To identify barriers and facilitating factors for the inclusion of tobacco cessation treatment coverage in the Argentine health system and to outline priority health policies for the development of smoking cessation programs.
A qualitative methodology was used based on in-depth interviews conducted with key informants from the State, NGOs and the health insurance sector.
Nine barriers were identified: tobacco consumption is not appreciated as an addiction or illness; lack of a culture of prevention in the health system; lack of agreement on the relevance of coverage in all clinical cases; mistrust about policy-making decisions made under pressure from various lobbies; lack of agreement about the importance of the different components of cessation; fear of overloading the health system with additional expenses; prioritization of other tobacco control interventions as being more effective; health professionals not completely trained to deliver cessation treatment. Four main facilitating factors were recognized: consensus about the necessity of cessation treatment coverage; magnitude of the problem of tobacco use; pressure from a more informed society for the inclusion of coverage; the emergence of new paradigms for the inclusion of health public policies.
The barriers create a vicious circle: members of the health care system do not fully appreciate the issues related to smoking, which leads to an inappropriate set of priorities resulting in a lack of preventive policies and insufficient health practices and interventions to curb the problem. However, this situation is changing since the facilitating factors are gaining strength, an observation supported by the changes witnessed in Argentina over the last few years.
Chandigarh healthy heart action project (CHHAP) was initiated in 2004 to increase awareness in the community for the major NCD risk factors by health promotion, training of health staff for CVD risk assessment and management, and surveillance of NCD risk factors.
Key strategies included capacity building, health promotion in different settings, risk factor surveillance and advocacy. Educational materials for the project included modules for doctors, health workers and school teachers; brochures, WHO protocol charts for CVD risk assessment and management, handbills and posters. Multiple health promotion activities were undertaken. An intersectoral committee for policy issues and a coordination committee for technical issues were also constituted.
Most of doctors in public (245) and private sectors (150), health workers (227), school teachers (190) and pharmacists/staff nurses (181) were trained for CVD assessment and management in batches during 2005–07. NCD risk factor surveillance encompassed 2763 individuals in the population of Chandigarh. The prevalence of smoking was 10.2% (20.1% among males and 0.8% among females). Alcohol was consumed by 14.2% (26.8% males and 1.2% females). A sedentary occupation was identified in 94.2% in Chandigarh. Due to strong advocacy, Chandigarh was declared a smoke free city from July 2007, which is a first in the developing world, and the project was up scaled to an integrated State NCD control program in the 11th 5-year plan (2007–12).
CHHAP is a large-scale implementation of the WHO CVD risk management package, implemented as a routine in the health care delivery system.
The objective of this study was to compare acute stroke (AS) and acute myocardial infarction (AMI) in terms of clinical characteristics, medications at discharge, and in-hospital outcomes.
Data were obtained from personal interviews as well as the medical files of the patients admitted to Al-wattani hospital, Palestine in the period September 2006 until August 2007. All data were analyzed using SPSS v15. Chi-square and student’s t test were used to test for significance.
A total of 281 patients were included, 186 had AS and 95 had AMI. AMI patients were significantly younger than those with AS (P = 0.000). Hypertension (HTN) (% 69.9) was the most prevalent risk factor for AS patients, while diabetes mellitus (DM) (46.3%) was the most prevalent risk factor for AMI patients. The prevalence of the following risk factors was significantly different between AS and AMI: HTN (P = 0.000), previous stroke (P = 0.000), and atrial fibrillation (P = 0.027). Antiplatelets (P = 0.000), statins (P = 0.000), and beta blockers (P = 0.005) were prescribed significantly more for patients with AMI than for patients with AS at discharge. However, ACE-I was the only class that was prescribed significantly (P = 0.000) more for AS patients compared to AMI. In-hospital mortality among both groups was 20.9% for AS and 16.8% for AMI. There was no significant difference in in-hospital mortality between AS and AMI patients regardless of age. Gender differences in in-hospital mortality between AS and AMI were observed. AS was significantly (P = 0.010) more fatal than AMI for males. However, AMI was significantly (P = 0.048) more fatal than AS in female patients. Furthermore, males who died after AMI were significantly younger than those who died after AS (P = 0.001).
AMI affects people at early life phases compared to AS. HTN and DM are among the common risk factors. Prescribing of medications for secondary prevention could be improved. Gender and age differences in outcome are seen in both AS and AMI patients.
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