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Applicant is also to provide description and timeline for key activities for entire project period cheap 100mg lasix visa blood pressure keeps rising. Evaluation Plan Provide an evaluation plan to assess project performance and progress order lasix 100mg visa blood pressure medication dry cough. The appendices should include materials that show evidence of the applicant’s ability to successfully conduct the proposed project and other evidence deemed necessary to support the contents of the proposal discount lasix 40 mg visa pulse pressure def. Applicants should include an example of a previous data collection instrument for cancer screening order lasix 100mg line arteria definicion. Availability of Funds It is anticipated that approximately $250,000 is available to fund 1 Prevention Research Center for a 1-year project period. The award for the recipient is expected to be approximately $250,000 for year one. Funding may vary and is subject to change Research Status It is expected that this project will be non-exempt research. Applicants should provide a federal-wide assurance number for each performance site included in the project. Barriers to colorectal cancer screening in community health centers: a qualitative study. Identifying barriers to colonoscopy screening for nonadherent african american participants in a patient navigation intervention. Updated Reviews and Findings added to The Community Guide: Increasing breast, cervical, & colorectal cancer screening. An assessment of patient navigator activities in breast cancer patient navigation programs using a nine-principle framework. Younger women are generally diagnosed with breast cancers that are more aggressive, harder to treat, and may metastasize [10-12]. The outcomes from this project are: 1) Economic cost data that could help decision makers better allocate public health resources (e. Collaboration/Partnerships • Describe and provide evidence of sufficient institutional and other necessary support for carrying out this project, including identification of key staff. For each staff, describe and provide evidence of their knowledge, skills, experience, and ability in planning and conducting similar research that is described in this proposal. Recruitment Plan This project will not involve recruitment of new research participants. Evaluation Plan /Performance measurement Provide detailed evaluation plan to assess project performance and progress, including a detailed timeline for completing the proposed activities within the 24-month project period. The plan should also include potential manuscripts to be published from this project. In addition, the outcomes from this project could be used to generate new economic knowledge that will promote the optimal design of cancer control strategies to improve the quality of a woman’s life if her breast cancer progresses to a metastatic stage. Funding Preferences None Research Plan Length and Supporting Material The Research Strategy Section of the Research Plan is limited to a maximum of 12 pages. The appendices should include materials that show evidence of the applicant’s ability to successfully conduct the proposed project and other evidence deemed necessary to support the contents of the proposal. Availability of Funds It is anticipated that approximately $500,000 is available to fund 1 (one) Prevention Research Center for a 2-year project period. The award for the recipient is expected to be approximately $350,000 for year one and $150,000 in year two. Research Status It is expected that this project will be exempt research; the project will involve analysis of previously collected treatment and cost data without identifiers. Treatment costs of breast cancer among younger women aged 19 to 44 years enrolled in Medicaid. Productivity costs associated with breast cancer among survivors aged 18–44 years. Breast cancer diagnosis in women < or = 40 versus 50 to 60 years: increasing size and stage disparity compared with older women over time. Living with metastatic breast cancer: A qualitative analysis of physical, psychological, and social sequelae. Incidence of breast cancer with distant involvement among women in the United States, 1976 to 2009. Medical costs and productivity losses of cancer survivors - United States, 2008–2011. Silent voices: Women with advanced (metastatic) breast cancer share their needs and preferences. Older Women With Breast Cancer: Slow Progress, Great Opportunity, Now Is the Time. These concerns, coupled with provider and parent attitudes and behaviors related to confidential care, could limit adolescent access to currently available services. Project Objectives/Outcomes The purpose of this project is to better understand provision of confidential sexual health services by pediatricians and family medicine providers to female and male adolescents 11-17 years of age. Specifically, the project will describe perspectives from three key populations—adolescents, providers, and parents. For each study population--parents, providers, and adolescents--indicate the specific research questions to be addressed and method(s) of data collection (quantitative and/or qualitative). It