J Natl Med Assoc
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The annual heart failure (HF) mortality rate in Africa is 34% according to the INTERHF study. This is twice the world average of 16.5% and 3.7 times that of South America, 9%. We review evidence-based explanations for the Hyper-mortality of HF, by comparison of North American, Caribbean, Afro-Brazilian with Sub-Saharan African (SSA) nations profiles, and suggest amelioration. 1 year HF mortality rates in SSA ranged from 29% to 58%, and intra-hospital mortality rate from 8 to 26% (n = 8). ⋯ There was sub-optimal use of guideline directed medical therapy (GDMT) and intracardiac device (ICD) unavailability. Gross Domestic Product -per purchasing power parity (GDP-PPP), which is low in SSA, was inversely correlated both to higher intra-hospital mortality rate % (r = -0.73, r 2 = 0.54 p = 0.038) and higher 1 year HF mortality rate % (r = -0.62, r 2 = 0.38, = 0.098). Localized primary prevention, early detection and prompt treatment of hypertension, diabetes, rheumatic fever, early cardiac valve repair and use of cardiovascular polypill, optimal use of GDMT, national health insurance scheme are advocated to stem the dismal mortality and cost burden of HF.
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Transparency about the costs that patients incur is an increasingly important factor in making decisions throughout the course of diagnosis and treatment. Both patients and providers regard honest, informed discussions about these costs as critical to providing person-centered care, but often encounter a range of barriers to initiating and maintaining these conversations. ⋯ This article reports the results of this work with recommendations for providers about how to incorporate cost of care discussions into the normal clinical work flow and patient life flow.
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Hypertension is responsible for about 12.8% of deaths around the world. Immigrants' risk of developing hypertension increases with length of residency. There is limited work on the role of social determinants of health and blood pressure control in immigrants. We created a theory-based conceptual model for immigrant-specific and general social determinants variables and their relationship to blood pressure. ⋯ One latent variable measuring need was significantly associated with BP in an immigrant sample. This suggests that interventions targeting burden of disease are likely to be effective in controlling blood pressure in immigrants.
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In this report, we used a qualitative descriptive design to explore young African American adults' intergenerationally influenced strategies to experienced racial discrimination. ⋯ Since intergenerationally influenced strategies are likely potential sources of strength and resilience for young African Americans, knowledge of these strategies might be useful to health care practitioners seeking to improve the mental health care of this population.