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Preparing the university community to respond to 21st century global public health needs
Kishore, Sandeep; Siegel, Karen R; Kelly, Bridget; Vedanthan, Rajesh; Ali, Mohammed K; Koplan, Jeffrey; Narayan, K M Venkat; Fuster, Valentin
PMID: 25691043
ISSN: 2211-8160
CID: 3240402
Trans-Disciplinary Education and Training for NCD Prevention and Control
Siegel, Karen R; Kishore, Sandeep P; Huffman, Mark D; Aitsi-Selmi, Amina; Baker, Phillip; Bitton, Asaf; Mwatsama, Modi; Ding, Eric L; Feigl, Andrea B; Khandelwal, Shweta; Rapkin, Nikka; Seligman, Benjamin; Vedanthan, Rajesh
PMID: 25691044
ISSN: 2211-8160
CID: 3240412
Social Gradient of Cardiovascular Risk Factors in Poland: Baseline Profile of the Polish Norwegian Study (PONS) [Meeting Abstract]
Manczuk, Marta; Vedanthan, Rajesh; Vatten, Lars; Polewczyk, Anna; Boffetta, Paolo; Zatonski, Witold
ISI:000299738704345
ISSN: 0009-7322
CID: 3239672
Global cardiovascular health: urgent need for an intersectoral approach
Fuster, Valentin; Kelly, Bridget B; Vedanthan, Rajesh
Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with more than 80% of CVD deaths occurring in low- and middle-income countries (LMICs). There have been several calls for action to address the global burden of CVD, but there remains insufficient investment in and implementation of CVD prevention and disease management efforts in LMICs. To catalyze the action needed to control global CVD, the Institute of Medicine recently produced a report, Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. This paper presents a commentary of the Institute of Medicine's report, focusing specifically on the intersectoral nature of intervention approaches required to promote global cardiovascular health. We describe 3 primary domains of intervention to control global CVD: 1) policy approaches; 2) health communication programs; and 3) healthcare delivery interventions. We argue that the intersectoral nature of global CVD interventions should ideally occur at 2 levels: first, all 3 domains of intervention must be activated and engaged simultaneously, rather than only 1 domain at a time; and second, within each domain, a synergistic combination of interventions must be implemented. A diversity of public and private sector actors, representing multiple sectors such as health, agriculture, urban planning, transportation, finance, broadcasting, education, and the food and pharmaceutical industries, will be required to collaborate for policies, programs, and interventions to be optimally aligned. Improved control of global CVD is eminently possible but requires an intersectoral approach involving a diversity of actors and stakeholders.
PMID: 21903051
ISSN: 1558-3597
CID: 3239792
Promoting global cardiovascular health ensuring access to essential cardiovascular medicines in low- and middle-income countries
Kishore, Sandeep P; Vedanthan, Rajesh; Fuster, Valentin
On May 13, 2010, a resolution passed at the United Nations for a high-level meeting with heads of state on noncommunicable chronic diseases (NCDs), catapulting NCDs atop the political and health agendas. This meeting on NCDs, slated for September 2011, provides the rare political moment to commit to scaling up international, regional, and national efforts to prevent and treat NCDs, giving the issue the priority it deserves. An analogous high-profile meeting transpired in 2001 on human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), effectively serving as the nucleating event for a vigorous global and political movement towards universal prevention and treatment. As was the case at the HIV/AIDS meeting, a key priority area in the new NCD movement remains ensuring universal access to reliable, affordable essential medicines to prevent and treat NCDs. The upcoming meeting, therefore, provides the perfect opportunity to capitalize on the increased political and social awareness of NCDs and to apply the lessons learned from the HIV/antiretroviral experience in order to improve access to essential medicines for NCDs. Social mobilization and political advocacy, used in tandem with technical solutions, is an important lesson from the HIV experience, and will likely be important to ensure access to essential medicines for NCDs, including cardiovascular disease. Here, we use cardiovascular disease as a specific case study to examine the issue, outlining early solutions while drawing parallels and analogies to the HIV experience.
PMID: 21565635
ISSN: 1558-3597
CID: 3239772
Global health delivery and implementation research: a new frontier for global health
Vedanthan, Rajesh
PMID: 21598257
ISSN: 1931-7581
CID: 3239782
Promoting global cardiovascular health: moving forward
Fuster, Valentin; Kelly, Bridget B; Vedanthan, Rajesh
PMID: 21502585
ISSN: 1524-4539
CID: 3239762
Urgent need for human resources to promote global cardiovascular health
Vedanthan, Rajesh; Fuster, Valentin
The World Health Organization estimates the existence of a global shortage of over 4 million health-care workers. Given the growing global burden of cardiovascular disease (CVD), the shortfall in global human resources for health (HRH) is probably even greater than predicted. A critical challenge going forward is to determine how to integrate CVD-related human resource needs into the overall global HRH agenda. We describe the CVD implications of core HRH objectives, including coverage, motivation, and competence, in addition to issues such as health-care worker migration and the need for input from multiple stakeholders to successfully address the current problems. We emphasize gaps in knowledge regarding HRH for global CVD-related care and research opportunities. In light of the current global epidemiologic transition from communicable to noncommunicable diseases, now is the time for the global health community to focus on CVD-related human resource needs.