is likely that both quantitative and qualitative data collection components with providers will be used. Please justify the selection of data collection methods based on the proposed research questions. Provide details on each data collection component, including sampling and recruitment plans, target sample size with justification, survey modes (e. Target populations Describe and provide evidence of access to clinic-based populations, including each of the following: • Pediatric and family medicine providers • Female and male adolescents 11-17 years of age • Parents of female and male adolescents 11-17 years of age It is anticipated that sample sizes will vary depending on the proposed data collection methods. For example, a quantitative data collection component would likely occur with a relatively large sample (e. Similarly, it is expected that a qualitative component could be conducted with a sufficient sample (e. Collaboration/Partnerships 50 of 57 Collaboration/Partnerships Describe and provide evidence of collaboration/partnerships with organizations that will facilitate recruitment of providers, adolescents, and parents, including national professional organizations or other organizations/networks able to reach a diverse sample of pediatric and family practice providers and clinics that will yield diverse samples for each of the three target populations. Recruitment Plan Describe plans to recruit research participants as part of the study design and methods section. Recruitment plans for each data collection component should be addressed and ensure guardian consent is discussed when conducting research with minors (e. For each person, describe their demonstrated knowledge and experience relevant to the proposed study. Applicant is also to provide description and timeline for key activities for entire project period. Evaluation Plan/Performance measurement Provide an evaluation plan to assess project performance and progress. Dissemination and Translation plans Describe a plan for disseminating the results of this project to relevant stakeholders, including researchers, providers, parents and adolescents. Increasing receipt of preventive services, including behavioral counseling, can reduce risk behavior and improve sexual and reproductive health outcomes.
At least twenty six states currently have ships and other incentives to recruit providers smoke-free laws that cover all these locations cheap 100mg lasix overnight delivery blood pressure chart 2015. Promote health and wellness programs at • Develop state employee and citizen wellness schools purchase lasix 100mg overnight delivery blood pressure medication used for headaches, worksites cheap 40 mg lasix overnight delivery pulse pressure 22, health care and programs statewide buy 100mg lasix with visa hypertension causes and treatment. Initiatives address a wide range of preventable health insurance coverage, they fnd that racial risks for chronic conditions such as cancer, heart minorities generally live with more diseases, die disease and type 2 diabetes. These include well- sooner than whites and suffer more with many ness programs that encourage tobacco-free living, chronic diseases. Nearly half of African Americans healthy eating and availability of nutritious food are obese, compared to 40 percent of Hispan- and promote active lifestyles and development of 28 ics and 34 percent of whites. In ad- 7 Chronic Disease Prevention and Management dition, African-American and non-Hispanic white • Include community health workers as part of American men are more likely die from heart team-based health care to better serve diverse disease than any other group. For example, poverty limits access to health public about health and prevention of insurance, health care and resources to manage chronic disease health. The communities in which people live af- Research shows that, when patients are actively in- fect whether they have access to fresh, healthy food volved in managing their own health and engaged and safe areas where they can be physically active. Community health centers and medical homes incorporate chronic disease self-management • Expand access to health care services through skills in the services they provide. State health departments can collaborate regardless of their insurance status, without copay- with other stakeholders to develop a compre- ments, prior authorization or eligibility restric- hensive approach to developing policies for tions. In both 2010 and 2011, the state State Program Examples legislature called for full implementation of the de- A few states are incorporating many of the policy livery system in every willing primary care practice options mentioned in this report into comprehen- by 2013. As an incentive for participation, Blue- sive systems to prevent and manage chronic condi- print provides enhanced per-member per-month tions, improve care and reduce costs. Participating providers also receive the sup- Vermont Blueprint for Health port and assistance of community health teams. Vermont Blueprint for Heath aims to improve In addition, Blueprint offers guidance, support health and control costs by delivering comprehen- and advice to medical