Displaying publications 1 - 20 of 227 in total

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  1. van der Eng P, Sohn K
    Econ Hum Biol, 2019 08;34:216-224.
    PMID: 30551996 DOI: 10.1016/j.ehb.2018.11.004
    This article analyses long-term changes in the mean age at menarche (MAM) as a biological indicator of changes in the standard of living in Indonesia. It finds that MAM was about 15.5 for birth cohorts in the late-19th century, decreasing to 14.5 by the 1930s, at which level it stagnated until the gradual decrease resumed since the early 1960s to around 12.5 in the mid-2000s. The article considers that long-term improvements in nutrition, educational attainment and health care explain these trends. An international comparison of long-term changes finds that MAM in Indonesia was much lower than in Korea and China until respectively 1970 and 1990, but comparable to Japan until 1950 and to Malaysia until 1930. The article presents reasons why these differences are unlikely to be related to dissimilarities in climate and ethnicity, and concludes that they are indicative of relative standards of living.
    Matched MeSH terms: Health Services Accessibility/statistics & numerical data
  2. van Prooije T, Ibrahim NM, Azmin S, van de Warrenburg B
    Parkinsonism Relat Disord, 2021 11;92:112-118.
    PMID: 34711523 DOI: 10.1016/j.parkreldis.2021.10.023
    This paper reviews and summarizes three main aspects of spinocerebellar ataxias (SCA) in the Asian population. First, epidemiological studies were comprehensively reviewed. Overall, the most common subtypes include SCA1, SCA2, SCA3, and SCA6, but there are large differences in the relative prevalence of these and other SCA subtypes between Asian countries. Some subtypes such as SCA12 and SCA31 are rather specific to certain Asian populations. Second, we summarized distinctive phenotypic manifestations of SCA patients of Asian origin, for example a frequent co-occurrence of parkinsonism in some SCA subtypes. Lastly, we have conducted an exploratory survey study to map SCA-specific expertise, resources, and management in various Asian countries. This showed large differences in accessibility, genetic testing facilities, and treatment options between lower and higher income Asian countries. Currently, many Asian SCA patients remain without a final genetic diagnosis. Lack of prevalence data on SCA, lack of patient registries, and insufficient access to genetic testing facilities hamper a wider understanding of these diseases in several (particularly lower income) Asian countries.
    Matched MeSH terms: Health Services Accessibility/trends
  3. Zun AB, Ibrahim MI, Hamid AA
    Oman Med J, 2018 Sep;33(5):416-422.
    PMID: 30210721 DOI: 10.5001/omj.2018.76
    Objectives: Implemented in 2010, 1 Malaysia Clinic (1MC) is the latest innovation in public primary healthcare services in Malaysia to serve the urban population. This study aimed to assess the level of satisfaction and its associated factors using the SERVQUAL (SERV-service, QUAL-quality) instrument. We also sought to compare the difference of mean score between expectation and perception of SERVQUAL dimension among patients attending 1MC in Kota Bharu district, Malaysia.

    Methods: This cross-sectional study included all nine 1MCs in the Kota Bharu district, Malaysia, and used the validated SERVQUAL questionnaire from Ministry of Health, Malaysia. The primary data was collected in January 2017. The sample size was proportionate to the average daily patient attendance for each clinic, and a simple random sampling method was applied to reduced selection bias. Satisfaction level was determined by the mean gap score of expectation and perception of the SERVQUAL dimension.

    Results: A total of 386 patients were involved in this study (184 male and 202 female). Most were from the low socioeconomic group. Less than half of the patients were satisfied with the clinic services. The tangible dimension (service quality (SQ) gap: -0.25) was the most critical dimension among all five SQ dimensions assessed. The factors included low education level (adjusted odds ratio (adj. OR) 1.87; 95% confidence interval (CI): 1.06, 2.67; p = 0.024), monthly household income less than RM 3000 (adj. OR 2.97; 95% CI: 1.72, 5.51; p < 0.001), and frequency 3 3 visits (adj. OR 2.23; 95% CI: 1.44, 3.45; p < 0.001) had significant association with high level of satisfaction.