PMID: 21045785
ISSN: 1759-5010
CID: 3239752
Validation of high-risk ecg features in acute drug overdose [Meeting Abstract]
Manini A.F.; Hoffman R.S.; Stimmel B.; Vedanthan R.; Vlahov D.
Background: In a previous study we derived high-risk ECG features associated with adverse cardiovascular events (ACVEs) in emergency department (ED) patients with acute drug overdose. Objectives: We aimed to externally validate that ischemia, non- sinus rhythm, and ectopy are associated with ACVE in this population. Methods: This prospective cohort study evaluated consecutive ED patients with acute drug overdose over 5 months at two urban teaching hospitals uninvolved in the original derivation cohort. Data included demographics, history, vital signs, and elements of the initial ECG (rhythm, intervals, ischemia, infarction), interpreted by a masked cardiologist. ECG evidence of ischemia and infarction were defined according to AHA criteria. In-hospital ACVE was defined by composite outcome: shock (vasopressors), myocardial injury (troponin I > 0.09ng/mL), severe dysrhythmia (VT/VF), or cardiac arrest (loss of pulse). Results: of 238 initially screened, 81 were excluded (30 age <18, 41 no ECG, 2 alternate diagnosis, 8 insufficient data), leaving 157 for analysis (48% female, mean age 40.8, 14% prior coronary disease). Most common drug classes ingested were acetamino- phen-containing (24%), sympathomimetics (20%), and opioids (19%). Included patients had mean pulse=84/minute (range 32-156), mean QRS=90 msec (range 68-174), mean QTc=433 msec (range 296-704), while 17% had ischemia, 9% infarction, and 4% ectopy. In-hospital ACVE occurred in 11 patients (7%), of whom 18% had prior coronary disease (p=NS). There were 9 myocardial injury, 3 shock, 2 dysrhythmia, and 3 cardiac arrests. Ischemia (OR 15.2, p<0.001), non-sinus rhythm (OR 8.6, p<0.01), and ectopy (OR 7.4, p<0.05) were highly associated with ACVE, while QRS, QTc, and infarction were not significantly predictive. Conclusion: This study validates the predictive utility of high- risk ECG features for ED patients with acute drug overdose. A screening ECG may be an important tool to evaluate in-hospital prognosis for acute drug overdose
EMBASE:70473627
ISSN: 1069-6563
CID: 135607
A cross-sectional study of cardiovascular disease and associated factors
Islami, Farhad; Mańczuk, Marta; Vedanthan, Rajesh; Vatten, Lars; Polewczyk, Anna; Fuster, Valentin; Boffetta, Paolo; Zatoński, Witold A
OBJECTIVE:Cardiovascular diseases (CVD) are a major cause of mortality and morbidity in Poland. Data on risk factors of CVD in this country are limited. The presented study investigated risk factors of self-reported CVD within the Polish- Norwegian Study (PONS). METHODS:PONS is an ongoing prospective study in Poland. The data used was provided by 3,853 participants, aged 45-64, during baseline interviews. RESULTS:Prevalence of chronic diseases among participants was as follows: hypertension, 38.4%; diabetes, 5.9%; and CVD, 11.0%. There was no association between CVD and gender and place of residence. CVD was associated with ever-smoking (OR= 1.25; 95% CI: 1.00-1.55), whereas there was an inverse association with alcohol drinking in the year preceding enrolment in the study (OR= 0.50; 95% CI: 0.39-0.63). CVD was associated with body mass index (BMI), as well as with measures of abdominal adiposity, in the following order: waist to height ratio>waist circumference>waist to hip ratio; however, none of these measures showed a stronger association with CVD than BMI. Both hypertension (OR= 1.33; 95% CI: 1.05-1.68) and diabetes (OR= 1.33; 95% CI: 1.05-1.68) were associated with CVD in adjusted models. CONCLUSIONS:This study shows the association between several risk factors and prevalence of self-reported CVD and provides information about distribution of those factors among an adult population in Poland. The results of the ongoing PONS study in a prospective setting will provide more accurate risk estimates for the observed associations, as well as risk estimates for other risk factors of CVD, including dietary factors, and attributable risks for various factors.
PMID: 22216792
ISSN: 1898-2263
CID: 3240332