practices that are making sive, well-coordinated care statewide. As of in 2003 by then-Governor James Douglas, the December 2012, 106 primary care practices were public-private partnership offers an innovative engaging in patient-centered medical home activi- delivery system based on a foundation of patient- ties and were serving more than 420,000 people. Nearly one-third broad areas: transitioning providers to the patient- of primary care providers who work in recognized centered medical home model, improving individ- medical homes are mid-level providers, such as ual self-management of chronic conditions, devel- nurse practitioners, advanced practice registered oping health information systems and improving nurses and physician assistants. Three years ther expanded the available workforce by formally after its inception, Blueprint was codifed by the recognizing naturopathic physicians as primary General Assembly as part of Act 191. Blueprint also is de- primary care and community-based services, con- veloping a statewide health information exchange necting patients to medical, social and economic and helping providers achieve meaningful use of support. Theams consist of a variety of professionals mont Blueprint for Health, patients with chronic and effectively expand the capacity of primary care conditions are seeing providers more frequently. Services are available support community health teams provide, which to all primary care practices that are recognized allows them to address both clinical and nonclini- or certifed as patient-centered medical homes cal patient needs. The model minimizes 9 Chronic Disease Prevention and Management found the model also signifcantly decreased hospi- As of May 2011, 14 community care networks tal admissions, emergency department visits and consisting of more than 5,000 providers covered related costs. One enhanced medical home model of care for Medic- recent study estimated that Community Care of aid benefciaries, aimed at improving quality and North Carolina saved the state nearly $1 billion 37 between 2007 and 2011. Case as a medical home for people with severe mental managers, such as social workers, nurses or other health conditions. They with severe mental illness are two to three times work with physicians to coordinate care, provide more likely to have a chronic medical condition, disease management education, and collect and it is ftting to provide services that focus on the report data as part of continuous quality improve- “whole person” at a location where those with ment efforts. Data on performance are collected, com- ditional training to providers on chronic diseases pared to regional and national benchmarks, and and use of data and analytic tools. Initially, more than 15,000 high-cost Med- tion also recently announced new funding to help icaid benefciaries with a serious mental illness, eight states in the Delta region—parts of Alabama, mental health condition, substance abuse disorder, Arkansas, Illinois, Kentucky, Louisiana, Missis- or one of the above and a chronic condition were sippi, Missouri and Thennessee—address specifc enrolled. Still in its initial phases, this initiative chronic conditions that disproportionately affect has been used by the state to expand the number that area of the country. Data are not yet available on how this As some of the most common, costly and prevent- model will affect hospitalization rates and emer- able health problems, chronic diseases and condi- gency department visits. Not only do they affect the lives of millions of Ameri- Federal Action cans, they result in lost productivity, missed school Through the Affordable Care Act and other initia- and work days, and high health care costs. Many tives, the federal government is working to prevent states are developing policies, programs and initia- and manage chronic conditions. Ross DeVol and Armen Bedroussian, An Unhealthy America: the Economic Burden of Chronic 1. Centers for Disease Control and Prevention, The Disease, Charting a New Course to Save Lives and In- Power of Prevention: Chronic Disease…The Public Health crease Productivity and Economic Growth (Santa Monica, Challenge of the 21st Century (Atlanta, Ga. Brian Ward and Jeannine Schiller, “Prevalence Prevalence and Access to Care in Uninsured U. National Association of Community Health 2010,” Preventing Chronic Disease 10 (April 2013). Gerard Anderson, Chronic Care: Making the Information/By-Topics/Long-Therm-Services-and-Sup- Case for Ongoing Care (Princeton, N. Census Bureau, eases see four or more doctors each year, and nearly half Population Projections: 2012 National Population Projec- report taking four or more medications. An Examination of forming chronic disease management and care transi- the Relationships Between Patient Activation and tions,” Primary Care 39 no. Thomas Bodenheimer, Ellen Chen, and Heath- Treatment Demonstration for Ethnic and Racial Minori- er D. Health Care Workforce Human Services, Centers for Medicare and Medicaid Do the Job? By 2020, the Health Resources and Services stration-Projects/DemoProjectsEvalRpts/downloads/ Administration anticipates there will be more than 1. Nell Brownstein, Talley Andrews, Hilary and