    Conclusion: 1MC has achieved its objective to increase the accessibility of health services among the low-income population in urban settings. However, most patients were not satisfied with certain parts of the services. Thus, proper evaluation of the service gap is required for improvement of the service.
    Matched MeSH terms: Health Services Accessibility
  4. Zahari N, Mat Bah MN, A Razak H, Thong MK
    Eur J Pediatr, 2019 Aug;178(8):1267-1274.
    PMID: 31222391 DOI: 10.1007/s00431-019-03403-x
    Limited data are available on the survival of patients with Down syndrome and congenital heart disease (CHD) from middle-income countries. This retrospective cohort study was performed to determine the trends in the prevalence and survival of such patients born from January 2006 to December 2015 in Malaysia. Among 754 patients with Down syndrome, 414 (55%) had CHD, and no significant trend was observed during the 10 years. Of these 414 patients, 30% had lesions that closed spontaneously, 35% underwent surgery/intervention, 9% died before surgery/intervention, and 10% were treated with comfort care. The overall mortality rate was 23%, the median age at death was 7.6 months, and no significant changes occurred over time. The early and late post-surgery/intervention mortality rates were 0.7% and 9.0%, respectively. Most deaths were of non-cardiac causes. The overall 1-, 5-, and 10-year survival rates were 85.5%, 74.6%, and 72.9%, respectively. Patients with severe lesions, persistent pulmonary hypertension of the newborn, atrioventricular septal defect, and pulmonary hypertension had low survival at 1 year of age.Conclusion: The prevalence of CHD in patients with Down syndrome is similar between Malaysia and high-income countries. The lower survival rate is attributed to limited expertise and resources which limit timely surgery. What is Known: • The survival of patients with Down syndrome with congenital heart disease (CHD) has improved in high-income countries. However, little is known about the survival of patients with Down syndrome with CHD from middle-income countries. • In the Caucasian population, atrioventricular septal defect is the most common type of CHD associated with Down syndrome. What is New: • In middle-income countries, the prevalence of CHD is the same as in high-income countries, but with a lower survival rate. • In the Asian population, ventricular septal defect is the most common type of CHD in patients with Down syndrome.
    Matched MeSH terms: Health Services Accessibility
  5. Yusof K, Neoh KH, bin Hashim MA, Ibrahim I
    Asia Pac J Public Health, 2002;14(1):29-34.
    PMID: 12597515
    The equitable access to quality healthcare by Malaysians has consistently been the primary objective of the Ministry of Health (MOH). The epidemiological transition to chronic illnesses, advances in medical technology, escalating healthcare costs and rising patient expectations has necessitated the strategic use of information systems in healthcare delivery. Malaysia has broken new ground by implementing a nationwide network to address inadequate access to healthcare, as well as to lower costs and achieve better health outcomes. Teleconsultation refers to the electronic transmission of medical information and services from one site to another using telecommunication technologies. This technology transforms the healthcare system by rapidly matching patient needs with the appropriate level of care however geographically remote they may be. Our findings suggest that even in these early stages of implementation, teleconsultation has led to cost savings, a more efficient allocation of resources, enhanced diagnostic options and better health outcomes.
    Matched MeSH terms: Health Services Accessibility
  6. Yunus RM, Azme N, Chen XW, Badlishah-Sham SF, Miptah HN, Azraai AM
    J Glob Health, 2021 Jan 30;11:03024.
    PMID: 33692879 DOI: 10.7189/jogh.11.03024
    Matched MeSH terms: Health Services Accessibility
  7. Yunus NA, Russell G, Muhamad R, Sturgiss EA
    BMJ Open, 2023 Nov 21;13(11):e071087.
    PMID: 37989390 DOI: 10.1136/bmjopen-2022-071087
    OBJECTIVE: To explore patients' experiences accessing healthcare for obesity and their perceived behaviour changes following the care.

    DESIGN: Using a descriptive qualitative research approach informed by Levesque's framework of access to healthcare, we conducted phone interviews in the Malaysian language, which were audio-recorded and transcribed verbatim. Data were analysed inductively using a reflexive thematic analysis approach.

    SETTING: Primary care clinics in five states in Peninsular Malaysia.

