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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Since the beginning of the WHO European Healthy Cities Network in 1987, the global and regional contexts for the promotion of health and well-being have changed in many ways. First, in 2000, the United Nations Millennium Goals explicitly and implicitly addressed health promotion and prevention at the global and regional levels. Second, the concern for sustainable development at the Rio Conference in 1992 was confirmed at the World Summit in Johannesburg in 2002. During the same period, in many regions including Europe, the redefinition of the roles and responsibilities of national, regional and local governments, reductions in budgets of public administrations, the privatization of community and health services, the instability of world trade, the financial system and employment, migration flows, relatively high levels of unemployment (especially among youth and young adults) have occurred in many countries in tandem with negative impacts on specific policies and programmes that are meant to promote health. Since 1990, the European Commission has been explicitly concerned about the promotion of health, environment and social policies by defining strategic agendas for the urban environment, sustainable development and governance. However, empirical studies during the 1990s show that urban areas have relatively high levels of tuberculosis, respiratory and cardiovascular diseases, cancer, adult obesity, malnutrition, tobacco smoking, poor mental health, alcohol consumption and drug abuse, sexually transmitted diseases (including AIDS), crime, homicide, violence and accidental injury and death. In addition, there is evidence that urban populations in many industrialized countries are confronted with acute new health problems stemming from exposure to persistent organic pollutants, toxic substances in building structures, radioactive waste and increasing rates of food poisoning. These threats to public health indicate an urgent need for new strategic policies and research agendas that address the complex interrelations between urban ecosystems, sustainable development, human health and well-being. The WHO Healthy Cities project is one important vector for achieving this objective at both global and regional levels.
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PMID:Healthy Cities in a global and regional context. 1991 84

Metabolic disturbances such as dyslipidemia, lipodystrophy syndrome, visceral obesity, hyperlactatemia, diabetes mellitus, and hepatic steatosis have been recognized as serious complications in long-term antiretroviral-treated HIV-infected patients. The oxidative capacity of liver mitochondria plays a central role in their pathogenesis and can be analyzed using the [(13)C]methionine breath test. We analyzed hepatic mitochondrial function using the [(13)C]methionine breath test in antiretrovirally treated and untreated HIV-infected patients as well as HIV-negative controls. Patients with hepatic steatosis, hypertriglyceridemia, lipohypertrophy, and older age showed reduced methionine metabolism. Hepatic mitochondrial function is impaired in antiretroviral-treated HIV-infected patients with disturbances of lipid metabolism.
AIDS Res Hum Retroviruses 2009 Dec
PMID:[(13)C]Methionine breath test as a marker for hepatic mitochondrial function in HIV-infected patients. 2000 11

Mortality in HIV-positive persons is increasingly due to non-HIV-related medical comorbidities. There are limited data on the prevalence and patient awareness of these comorbid conditions. Two hundred subjects at an urban HIV clinic were interviewed in 2005 to assess their awareness of 15 non-HIV-related medical comorbidities, defined as medical problems that are neither AIDS-defining by standard definitions, nor a direct effect of immune deficiency. Medical charts were subsequently reviewed to establish prevalence and concordance between self-report and chart documentation. Eighty-four percent of subjects self-reported at least 1 of 15 medical comorbidities and 92% had at least 1 condition chart-documented. The top 5 chart-documented conditions were hepatitis C (51.5%), pulmonary disease (28.5%), high blood pressure (27%), high cholesterol (24.5%), and obesity (22.5%). In multivariate analysis, higher number of non-HIV-related medical comorbidities was associated with older age, female gender, and intravenous drug use as route of HIV transmission. Across self-reported non-HIV-related medical comorbidities, the absolute concordance rate ranged from 67% to 96%, the sensitivity ranged from 0% to 79%; the positive predictive value ranged from 0% to 100%. While the vast majority of largely urban minority HIV-positive subjects were diagnosed with non-HIV-related medical comorbidities, there is significant room for improvement in patient awareness. In order to help patients optimally access and adhere to medication and medical care for these non-HIV-related medical comorbidities, interventions and educational campaigns to improve patient awareness that take cultural background, literacy, and educational level into account should be developed, implemented, and evaluated.
AIDS Patient Care STDS 2010 Jan
PMID:Prevalence and patient awareness of medical comorbidities in an urban AIDS clinic. 2009 1