surgeons, and hundreds of thousands more for Wall, and Qaiser Mukhtar, Addressing Chronic Dis- other primary care providers. Amy Winterfeld, “The New Healthy,” State Blueprint for Medical Homes, Community Health Legislatures (National Conference of State Legislatures) Theams, and Better Health at Lower Cost,” Health Af- 38, no. Department of Vermont Health Access, Ver- and Cynthia Ogden, “Prevalence of Obesity and Trends mont Blueprint for Health: 2012 Annual Report (Wil- in the Distribution of Body Mass Index Among U. Community Care of North Carolina website, Health Risks and Safety Risks to Children, Coordinated www. National Center for Health Statistics, Health, sion of Medical Assistance, (San Diego, Calif. Depart- Effects on Healthcare Expenditures,” Psychiatric Annals ment of Health and Human Services, 2012), www. Department of Health and Hu- Mental Health, Missouri Community Mental Health man Services, 2013), www. Phlebotomine sandflies transmit pathogens that affect humans and animals worldwide. We review the roles of phlebotomines in the spreading of leishmaniases, sandfly fever, summer meningitis, vesicular stomatitis, Chandipura virus encephalitis and Carrion’s´ disease. Among over 800 species of sandfly recorded, 98 are proven or suspected vectors of human leishmaniases; these include 42 Phlebotomus species in the Old World and 56 Lutzomyia species in the New World (all: Diptera: Psychodidae). Based on incrimination criteria, we provide an updated list of proven or suspected vector species by endemic country where data are available. Increases in sandfly diffusion and density resulting from increases in breeding sites and blood sources, and the interruption of vector control activities contribute to the spreading of leishmaniasis in the settings of human migration, deforestation, urbanization and conflict.
However order 40 mg lasix with amex arteria frontalis-, standards of acceptable and unacceptable professionalism must be set and implemented in the interests of the quality and integrity of medical education and training in general and the relevant programme and its graduates in particular 40mg lasix with visa prehypertension lower blood pressure. But the primary aim of exclusion is the protection and well-being of patients proven lasix 40 mg arrhythmia ventricular tachycardia, peers purchase 40mg lasix visa pulse pressure range elderly, staff and the public. The Council’s quality assurance and enhancement activity is undertaken under the provisions of the Act, an act “for the [purpose of better protecting…the public …. Approved bodies have an obligation to support the approving body – Council – in the fulflment of this key part of its remit. Action plan drawn up Relevant individuals consider the student’s Plan developed specifying expected Student referred following unsuccessful measurable outcomes, expected timescale potential professional defcits informal advice and support (Section 11 of Guidelines) (Section 11 of Guidelines) 6. However, when students do not (because they will not or cannot) demonstrate professionalism, they should not be allowed to graduate with a medical degree even if they demonstrate satisfactory academic outcomes. However, the career aspirations of an individual cannot be allowed to outweigh the interests of patients. The Council’s statutory duty to better ensure the education and training of medical practitioners is specifcally linked to the protection of the public; it is “for that purpose”. The conferral of a medical degree is a de facto assurance from the medical school to the Medical Council that the graduate has demonstrated to the required level the competencies required to be a doctor. If a student has been advised, supported and remediated in line with the Guidelines contained in this document, yet continues to display major defcits in professionalism, or if they commit a gross breach of professionalism, it is not appropriate for them to be conferred with a medical degree which enables them to register and practise. Developing and maintaining high standards through education, training, and professional competence plays a key role in protecting the public. This is particularly important in an environment of rapidly changing scientifc knowledge, high patient expectations and increasingly sophisticated health care delivery systems. Patients and the public rely on education and training to produce the high quality doctors that they need and deserve. The responsibility to ensure these high standards of medical education and training is a shared one: The Medical Council as the regulator has the statutory authority to set standards and monitor their delivery, and to make the accreditation decisions appropriate to its fndings Medical schools as the deliverers have a duty to ensure that professionalism is fostered and embedded, and that defcits in professional behaviour are appropriately dealt with Doctors – irrespective of whether they have formal teaching commitments or not- have a duty to encourage students to achieve their potential and to provide role models that can be admired and emulated Managers of clinical sites have a responsibility to facilitate the education and training of medical students