    PARTICIPANTS: Adult patients with obesity receiving face-to-face care for obesity from healthcare providers in Peninsular Malaysia.

    RESULTS: We interviewed 22 participants aged 24-62, with the majority being female (77%), Malay (95%), married (73%) and with tertiary education (82%). Most participants attended obesity management services at public primary care clinics. We identified five themes: (1) moving from perceiving the need to seeking obesity care is a non-linear process for patients, (2) providers' words can inspire patients to change, (3) patients' needs and preferences are not adequately addressed in current obesity care, (4) over-focusing on weight by patients and healthcare providers can lead to self-blame and loss of hope for patients and (5) obesity healthcare can have consequences beyond weight loss.

    CONCLUSION: Patients lack the self-regulatory skills to continue their lifestyle changes and struggle with self-blame and hopelessness. Over-focusing on weight by patients and obesity healthcare increase patients' self-stigmatisation. While provider-initiated weight discussions and engaging and personalised consultation provide the initial step towards weight management, obesity healthcare could be enhanced by behavioural support and patient education on the complexity of obesity. Further considerations could be given to shifting from a weight-centric to a more holistic health-centred approach in obesity healthcare.

    Matched MeSH terms: Health Services Accessibility*
  8. Yu CP, Whynes DK, Sach TH
    Health Policy, 2011 May;100(2-3):256-63.
    PMID: 21129808 DOI: 10.1016/j.healthpol.2010.10.018
    This paper assesses the potential equity impact of Malaysia's projected reform of its current tax financed system towards National Health Insurance (NHI).
    Matched MeSH terms: Health Services Accessibility*
  9. Yip CH, Samiei M, Cazap E, Rosenblatt E, Datta NR, Camacho R, et al.
    Asian Pac J Cancer Prev, 2012;13(4 Suppl):23-36.
    PMID: 22631594
    Survival following a diagnosis of cancer is contingent upon an interplay of factors, some non-modifiable (e.g., age, sex, genetics) and some modifiable (e.g., volitional choices) but the majority determined by circumstance (personal, social, health system context and capacity, and health policy). Accordingly, mortality and survival rates vary considerably as a function of geography, opportunity, wealth and development. Quality of life is impacted similarly, such that aspects of care related to coordination and integration of care across primary, community and specialist environments; symptom control, palliative and end-of-life care for those who will die of cancer; and survivorship challenges for those who will survive cancer, differs greatly across low, middle and high-income resource settings. Session 3 of the 4th International Cancer Control Congress (ICCC-4) focused on cancer care and treatment through three plenary presentations and five interactive workshop discussions: 1) establishing, implementing, operating and sustaining the capacity for quality cancer care; 2) the role of primary, community, and specialist care in cancer care and treatment; 3) the economics of affordable and sustainable cancer care; 4) issues around symptom control, support, and palliative/end-of-life care; and 5) issues around survivorship. A number of recommendations were proposed relating to capacity-building (standards and guidelines, protocols, new technologies and training and deployment) for safe, appropriate evidence-informed care; mapping and analysis of variations in primary, community and specialist care across countries with identification of models for effective, integrated clinical practice; the importance of considering the introduction, or expansion, of evidence-supported clinical practices from the perspectives of health economic impact, the value for health resources expended, and sustainability; capacity-building for palliative, end-of-life care and symptom control and integration of these services into national cancer control plans; the need for public education to reduce the fear and stigma associated with cancer so that patients are better able to make informed decisions regarding follow-up care and treatment; and the need to recognize the challenges and needs of survivors, their increasing number, the necessity to integrate survivorship into cancer control plans and the economic and societal value of functional survival after cancer. Discussions highlighted that coordinated care and treatment for cancer patients is both a ' systems'challenge and solution, requiring the consideration of patient and family circumstances, societal values and priorities, the functioning of the health system (access, capacity, resources, etc.) and the importance assigned to health and illness management within public policy.
    Matched MeSH terms: Health Services Accessibility
  10. Yip CH, Cazap E, Anderson BO, Bright KL, Caleffi M, Cardoso F, et al.
    Breast, 2011 Apr;20 Suppl 2:S12-9.
    PMID: 21388811 DOI: 10.1016/j.breast.2011.02.015
    In middle resource countries (MRCs), cancer control programs are becoming a priority as the pattern of disease shifts from infectious diseases to non-communicable diseases such as breast cancer, the most common cancer among women in MRCs. The Middle Resource Scenarios Working Group of the BHGI 2010 Global Summit met to identify common issues and obstacles to breast cancer detection, diagnosis and treatment in MRCs. They concluded that breast cancer early detection programs continue to be important, should include clinical breast examination (CBE) with or without mammography, and should be coupled with active awareness programs. Mammographic screening is usually opportunistic and early detection programs are often hampered by logistical and financial problems, as well as socio-cultural barriers, despite improved public educational efforts. Although multidisciplinary services for treatment are available, geographical and economic limitations to these services can lead to an inequity in health care access. Without adequate health insurance coverage, limited personal finances can be a significant barrier to care for many patients. Despite the improved availability of services (surgery, pathology, radiology and radiotherapy), quality assurance programs remain a challenge. Better access to anticancer drugs is needed to improve outcomes, as are rehabilitation programs for survivors. Focused and sustained government health care financing in MRCs is needed to improve early detection and treatment of breast cancer.
    Matched MeSH terms: Health Services Accessibility
  11. Yang CH, Li XY, Lv JJ, Hou MJ, Zhang RH, Guo H, et al.
    JMIR Public Health Surveill, 2024 Mar 14;10:e55327.
    PMID: 38483459 DOI: 10.2196/55327
    BACKGROUND: Asthma has become one of the most common chronic conditions worldwide, especially among children. Recent findings show that the prevalence of childhood asthma has increased by 12.6% over the past 30 years, with >262 million people currently affected globally. The reasons for the growing asthma epidemic remain complex and multifactorial.

