Towards a common definition of global health Koplan, Jeffrey P, Prof; Bond, T Christopher, PhD; Merson, Michael H, Prof ...
The Lancet (British edition),
06/2009, Letnik:
373, Številka:
9679
Journal Article
Recenzirano
Odprti dostop
A steady evolution of philosophy, attitude, and practice has led to the increased use of the term global health. ... on the basis of this analysis, we offer the following definition: global health is ...an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide.
Background Data from an immunocompromised subpopulation in which both vaccine recipients and nonrecipients have frequent opportunities for vaccination can help determine the associations between ...vaccination against seasonal influenza and pneumococcal disease and all-cause mortality. Study Design We surveyed dialysis centers and performed a retrospective analysis of health status at dialysis therapy initiation, vaccination for influenza and pneumococcal disease, laboratory results, and mortality associated with the 2005-2006 influenza season for patients in 3 End-Stage Renal Disease Networks across the United States. Setting & Participants Of 1,033 dialysis facilities considered, 903 centers with a total patient population of 54,734 reported vaccination data. Analysis was limited to 36,966 patients on dialysis treatment for at least 1 year as of December 31, 2005. Predictor Vaccination status. Outcomes OR for all-cause mortality (vaccinated vs unvaccinated patients). Results The estimated adjusted OR for mortality was significantly less than 1.0 for patient who received either vaccination and was lower for patients who had received both vaccinations than for those who had received either. Survival analysis confirmed these findings. Limitations Possible misclassification due to self-report of vaccination for some patients. Lack of vaccination date. Conclusions Vaccination against influenza and pneumococcal disease is associated with improved survival in dialysis patients. The 2 vaccinations have independent effects on mortality.
Background Patients with end-stage renal disease (ESRD) are at high risk of complications from influenza, but many dialysis centers report <50% influenza immunization coverage. Study Design A ...group-randomized evaluation of a multicomponent intervention to increase influenza vaccination rates in poorly performing dialysis centers in ESRD Networks 6, 11, and 15. Setting & Participants Facilities with the lowest immunization percentages in 2006-2007 were selected from each network and randomly assigned to a standard (n = 39) or intensive intervention (n = 38). Intervention Standard intervention included a feedback report with comparison to other centers in their network and educational materials for staff and patients. Intensive-intervention centers also received 3 educational seminars, assistance with and review of center-specific action plans, and monthly monitoring of vaccination plan and rates. Outcomes Change in vaccination rate in following year. Measurements Dialysis center records of patient vaccination status. Results There was an 8.9% ( P = 0.04) adjusted mean absolute difference in improvement between intensive- and standard-intervention centers. Limitations Some vaccinations were self-reported by patients. The vaccination data form does not have an option for patient data unavailable, which may have caused patients without data to be coded as unvaccinated. Conclusions Multicomponent interventions may serve as a successful strategy to increase influenza vaccination rates at poorly performing centers, with a benefit beyond that provided by usual oversight and support.
Background Patients with end-stage renal disease are at increased risk of morbidity and mortality because of infection. Quality improvement efforts for this patient population include assessment of ...institutional policies and practices that may increase vaccination rates for influenza, hepatitis B, and pneumococcal disease. Study Design A survey of vaccination practices, beliefs, and attitudes was sent to all dialysis centers in End-Stage Renal Disease Networks 6, 11, and 15. Setting & Participants Of 1,052 dialysis facilities considered, 683 returned the survey, reported vaccination rates for 2005 to 2006, and had 20 or more patients. Predictor or Factor Standing-order policy of the dialysis facility, categorized as facility-wide orders, preprinted admission orders for each patient (chart orders), physician-specific orders, and individual orders. Outcomes Vaccination rates for influenza, hepatitis B (full or partial series), hepatitis B, and pneumococcal vaccine. Measurements Patient vaccination, given at or outside the center. Results Overall vaccination rates were 76% ± 18% (SD) for influenza, 73% ± 22% for hepatitis B full or partial series, 62% ± 25% for hepatitis B full series, and 44% ± 34% for pneumococcal vaccine. Compared with individual orders, facility-wide standing orders and chart orders were not associated with greater vaccination rates for influenza (0.4%; confidence interval, −4 to 5; and 1.27%; confidence interval, −3 to 5, respectively), but were associated with greater vaccination rates for hepatitis B full or partial series (9%; confidence interval, 3 to 15; and 11%; confidence interval, 5 to 17, respectively), hepatitis B full series (11%; confidence interval, 4 to 17; and 13%; confidence interval, 7 to 19, respectively), and pneumococcal disease (21%; confidence interval, 14 to 29; and 20%; confidence interval, 13 to 27, respectively). Limitations Data are cross-sectional, and vaccinations outside the center were self-reported. Conclusions Existing facility-wide or chart-based order programs may be effective in promoting vaccination against hepatitis B and pneumococcal disease.
Abstract Erectile dysfunction (ED) has high impact on quality of life in prostatectomy, diabetic and aging patients. An underlying mechanism is cavernous nerve (CN) injury, which causes ED in up to ...80% of prostatectomy patients. We examine how sonic hedgehog (SHH) treatment with innovative peptide amphiphile nanofiber hydrogels (PA), promotes CN regeneration after injury. SHH and its receptors patched (PTCH1) and smoothened (SMO) are localized in PG neurons and glia. SMO undergoes anterograde transport to signal to down stream targets. With crush injury, PG neurons degenerate and undergo apoptosis. SHH protein decreases, SMO localization changes to the neuronal cell surface, and anterograde transport stops. With SHH treatment SHH is taken up at the injury site and undergoes retrograde transport to PG neurons, allowing SMO transport to occur, and neurons remain intact. SHH treatment prevents neuronal degeneration, maintains neuronal, glial and down stream target signaling, and is significant as a regenerative therapy. Summary Sentence: Sonic hedgehog delivered by peptide amphiphile nanofiber hydrogel maintains normal signaling between pelvic ganglia neurons and glia after cavernous nerve crush, preventing neuronal degeneration and apoptosis, and erectile dysfunction.
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