Last but not least, students themselves have a responsibility to be active participants in their own professional development and to be professional. Criminality (caution or conviction) f) Controlled drug offences (including cultivation or manufacture, possession for sale or supply, possession) g) Criminal damage h) Public order offences i) Road and traffc offences a) Inappropriate examinations of patients b) Other breach of apprpriate boundaries in patient interaction c) Poor communication skills, including rudeness or lack of respect 2. Professional defcit in attitudes d) Breaching patient confdentiality or behaviour towards patients e) Deceiving patients about their care or treatment f) Deceiving a patient about one’s student status, including the inappropriate provision of medical advice a) Verbal abuse b) Intimidation c) Bullying d) Persistent harassment (including sexual 3. Abuse, aggression, threat of harassment) violence, use of violence e) Assault f) Incitement to violence (all irrespective of whether legal proceedings are involved) 42 Medical Council A Foundation For The Future Areas of concern Indicative examples a) Poor communication skills b) Persistent rudeness or lack of respect 4. Poor interaction (including c) Disruption of teaching and learning with other students, staff members, the public, and the d) Persistent failure to work as a member of a clinical team) clinical team or other group or team e) Unfair or unlawful discrimination on the grounds of gender, race or other factors a) Persistent poor attendance b) Cheating in examinations, logbooks or portfolios or other assignments (including plagiarism) c) Passing off others’ work as one’s own 5. Academic professional defcit d) Forging a teacher’s or supervisor’s signature on assessments e) Falsifying research undertaken or research results a) Financial fraud b) Producing fraudulent documentation c) Misrepresentation of academic attainments or 6. Other dishonesty or fraud qualifcations d) Misrepresentation of medical student status in the clinical environment 43 Medical Council A Foundation For The Future Areas of concern Indicative examples a) Misuse of controlled drugs or substances (including cultivation or manufacture, possession for sale or supply, possessing or misusing illegal drugs) b) Alchohol or substance consumption impacting on the health of patients, the student, or those 7. Alcohol or substance misuse working in the academic or clinical environment c) Driving under the infuence of alcohol or drugs (all irrespective of whether legal proceedings are involved) Use of information technology to support potentially unprofessional activity in oneself or others including: a) Criminal activity 8. Professional defcit in use b) Substance abuse of information technology (including the internet and c) Threatening, abusive, rude or lewd behaviour social media) d) Falsifcation and dishonesty e) Breaches of patient confdentiality or dignity a) Not declaring health or disability issue b) Demonstrable lack of insight into health concerns and their potential impact 9. Poor management of one’s own c) Failure to seek necessary medical treatment or health other support d) Refusal to follow medical advice or care plan in relation to maintaining/regaining ftness to proceed 44 Medical Council A Foundation For The Future Documents referenced 1. Guidelines for Medical Schools on Ethical Standards and Behaviour Appropriate for Medical Students. Guide to Professional Conduct and Ethics for Registered Medical Practitioners (7th Edition). Talking about Good Professional Practice: views on what it means to be a good doctor. Procedures + Calcs Vasopressors: a quick reference for use of common vasopressor agents. This helps you stratify your patient with Acute Decompensated Heart Failure and tailor therapy based on where in Quick Links the disease spectrum they are. Step 3 Thorough Eval for Other Causes of Exacerbation • Drugs Intensive Care Topics Patients to consider double coverage (Clinicians should be • Arrhythmias (Afib) selective in application! For patients receiving > 5 days of vancomycin Mechanical Ventilation should have least one steady-state trough concentration obtained. Frequent monitoring (more than single trough concentration before 4th Procedures + Calcs dose) for < 5 days or for lower intensity dosing (target trough vancomycin concentration < 15 mcg/mL) is not recommended. For hemodynamically unstable patients when goal trough concentration is 15 - 20 mcg/mL, more frequent than once weekly vancomycin trough concentration is recommended. Hypoglycemia), stroke, structural, trauma, neoplastic, iatrogenic, delirium tremens Labs: accucheck; clin chem. Your secondary concern, once you initiate efforts to improve hemodynamics, is to find out where the volume has been lost. Third spacing fluid loss can occur, but acute anemia of blood loss should always be assessed for. Obtain Hgb levels, evaluate the patient for possible Gi bleed or intra-abdominal bleeding. What do you think might happen to you if you decide to accept (or not accept) the recommended Home tx? What do we, as your medical team, think might happen if you decide to accept (or not accept) the recommended tx? What are