    OBJECTIVE: This study aims to provide an up-to-date analysis of the changing global and regional asthma prevalence, mortality, disability, and risk factors among children aged <20 years by leveraging the latest data from the Global Burden of Disease Study 2019. Findings from this study can help inform priority areas for intervention to alleviate the rising burden of childhood asthma globally.

    METHODS: The study used data from the Global Burden of Disease Study 2019, concentrating on children aged 0 to 14 years with asthma. We conducted an in-depth analysis of asthma, including its age-standardized prevalence, incidence, mortality, and disability-adjusted life years (DALYs), across diverse demographics, such as region, age, sex, and sociodemographic index, spanning 1990 to 2019. We also projected the future burden of the disease.

    RESULTS: Overall, in the Western Pacific Region, the age-standardized prevalence rate of asthma among children increased slightly, from 3898.4 cases per 100,000 people in 1990 to 3924 per 100,000 in 2019. The age-standardized incidence rate of asthma also increased slightly, from 979.2 to 994.9 per 100,000. In contrast, the age-standardized death rate of asthma decreased from 0.9 to 0.4 per 100,000 and the age-standardized DALY rate decreased from 234.9 to 189.7 per 100,000. At the country level, Japan experienced a considerable decrease in the age-standardized prevalence rate of asthma among children, from 6669.1 per 100,000 in 1990 to 5071.5 per 100,000 in 2019. Regarding DALYs, Japan exhibited a notable reduction, from 300.6 to 207.6 per 100,000. Malaysia also experienced a DALY rate reduction, from 188.4 to 163.3 per 100,000 between 1990 and 2019. We project that the burden of disease in countries other than Japan and the Philippines will remain relatively stable up to 2045.

    CONCLUSIONS: The study indicates an increase in the prevalence and incidence of pediatric asthma, coupled with a decrease in mortality and DALYs in the Western Pacific Region between 1990 and 2019. These intricate phenomena appear to result from a combination of lifestyle shifts, environmental influences, and barriers to health care access. The findings highlight that nations such as Japan have achieved notable success in managing asthma. Overall, the study identified areas of improvement in view of persistent disease burden, underscoring the need for comprehensive collaborative efforts to mitigate the impact of pediatric asthma throughout the region.

