Diabetes Mellitus/terapia , Fidelidade a Diretrizes/economia , Fidelidade a Diretrizes/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Pessoal de Saúde/economia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Renda , Guias de Prática Clínica como Assunto/normas
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