the alternatives available and what are the consequences of accepting each? Document that the pt has decision-making capacity for the following reasons: Mechanical Ventilation * Pt understand his present medical condition and the tx that is being recommended. Review chart for other med/family issues In the Room: Explain the purpose of the pronouncement to family. Ask if family wishes to be present, Also, ask if family would like the chaplain to be present Home Address any questions from family. Note no breathing or lung sounds or heart beat/pulse Vasopressors **when to call coroner: if pt was in hospital <24hrs, death w/ unusual circumstances, or if death was assoc w/ trauma regardless of cause of death** Orders to be done. Additional patient initiated breaths are not vent supported, but the patient must overcome resistance of vent circuit during spontaneous breaths. A partial vent support sometimes used to evaluate for weaning • Continuous positive airway pressure: patient breathes spontaneously while vent maintains constant airway pressure Home Volume targeted vs. Pressure targeted • Volume-targeted: vent delivers a set tidal volume, pressure depends on airway resistance and compliance. Inspiratory time: Normal I:E ratio is ~1:2, but can be controlled on ventilator, use for management of obstructive diseases 4. Inspiratory flow rates: usually 60, increased inspiratory flow rates achieve set volume or pressure in a shorter amount of time, and decrease inspiratory time and allowing for a longer expiratory time before next breath. Plateau pressure: pressure at end of inspiration when flow has ceased, dependent on compliance. Intensive Care Topics A Airway resistance® check endotracheal tube; is it obstructed or too small?
Second generic lasix 40mg on line blood pressure medication given during pregnancy, model incidence and duration from estimates of prevalence buy generic lasix 100 mg on line heart attack lyrics, because the various epidemiological variables are causally remission 40 mg lasix free shipping heart attack remix, case fatality rates buy cheap lasix 40mg on-line arteria umbilical unica, and background mortality. For most disease and injury groups, rele- of different epidemiological estimates and ensure that the vant experts were consulted during the development and estimates used were internally consistent. For certain condi- developed with a number of additional features (Barendregt tions for which weights were not available from the original and others 2003). As well as calculating solutions when the three calculations quantify societal preferences for different health states. These weights do not represent the lived experience of any disability or health state or imply any societal value of the person in a disability or health state. Thus, for example, Population m Deaths from without disease All other other causes disability weights of 0. It rate i rate r m also means that, on average, a person who lives three years Cases of Cause-specific with paraplegia followed by death is considered to experi- deaths disease Case fatality ence more equivalent healthy years than a person who rate f has one year of good health followed by death (3 years Source: Barendregt and others 2003. In other words, for most and sex were then added for all countries in each region to conditions the combination of incidence, case fatality, and provide regional estimates for 2001. The effect of discounting compli- specificratesformortality,incidence,andprevalencefor2000 cates this, however, with low incidence and long duration and 2002 and applying them to population data for 2001. These included the relative risk of mortality for those with diabetes com- pared with those without diabetes (Roglic and others 2005), • Disease registers. Disease registers record new cases of dis- and the assumption that remission rates are zero. For some causes, the only counts available were of calculations than self-reported interview surveys. In particular, longitudinal stud- there is huge variability in the information content across ies of the natural history of a disease have provided a studies or data sets, and that small epidemiological studies wealth of information about incidence, average duration, are counted equally in table 3. That said, it is striking that of the more than 8,000 data • Health facility data. Furthermore, one-quarter of the system is virtually total, facilities-based data will be data sets relate to populations in Sub-Saharan Africa and based on biased samples that do not reflect the preva- around one-fifth to populations in high-income countries. Likewise, hospital deaths are unlikely to be use- tions and to Sub-Saharan Africa is not entirely surprising, ful because of the same problems of selection bias. Noncommunicable diseases Malignant neoplasms Incidence 11 8 11 10 2 14 25 81 Survival 3 4 1 0 1 0 15 24 (Continues on the following page. Injuries 3 1 1 0 0 6 7 18 Totall 1,155 914 1,239 590 522 1,955 1,735 8,096 Source: Authors’ compilation. Note: The data sources include population-based epidemiological studies, disease registers, and surveillance and notification systems, but exclude death registration data (see tables 3. Where possible, regional