    Matched MeSH terms: Health Services Accessibility
  12. Yadav H, Lin WY
    Asia Pac J Public Health, 2001;13 Suppl:S36-8.
    PMID: 12109246
    Telemedicine is fast becoming popular in many countries in the world. It has several advantages such as being cost saving and providing better access to health care in the remote areas in many parts of the world. However, it has some disadvantages as well. One of the major problems is the problem of patients' rights and confidentiality in the use of telemedicine. There are no standard guidelines and procedures in the practice of telemedicine as yet. Both the patient and the physician are unsure of the standard of practice and how to maintain confidentiality. The patient is uncertain as to how to protect her/his rights in the use of telemedicine. The issue of litigation is also unclear as to where the physician is practicing when he/she uses telemedicine. Is she/he practicing in the country where the patient is or is the physician practicing in the country of her/his origin? These issues need to be addressed urgently so that telemedicine will have standards of ethical practice and the patient's rights and confidentiality will be protected.
    Matched MeSH terms: Health Services Accessibility
  13. Woodward M
    Asian Pac J Cancer Prev, 2014;15(19):8521-6.
    PMID: 25339057
    In many countries of the Association of Southeast Asian Nations (ASEAN), cancer is an increasing problem due to ageing and a transition to Western lifestyles. Governments have been slow to react to the health consequences of these socioeconomic changes, leading to the risk of a cancer epidemic overwhelming the region. A major limitation to motivating change is the paucity of high-quality data on cancer, and its socioeconomic repercussions, in ASEAN. Two initiatives have been launched to address these issues. First, a study of over 9000 new cancer patients in ASEAN - the ACTION study - which records information on financial difficulties, as well as clinical outcomes, subsequent to the diagnosis. Second, a series of roundtable meetings of key stakeholders and experts, with the broad aim of producing advice for governments in ASEAN to take appropriate account of issues relating to cancer, as well as to generate knowledge and interest through engagement with the media. An important product of these roundtables has been the Jakarta Call to Action on Cancer Control. The growth and ageing of populations is a global challenge for cancer services. In the less developed parts of Asia, and elsewhere, these problems are compounded by the epidemiological transition to Western lifestyles and lack of awareness of cancer at the government level. For many years, health services in less developed countries have concentrated on infectious diseases and mother-and-child health; despite a recent wake-up call (United Nations, 2010), these health services have so far failed to allow for the huge increase in cancer cases to come. It has been estimated that, in Asia, the number of new cancer cases per year will grow from 6.1 million in 2008 to 10.6 million in 2030 (Sankaranarayanan et al., 2014). In the countries of the Association of Southeast Asian Nations (ASEAN), corresponding figures are 770 thousand in 2012 (Figure 1), rising to 1.3 million in 2030 (Ferlay et al., 2012). ASEAN consists of Brunei Darussalam, Cambodia, Indonesia, Lao, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Viet Nam. It, thus, includes low- and middle-income countries where the double whammy of infectious and chronic diseases will pose an enormous challenge in allocating limited resources to competing health issues. Cancer statistics, even at the sub-national level, only tell part of the story. Many individuals who contract cancer in poor countries have no medical insurance and no, or limited, expectation of public assistance. Whilst any person who has a family member with cancer can expect to bear some consequential burden of care or expense, in a poor family in a poor environment the burden will surely be greater. This additional burden from cancer is rarely considered, and even more rarely quantified, even in developed nations.
    Matched MeSH terms: Health Services Accessibility*
  14. Woo YL, Omar SZ
    Best Pract Res Clin Obstet Gynaecol, 2011 Oct;25(5):597-603.
    PMID: 21684811 DOI: 10.1016/j.bpobgyn.2011.05.004
    Human papillomavirus has been established as the causal agent for cervical cancer. The identification of a clear cause presents an unparalleled opportunity for cancer control. As such, the development of prophylactic human papillomavirus vaccines has been rightly hailed as one of the significant scientific triumphs of the past 20 years. This story of scientific triumph over disease, however, is not yet complete. The fruit of scientific labour must be delivered to the people in order to fulfil the underlying intent of the research (i.e. to prevent cancer and save lives). The success of a vaccination programme, however, does not depend on the biological efficacy of the vaccine alone. Various other local factors, such as poverty, gender inequality, cultural traditions, or religious beliefs, can significantly constrain the success of any vaccination programme. In this chapter, we provide an overview of how the human papillomavirus vaccine works and its global uptake, as well as, how variations in local contexts can affect the successful implementation of a vaccination programme. Other factors besides vaccine costs also need serious attention. With better understanding of such factors, policy makers and medical health professionals will be better equipped to make informed decisions to maximise the potential benefits of the human papillomavirus vaccines for the most number of people in individual countries.
    Matched MeSH terms: Health Services Accessibility*
  15. Wong YJ, Lee SWH
    J Glob Health, 2021 Jan 30;11:03005.
    PMID: 33643615 DOI: 10.7189/jogh.11.03005
    Matched MeSH terms: Health Services Accessibility/trends*
  16. Wong WJ, Mosiun JA, Hidayati Z, Balkis R, Sharif SZ, Lee D, et al.
    Breast, 2019 Aug;46:136-143.
    PMID: 31176055 DOI: 10.1016/j.breast.2019.05.016
    INTRODUCTION: Breast-conserving surgery (BCS) with radiation therapy is the procedure of choice for early-stage breast cancer. Survival and locoregional recurrence is non-inferior to mastectomy, with superior cosmetic and psycho-social outcomes. Differing health systems have demonstrated a wide variation in the rate of BCS. Little is known about the rate of BCS and factors influencing its practice in middle resource countries. This study aims to examine the BCS rates in Malaysia and to identify factors influencing its uptake.