To assess the effect of obesity on CD4 cell counts, we estimated the association of time-updated BMI categories with CD4 changes among 1001 documented HIV seroconverters. During the pre-highly active antiretroviral therapy (HAART) era, a higher BMI was associated with less reduction in CD4 cell counts over time. However during the HAART era, obese versus normal weight patients had smaller increases in CD4 cell counts (+69 versus +116 cells, P = 0.01). Lower CD4 cell counts may now be another adverse consequence of obesity.
AIDS 2010 Apr 24
PMID:Obesity among HIV-infected persons: impact of weight on CD4 cell count. 2021

With each passing decade, the United States has become a more racially and ethnically diverse nation. Many consider children our world's greatest resource. Addressing unequal health outcomes and educational achievement in children of different races and economic backgrounds is paramount. Dismal projections on the increased rates of obesity chronic disease and HIV/AIDS among adults may become a reality if more actions are not taken to help curb their current growing trends among youth, particularly youth of color. Health, education, and supportive and safe living environments are necessary to appropriately develop the world's future adults and leaders. Greater efforts must be made to ensure that the world's future leaders are a true racial and ethnic representation of the world they serve.
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PMID:Promoting racial equality, parental involvement, and youth engagement: an interview with Dr. Gail Christopher. Interview by Carmen J. Head. 2048 63

The increasing prevalence of non-communicable diseases (NCDs) in low- and middle-income countries is a big challenge to the governments, which are still struggling with a myriad of communicable diseases (e.g. malaria, tuberculosis and HIV/AIDS). There are common risk factors for the four major NCDs in Africa (cancer, diabetes, cardiovascular disease [CVD] and chronic respiratory infections), which are: obesity; lack of physical activity (PA); tobacco consumption; and inappropriate use of alcohol. Furthermore, NCDs are determined by individual and societal level factors, and the general socio-economic, cultural and environmental conditions (e.g. agriculture and food production, education, working and living conditions, transport, housing and unemployment) which can be addressed by use of health promotion. Thus, in order to address the multiple factors comprehensively, there is need for multi-pronged approaches that bring together multiple disciplines, sectors and partners focused on addressing NCDs in an effective, efficient and sustainable manner.
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PMID:Need for a multi-factorial, multi-sectorial and multi-disciplinary approach to NCD prevention and control in Africa. 2059 37

While communicable diseases such as human immunodeficiency virus/acquired immune deficiency syndrome, malaria, and tuberculosis have continued to pose greater threats to the public health system in sub-Saharan Africa (SSA), it is now apparent that non-communicable diseases such as diabetes mellitus are undoubtedly adding to the multiple burdens the peoples in this region suffer. Type 2 diabetes mellitus (T2DM) is the most common form of diabetes (90-95%), exhibiting an alarming prevalence among peoples of this region. Its main risk factors include obesity, rapid urbanization, physical inactivity, ageing, nutrition transitions, and socioeconomic changes. Patients in sub-Saharan Africa also show manifestations of beta-cell dysfunction and insulin resistance. However, because of strained economic resources and a poor health care system, most of the patients are diagnosed only after they have overt symptoms and complications. Microvascular complications are the most prevalent, but metabolic disorders and acute infections cause significant mortality. The high cost of treatment of T2DM and its comorbidities, the increasing prevalence of its risk factors, and the gaps in health care system necessitate that solutions be planned and implemented urgently. Aggressive actions and positive responses from well-informed governments appear to be needed for the conducive interplay of all forces required to curb the threat of T2DM in sub-Saharan Africa. Despite the varied ethnic and transitional factors and the limited population data on T2DM in sub-Saharan Africa, this review provides an extensive discussion of the literature on the epidemiology, risk factors, pathogenesis, complications, treatment, and care challenges of T2DM in this region.
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PMID:Type 2 diabetes mellitus and obesity in sub-Saharan Africa. 2064 Nov 42