and global totals refer to numbers of separate studies, or country-years of reported data from surveillance or notification systems. Global totals may include global review studies not counted in regional subtotals. Totals refer to numbers of countries for which data were available, not to total data sets or country-years. Country-years of surveillance reports (approximate, minimum estimate for Latin America and the Caribbean). Actual numbers of studies used exceed the minimums shown here, based on summed table entries for specific causes regardless of whether counts were of data sets or of countries. Because different countries may be in has drawn on more than 10,000 data sets or studies, making different phases of the epidemic, the relationship between it almost certainly the largest synthesis and analysis of global prevalence and mortality may vary across countries. To estimate the incidence of diarrheal diseases in children under five in developing and developed Communicable Diseases and Maternal, Perinatal, countries, 357 community-based studies and population and Nutritional Conditions surveys were used (Bern 2004; Murray and Lopez 1996d). This section gives an overview of data sources and methods Point prevalences were estimated assuming an average dura- for specific Group I causes and references to more detailed tion of six days per episode. The The methods used to estimate incidence for childhood-cluster methods and data used to estimate incidence and mortality diseases were summarized earlier. Country-specific estimates of duration were weighted for the proportion of Hepatitis B and C. Malaria prevalence was based on regional preva- of syphilis, chlamydia, and gonorrhea. The methodology is lence rates for acute symptomatic episodes estimated by described in detail elsewhere (Gerbase and others 1998; Murray and Lopez (1996d). Regional incidence and prevalence rates for lep- mate country-specific prevalence rates. The baseline regional and subregional preva- ered to be endemic in these countries. Prevalence studies in the Middle East and North Africa and Sub-Saharan estimates were based on regional prevalence rates for cases Africa. As the prevalence of blinding trachoma declines with of hydrocele or lymphodaema caused by infection with socioeconomic development even in the absence of a specif- filariae. For this rea- son, both nationally reported data and specific criteria for a Onchocerciasis. Following the continued were then applied to countries that have reported cases of success of the Onchocerciasis Control Program in western blinding trachoma (Shibuya and Mathers 2003). African countries and the introduction of population-wide administration of ivermectin in other endemic areas, the Intestinal Nematode Infections. Therefore, the prevalence of community-based, cross-sectional surveys for subnational blindness from onchocerciasis was reestimated by taking administrative regions (Brooker and others 2000; de Silva into account the declining trends in prevalence and the cov- and others 2003). In areas without comprehensive data, pre- erage and duration of onchocerciasis control programs dictions of the distribution of soil-transmitted helminths (Alley and others 2001). However, prevalence studies of Chan and others (Bundy and others 2004; Chan 1997). Prevalence and incidence the estimated prevalence may not be generalizable to the estimates for lower respiratory infections were based on an country as a whole. For this reason, the current prevalence analysis of published data on the incidence of clinical pneu- of blindness due to onchocerciasis was estimated by monia from 95 community-based studies published since nationally reported data, if available, and extrapolation 1961 (Rudan and others 2004). Most of the studies were lon- from 1993 estimates using trend analysis of onchocerciasis gitudinal and conducted over long enough periods to control programs in each endemic country (Shibuya and account for seasonal variation. The database compiles information for all popula- tion of deliveries occurring in hospitals (Dolea and tion groups, especially preschool-age children and women AbouZahr 2003a, 2003b; Dolea, AbouZahr, and Stein 2003; of childbearing age, and includes information on the preva- Dolea and Stein 2003). The incidence of unsafe induced lence of xerophthalmia, including night blindness and abortion was estimated at the country level using 156 pub- serum retinol distributions. Incidence rates for low birthweight, prevalence rates for mild, moderate, and severe anemia. The program is currently preparing registration systems in high-income countries and from a comprehensive database of country-specific prevalence mothers participating in nationally representative household estimates of both clinical and subclinical iron deficiency surveys (such as the U. For countries for which no studies were available,the regional Protein-Energy Malnutrition. Regional survival models were epidemiological characteristics were used (Stein 2002c). Country- country (Mathers, Shibuya, and others 2002; Shibuya and specificestimatesforgoiterrateswereobtainedandusedtocal- others 2002).
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