    METHODOLOGY: This is a multi-centre, cross-sectional study involving the University of Malaya Medical Centre (UMMC), Queen Elizabeth II Hospital (QEH), and Tengku Ampuan Rahimah Hospital (TARH). Patients diagnosed with invasive breast cancer from January 2014 to December 2015 were included, excluding stromal cancers and lymphomas. Univariate and multivariate analyses identified factors influencing BCS.

    RESULTS: A total of 1005 patients were diagnosed with breast cancer in the allocated time frame. Excluding incomplete records and those who did not have surgery, 730 patients were analysed. Overall BCS rate was 32.9%. The BCS rate was highest at QEH (54.1%), followed by UMMC (29.5%), and TARH (17.4%). 16.9% had BCS after neoadjuvant therapy. Factors influencing BCS uptake included age, ethnic group, breast-surgeon led services, AJCC Stage, tumour size, HER-2 expression, and tumour grade.

    CONCLUSIONS: The rate of BCS in Malaysia is low. A wide variation of rate exists among the studied hospitals. Younger age, earlier AJCC stage, and the presence of a Breast sub-specialist surgeon, would make it more likely that the patient has her breast conserved.

    Matched MeSH terms: Health Services Accessibility/statistics & numerical data
  17. Wong LP
    J Community Health, 2011 Feb;36(1):14-22.
    PMID: 20431926 DOI: 10.1007/s10900-010-9275-0
    The study was conducted to investigate issues surrounding human papillomavirus (HPV) vaccine delivery in a multi-ethnic, multi-religious and multi-cultural society. A qualitative in-depth interview study was conducted with a sample of 20 physicians. Physicians described the success of HPV vaccines recommendation as very poor. Many expressed reluctance to offer the vaccine to preadolescents. The most notable barrier to vaccination was the vaccine's high cost. Parents of eligible vaccinees were concerned about the efficacy and side effects of the new vaccine, while adult women have low risk perception for HPV infection. Promoters and inhibitors of HPV vaccination in our multi-ethnic, multi-religious and multi-cultural community were identified. This study suggests the need to strengthen the infrastructure necessary for HPV vaccine delivery and to specifically target poor underserved women.
    Matched MeSH terms: Health Services Accessibility
  18. Wolfe D, Carrieri MP, Shepard D
    Lancet, 2010 Jul 31;376(9738):355-66.
    PMID: 20650513 DOI: 10.1016/S0140-6736(10)60832-X
    We review evidence for effectiveness, cost-effectiveness, and coverage of antiretroviral therapy (ART) for injecting drug users (IDUs) infected with HIV, with particular attention to low-income and middle-income countries. In these countries, nearly half (47%) of all IDUs infected with HIV are in five nations--China, Vietnam, Russia, Ukraine, and Malaysia. In all five countries, IDU access to ART is disproportionately low, and systemic and structural obstacles restrict treatment access. IDUs are 67% of cumulative HIV cases in these countries, but only 25% of those receiving ART. Integration of ART with opioid substitution and tuberculosis treatment, increased peer engagement in treatment delivery, and reform of harmful policies--including police use of drug-user registries, detention of drug users in centres offering no evidence-based treatment, and imprisonment for possession of drugs for personal use--are needed to improve ART coverage of IDUs.
    Matched MeSH terms: Health Services Accessibility
  19. William Cairns Steward Smith
    Int J Public Health Res, 2014;4(1):425-430.
    MyJurnal
    Introduction Cardiovascular diseases are a major component of non-communicable
    diseases and include coronary heart disease, stroke and peripheral vascular
    disease. Public health strategies to address cardiovascular disease require
    three elements: surveillance, health promotion, and individual health care.

