HORIZON Center: Promoting Health and Health Equity in Inner Boston

The HORIZON Center is an Exploratory Center of Excellence (COE) funded by a grant from the National Institute on Minority Health and Health Disparities (NIMHD). Our mission is to improve minority health and promote health equity through research, research training, and community engagement. Like other COEs, HORIZON is organized into four core areas: research, research training, community engagement, and administration. However, we work to promote collaboration and integration across core areas

Awareness, Treatment and Control of Hypertension in Kenya

The emerging epidemic of hypertension (HTN) in sub-Saharan Africa is predicted to worsen. Uncontrolled HTN is associated with CVD, high morbidity and premature mortality; hence early detection, treatment and control of HTN is critical to reduction of the associated sequelae. The study was guided by the Social Ecological Model and principles of Community Based Participatory Research

Methodological Challenges in Estimating Trends and Burden of Cardiovascular Disease in Sub-Saharan Africa

Background. Although 80% of the burden of cardiovascular disease (CVD) is in developing countries, the 2010 global burden of disease (GBD) estimates have been cited to support a premise that sub-Saharan Africa (SSA) is exempt from the CVD epidemic sweeping across developing countries. The widely publicized perspective influences research priorities and resource allocation at a time when secular trends indicate a rapid increase in prevalence of CVD in SSA by 2030. Purpose. To explore methodological challenges in estimating trends and burden of CVD in SSA via appraisal of the current CVD statistics and literature. Methods. This review was guided by the Critical review methodology described by Grant and Booth. The review traces the origins and evolution of GBD metrics and then explores the methodological limitations inherent in the current GBD statistics. Articles were included based on their conceptual contribution to the existing body of knowledge on the burden of CVD in SSA. Results/Conclusion. Cognizant of the methodological challenges discussed, we caution against extrapolation of the global burden of CVD statistics in a way that underrates the actual but uncertain impact of CVD in SSA. We conclude by making a case for optimal but cost-effective surveillance and prevention of CVD in SSA

Global risk assessment of cardiovascular disease in resource constrained settings

Cardiovascular disease (CVD) is an emerging problem in Sub-Saharan Africa. Many current guidelines recommend using global risk assessment (GRA) to quantify the risk for developing CVD and to guide treatment and policy. Most GRA tools require lipid measures which are not readily available in resource-constrained settings. Of the 3 most published non-laboratory based tools: Gaziano and Framingham substitute BMI for cholesterol; WHO does not include BMI or cholesterol

Prehospital paths and hospital arrival time of patients with acute coronary syndrome or stroke, a prospective observational study

Background: Patients with a presumed diagnosis of acute coronary syndrome (ACS) or stroke may have had contact with several healthcare providers prior to hospital arrival. The aim of this study was to describe the various prehospital paths and the effect on time delays of patients with ACS or stroke. Methods: This prospective observational study included patients with presumed ACS or stroke who may choose to contact four different types of health care providers. Questionnaires were completed by patients, general practitioners (GP), GP cooperatives, ambulance services and emergency departments (ED). Additional data were retrieved from hospital registries. Results: Two hundred two ACS patients arrived at the hospital by 15 different paths and 243 stroke patients by ten different paths. Often several healthcare providers were involved (60.8 % ACS, 95.1 % stroke). Almost half of all patients first contacted their GP (47.5 % ACS, 49.4 % stroke). Some prehospital paths were more frequently used, e.g. GP (cooperative) and ambulance in ACS, and GP or ambulance and ED in stroke. In 65 % of all events an ambulance was involved. Median time between start of symptoms and hospital arrival for ACS patients was over 6 h and for stroke patients 4 h. Of ACS patients 47.7 % waited more than 4 h before seeking medical advice compared to 31.6 % of stroke patients. Median time between seeking medical advice to arrival at hospital was shortest in paths involving the ambulance only (60 min ACS, 54 min stroke) or in combination with another healthcare provider (80 to 100 min ACS, 99 to 106 min stroke). Conclusions: Prehospital paths through which patients arrived in hospital are numerous and often complex, and various time delays occurred. Delays depend on the entry point of the health care system, and dialing the emergency number seems to be the best choice. Since reducing patient delay is difficult and noticeable differences exist between various prehospital paths, further research into reasons for these different entry choices may yield possibilities to optimize paths and reduce overall time delay