The Societal Burden of Osteoporosis

Osteoporosis currently affects 10 million Americans and is responsible for more than 1.5 million fractures annually. The financial burden of osteoporosis is substantial, with annual direct medical costs estimated at 17 to 20 billion dollars. Most of these costs are related to the acute and rehabilitative care following osteoporotic fractures, particularly hip fractures. The societal burden of osteoporosis includes these direct medical costs and the monetary (eg, caregiver time) and nonmonetary costs of poor health. The aging of the US population is expected to increase the prevalence of osteoporosis and the number of osteoporotic fractures. Growth of the older adult population will pose significant challenges to Medicare and Medicaid, which bear most of the cost of osteoporosis. Efforts to address the looming financial burden must focus on reducing the prevalence of osteoporosis and the incidence of costly fragility fractures.     

Premature Coronary Heart Disease in South Asians: Burden and Determinants

Purpose of Review

While the burden of cardiovascular disease (CVD) is on the decline globally, it is on the rise among South Asians. South Asians are also believed to present early with coronary artery disease (CAD) compared with other ethnicities.

Recent Findings

South Asians have demonstrated a higher burden of premature CAD (PCAD) compared with other ethnicities. These findings are not limited to non-immigrant South Asians but have also been found in immigrant South Asians settled around the world. In this article, we first discuss studies evaluating PCAD among South Asians residing in South Asia and among South Asian immigrants in other countries. We then discuss several traditional risk factors that could explain PCAD in South Asians (diabetes, hypertension, dietary factors, obesity) and lipoprotein-associated risk (low HDL-C levels, higher triglycerides, and elevated apolipoprotein B levels). We then discuss several emerging areas of research among South Asians including the role of dysfunctional HDL, elevated lipoprotein(a), genetics, and epigenetics. Although various risk markers and risk factors of CAD have been identified in South Asians, how they impact therapy is not well-known.

Summary

PCAD is prevalent in the South Asian population. Large-scale studies are needed to identify how this information can be rationally utilized for early identification of risk among South Asians, and how currently available therapies can mitigate this increased risk.

     

The Acute Cardiorenal Syndrome: Burden and Mechanisms of Disease

Worsening renal function during the treatment of acute decompensated heart failure, so-called acute cardio-renal syndrome, is very common and complicates the treatment course. The underlying pathophysiology of worsening renal function (WRF) involves variable contributions of renal hemodynamics, neurohormonal activity, and oxidative stress. Historically, WRF has been associated with adverse outcomes. However, emerging data support therapeutic strategies that permit WRF while effectively treating congestion as they are associated with improved outcomes.     

The Global Burden of Disease Study and the Preventable Burden of NCD

Noncommunicable diseases (NCD) now account for more than one-half of the global burden of disease. Cardiovascular diseases account for about one-half of NCD deaths, and the majority of cardiovascular disease deaths occur in low- and middle-income countries. The GBD (Global Burden of Disease) study measures and benchmarks health loss from death or disability from more than 300 diseases in over 100 countries. According to GBD analyses, the rise of NCD is in part due to increased life expectancy due to reduced premature mortality from communicable, child, and maternal illnesses, but preventable risk factors also contribute and present targets for NCD control efforts. In addition to traditional NCD risk factors, like tobacco smoking, high blood pressure, and unhealthful diet, nontraditional risk factors like air pollution and unhealthful alcohol consumption also play a role. The GBD study continues to grow by gathering more data from country partners than ever before, and by measuring health at the national and subnational levels and in smaller time increments. The GBD study will continue to provide the data to set priorities for and measure progress in the global effort to control the rising burden of NCD.     

The Global Burden of Cardiovascular Disease in Women

Purpose of review

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, accounting for one third of all deaths in 2015. Alarmingly, there has been slowing of the decline in age-standardized CVD mortality over the last 5 years compared to the previous 25 years.

Recent findings

Given the increasing global CVD burden, in 2011, the United Nations declared the goal to reduce premature mortality from the four main non-communicable diseases by 25% from 2010 to 2025, abbreviated as the 25?×?25 goal. The United Nations has further created nine targets to achieve the 25?×?25 goal. These targets emphasize risk factor modification and strengthening of healthcare delivery systems.

Summary

Achieving the nine targets and 25?×?25 goal set by the United Nations will undoubtedly benefit the world as a whole. However, women face additional, unacceptable, disproportionate CVD risk factors that need to be addressed, including psychological stressors contributing to ischemic heart disease, pregnancy-related CVD, environmental and infectious exposures in low socioeconomic settings, and limited healthcare access and delivery. This paper highlights global CVD gender disparities in order to stimulate awareness and discussion of potential interventions to address the rapidly growing burden of heart disease in women.

     

韩国的结核病治疗

尚未见对韩国结核病控制系统进行全面描述的文献。韩国结核病患病率自1965年来急剧下降，部分原因是其远见性的政府政策，即对整个人群提供低价、可及的结核病治疗。在结核病控制体系内公立和私立医疗机构可提供多种治疗选择。国家结核病规程以提高新病例的治愈率为重点，而私立医疗机构则在治疗耐药结核病和其他疑难类型病例上发挥更大的作用。自1980年以来，耐药结核病由于多种原因出现下降趋势，包括引入利福平基础的方案提高了治愈率，营养和生活水平的提高以及私立医疗机构对耐药结核病的治疗。耐多药结核病仍然对公众健康造成严重威胁。韩国关于耐多药结核病治疗结局的有限资料表明，耐多药结核病的治愈率低，失败和放弃率高。控制耐多药结核病需要新的新公共卫生措施。     

Decreased Prohepcidin Levels in Patients with HBV-Related Liver Disease: Relation with Ferritin Levels

Background

Levels of prohepcidin, a homeostatic regulator of iron absorption, are altered in chronic hepatitis C and liver cirrhosis. However, data on the potential alterations of prohepcidin in patients with HBV-related liver disease are scarce. We investigated whether serum prohepcidin is related to iron overload and perenchymal dysfuction in HBV-related liver disease.