    Methods Surveillance includes monitoring of mortality and morbidity as well as
    surveys to monitor risk factors levels in the community. Data on mortality
    from cardiovascular diseases are readily available and analysed by age and
    sex specific rates looking are secular trends, geographical and ethnical group
    variations and international comparisons. However many deaths from
    cardiovascular disease occur suddenly and the cause of death may be
    registered without autopsy or any other validation. Cardiovascular morbidity
    information is more difficult to collate and interpret as it is closely related to
    availability and access to health care. Periodic surveys of cardiovascular risk
    factors are essential in monitoring the underlying trends in blood pressure,
    smoking, cholesterol, obesity, and diabetes as they predict future trends, and
    support planning for prevention and healthcare.

    Results Prevention and health promotion activities are informed by the levels and
    trends in cardiovascular disease and its risk factors. There has been debate
    about population health promotion and individual health care strategies, but
    both are necessary. Cigarette smoking, nutrition and physical exercise are the
    main behaviours to be addressed but these are complex and require
    multifaceted approaches. Education alone is insufficient to change health
    behaviours and health promotion needs to look to changing attitudes.
    Legislation, taxation and other fiscal interventions have been shown to be
    effective however these can be difficult for legislators as there are other
    competing interests, particularly in the area of nutrition and tobacco. Creating
    health promoting environments that make healthy behaviour choices easier
    can be beneficial.

    Conclusions Health care interventions are also effective in reducing the burden of
    cardiovascular disease. A balanced approach of health promotion and
    individual health care is recommended in the development of a strategy for
    cardiovascular disease.
    Matched MeSH terms: Health Services Accessibility
  20. Waran V, Thillainathan R, Karuppiah R, Pickard JD
    World Neurosurg, 2022 01;157:135-142.
    PMID: 34687934 DOI: 10.1016/j.wneu.2021.10.112
    BACKGROUND: The provision of equitable and affordable health care has become increasingly challenging as advanced technology is introduced, particularly in developing countries. We explored the hypothesis that focused, small-scale mini-public-private partnerships have a potential role in providing equitable and affordable access to advanced technology for the benefit of all patients in developing nations, particularly middle-income countries.

    METHODS: A clinician-led financial plan was developed at the University of Malaya to create the Centre for Image Guidance and Minimally Invasive Therapy (CIGMIT) to provide an integrated platform for high-end care for Malaysian patients of all ages, both public and private, requiring complex neurosurgical and spinal procedures and stereotactic and intensity-modulated radiotherapy. The challenges faced during development of the plan were documented together with an audit of patient throughput and analyses of financial risk and return.

    RESULTS: CIGMIT opened in 2015. Patient throughput, both public and private, progressively increased in all facilities. In 2015-2019, 37,724 patients used the Centre's facilities. CIGMIT has become progressively more profitable for the University of Malaya, the public and private hospitals, and the investor. CIGMIT has weathered the challenges posed by coronavirus disease 19.

    CONCLUSIONS: Focused, small-scale mini-public-private partnerships have a potential role in providing advanced technology for the benefit of patients in developing nations, particularly middle-income countries, subject to an approach that balances equity of access between public and private health care systems with fair reward.

    Matched MeSH terms: Health Services Accessibility/organization & administration*
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