The growing incidence of diabetes mellitus in the world is a widespread concern. While there has been improvement in the epidemiology and management of the disease in the developed world, the same cannot be said in sub-Saharan Africa. The disease is getting less attention as is the funding that it merits compared to communicable diseases. Type 2 diabetes is becoming more prevalent due to rising rates of obesity, physical inactivity, and urbanization. In contrast to the developed world, where the majority of the people with diabetes are over the age of 60 years, the sub-Saharan Africa diabetic population is in the economically productive age group of 30 to 45 years. The late diagnosis of diabetes in this region, coupled with inequalities in accessing care, leads to early presentations of diabetic complications. The health care delivery agenda is overwhelmed by poverty, as such diabetes management costs have to compete with other health issues such as antiretroviral drugs for HIV/ AIDS, tuberculosis treatment, and malarial control programs. There is an urgent need to place diabetes on the national health agenda in sub-Saharan Africa and ensure that this agenda is properly positioned and integrated into the health policies and strategies.
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PMID:Diabetes in sub-Saharan Africa: health care perspectives, challenges, and the economic burden of disease. 2069 Mar 30

Obesity is now a common problem among HIV-infected patients receiving antiretroviral therapy (ART). Gastric bypass surgery may be an option for some patients who have failed diet and therapeutic lifestyle changes, changes in ART or other treatment modalities for HIV/ART-related lipohypertrophy and obesity. However, few data are available regarding HIV-related outcomes after such surgery and its impact on ART tolerability. We present here a case series of seven subjects with HIV infection who underwent bariatric surgery. Viral suppression was maintained in five of the six subjects who were receiving ART prior to surgery, including three subjects who experienced surgical complications. The median (range) decrease in body mass index (BMI) postoperatively was 10 kg/m(2) (6-28 kg/m(2)). Improvements were also seen in serum lipid fractions with median (range) changes in total cholesterol of -19 mg/dL (-61 to +3 mg/dL) and triglycerides of -185 mg/dL (-739 to +35 mg/dL). Four of the subjects had a reduction in their metabolic medication prescriptions postoperatively. Three of the subjects experienced postsurgical complications. Based on our experience, bariatric surgery may provide an effective treatment modality for obesity and its related comorbidities in the HIV-infected population while not sacrificing virologic suppression. Larger studies are needed to verify these results, especially in regards to surgical complications.
AIDS Patient Care STDS 2010 Sep
PMID:Bariatric surgery outcomes in HIV-infected subjects: a case series. 2073 8

Pandemic influenza caused byA H1N1 virus, that started in Mexico in 2009 and that persist though with mortality and morbidity much lower rates, did not have the repercussions of the other pandemias in the 20th Century, this is because the members of the World Health Organization anticipated everything that was necessary to fight it since 1997, when that international organism suggested to be prepared because the bird flu H5N1 was suffering mutations and was creating a new type of virus that have already caused human deaths. This information allowed the creation of strategies to protect the world population and mainly the most vulnerable groups such as pregnant women. In this group the lung complications specially the pneumonia cases, leads to the patient hospitalization with a higher perinatal mortality rates. The signs and symptoms of seasonal influenza as well as A H1N1 influenza in pregnant women are always more serious, and this is why they need intensive treatments. However, not all patients need to be hospitalized nor to check with sophisticated exams the presence of the virus. Every unhealthy women need to be classified by their signs and symptoms according Triage scale, and their hospitalization has to be only if the situation gets worse or if a chronic disease complicate it such as diabetes, AIDS, heart condition, asthma, obesity, etc. According to the scale in which the patient has been classified, she needs to be isolated in her home and start a symptomatic treatment and add antiviral medications only in suspicious pandemic influenza cases. However if respiratory pathology gets worse the patient should be hospitalized immediately in a unit with the proper equipment. Every citizen must receive the A H1N1 vaccine, but pregnant women and breastfeeding women particularly. Pregnant women should receive the vaccine in any trimester of pregnancy, but especially in the last to prevent maternal and fetal complications as well as elevation of perinatal mortality.
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PMID:[Pandemic influenza caused by A(H1N1) in pregnant women]. 2093 15


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