Methods

Three groups of subjects were studied: 66 patients with chronic hepatitis B, 32 patients with HBV-related cirrhosis, and 42 healthy controls without evidence of liver disease. Serum levels of prohepcidin were determined by enzyme-linked immunosorbent assay.

Results

Serum prohepcidin levels were significantly lower in patients with HBV-related cirrhosis (175.85 ± 71.5 ng/ml) than in patients with chronic hepatitis B (209.02 ± 62.7 ng/ml P < 0.05) and controls (222.4 ± 128.4 ng/ml, P < 0.05). After adjustment for potential confounders, prohepcidin was found to be an independent predictor of ferritin levels in multiple linear regression analysis (β = ?1.10, t = ?3.11, P < 0.01).

Conclusion

These results demonstrate that prohepcidin levels are reduced in patients with HBV-related cirrhosis and are an independent correlate of serum ferritin.     

The treatment of tuberculosis in South Korea.

South Korea's complex system of tuberculosis control has never been fully described. The prevalence of tuberculosis has dropped dramatically since 1965, partly because of farsighted governmental policy that provided low-cost, accessible tuberculosis treatment to the entire population. Within the tuberculosis control system, public and private sector entities provide a wide variety of treatment options. The National Tuberculosis Program focuses on improving cure rates for new cases, while the private sector has taken more of a role in the treatment of drug-resistant tuberculosis and other types of complicated cases. There has been a decrease in drug-resistant tuberculosis since 1980 for multiple reasons, including increased cure rates from the introduction of rifampin-based regimens, improved nutrition and living standards, and the treatment of drug-resistant cases in the private sector. Multidrug-resistant tuberculosis, however, still poses a significant threat to public health. The limited outcomes data that exist in South Korea for multidrug-resistant tuberculosis treatment suggest that cure rates are low and failure and abandonment rates are high. New public health measures are needed to improve the control of multidrug-resistant tuberculosis.     

The Burden of Uncontrolled Hypertension: Morbidity and Mortality Associated With Disease Progression

Even small elevations above optimal blood pressure values (<120/80 mm Hg) increase the likelihood of developing hypertension (blood pressure 140/90 mm Hg) and incurring target organ damage. Until recently, the main emphasis in hypertension treatment had been lowering diastolic blood pressure; however, in the past decade, the important contributions of systolic hypertension, increased pulse pressure, and a blunted reduction in nocturnal blood pressure have been described. Primary hypertension arises from complex, interrelated pathologies. Among the contributors are genetic, environmental, metabolic, vascular, and endothelial factors. Signs of target organ damage herald a poorer prognosis and may present in the heart, blood vessels, kidneys, brain, or eyes. Later consequences include cardiac, cerebrovascular, vascular, and renal morbidities and death. The goal in treating hypertension is to prevent cardiovascular and renal complications. Thus, hypertensive patients with high-normal blood pressure values may benefit from intensive lifestyle interventions to further reduce blood pressure. This is particularly true in patients with additional cardiovascular risk factors. Because of the complex nature of hypertension, it is not surprising that single antihypertensive agents normalize blood pressure for less than a majority of hypertensive patients. Using combination antihypertensive therapy consisting of agents from two or more different antihypertensive drug classes not only increases the likelihood of achieving the target blood pressure goal, but also offers the potential for greater protection against target organ damage by targeting separate pathologic mechanisms.     

The Recent Development of Emergency Medicine in South Korea

Emergency medicine has developed rapidly in South Korea in the past decade, giving Korea one of the most advanced systems of emergency medical care in Asia. This article reviews the overall health care system and medical climate in Korea, as well as the great progress made in establishing emergency medicine as a specialty. It also describes the many improvements implemented in academic emergency medicine, emergency patient care, and emergency medicine management systems. Although the current economic crisis offers new challenges, much optimism remains about the future of this new Korean specialty. [Arnold JL, Song HS, Chung JM: The recent development of emergency medicine in South Korea. Ann Emerg Med December 1998;32:730-735.]     

The Burden of Obstructive Lung Disease Initiative (BOLD): Rationale and Design

Quantifying COPD prevalence worldwide is needed to document COPD's effect on disability, health care costs, and impaired quality of life and to inform governments and health planners. As an adjunct to data obtained from population-based studies, and for countries where a fully powered prevalence survey cannot be done, modeling of COPD prevalence and its economic burdens can help estimate potential health care needs and costs. For comparability, standardized methods for prevalence surveys are needed that can be used in countries at all levels of economic development. The Burden of Obstructive Lung Disease (BOLD) Initiative has developed a set of methods for estimating COPD prevalence and a model for assessing its economic impact, and piloted these methods in China and Turkey. The methods were revised to reflect the findings in the pilot studies, and BOLD is now making the standardized methods available worldwide. The BOLD Operations Center provides training, materials, quality control, and data analysis. BOLD emphasizes data quality control at every stage of the process. Data from paper forms completed in the field are entered electronically to a specially designed secure Web platform. Pre- and post-bronchodilator spirometry testing is done on all participants, and all spirometry data are reviewed for quality. Questionnaires are used to obtain information about respiratory symptoms, health status, exposure to risk factors, and economic data about the burden of COPD. BOLD's standardized methods will provide a uniform way to compare COPD burden within and between countries, and where differences are found, to explore explanations for these differences.