1
|
Mansour W, Arjyal A, Hughes C, Gbaoh ET, Fouad FM, Wurie H, Kyaw HK, Tartaggia J, Hawkins K, Than KK, Kallon LH, Saad MA, Chand O, Win PM, Yamout R, Regmi S, Baral S, Theobald S, Raven J. Health systems resilience in fragile and shock-prone settings through the prism of gender equity and justice: implications for research, policy and practice. Confl Health 2022; 16:7. [PMID: 35189938 PMCID: PMC8860254 DOI: 10.1186/s13031-022-00439-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
Fragile and shock-prone settings (FASP) present a critical development challenge, eroding efforts to build healthy, sustainable and equitable societies. Power relations and inequities experienced by people because of social markers, e.g., gender, age, education, ethnicity, and race, intersect leading to poverty and associated health challenges. Concurrent to the growing body of literature exploring the impact of these intersecting axes of inequity in FASP settings, there is a need to identify actions promoting gender, equity, and justice (GEJ). Gender norms that emphasise toxic masculinity, patriarchy, societal control over women and lack of justice are unfortunately common throughout the world and are exacerbated in FASP settings. It is critical that health policies in FASP settings consider GEJ and include strategies that promote progressive changes in power relationships. ReBUILD for Resilience (ReBUILD) focuses on health systems resilience in FASP settings and is underpinned by a conceptual framework that is grounded in a broader view of health systems as complex adaptive systems. The framework identifies links between different capacities and enables identification of feedback loops which can drive or inhibit the emergence and implementation of resilient approaches. We applied the framework to four different country case studies (Lebanon, Myanmar, Nepal and Sierra Leone) to illustrate how it can be inclusive of GEJ concerns, to inform future research and support context responsive recommendations to build equitable and inclusive health systems in FASP settings.
Collapse
Affiliation(s)
- Wesam Mansour
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | | | | | - Emma Tiange Gbaoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Fouad Mohamed Fouad
- Faculty of Health and Sciences, American University in Beirut, Beirut, Lebanon
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | | | | | | | - Lansana Hassim Kallon
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Maya Abou Saad
- Faculty of Health and Sciences, American University in Beirut, Beirut, Lebanon
| | | | | | - Rouham Yamout
- Faculty of Health and Sciences, American University in Beirut, Beirut, Lebanon
| | | | | | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Joanna Raven
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| |
Collapse
|
2
|
Gedela MG, Giustino GG, Kyaw HK, Johal GJ, Hooda AH, Sartori SS, Qiu HQ, Mehran RM, Kini AK, Sharma SS. Comparison of cardiovascular outcomes of moderate to severely calcific de novo coronary lesion preparation for stent implantation using rotational atherectomy in conjunction with cutting balloon versu. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Previous studies showed the combined rotational atherectomy (RA) and cutting balloon angioplasty (CBA) strategy was associated with favourable cardiovascular outcomes compared to RA and plain balloon angioplasty (PBA) for adequate lesion preparation before stent implantation in moderate to severely calcified coronary lesions. However, these studies were limited by small sample size.
Purpose
To assess clinical outcomes in a large group of patients with moderate to severely calcified de novo severe coronary artery stenoses using RA followed by CBA (RA+CBA) compared to RA followed by PBA (RA+PBA) before 2.5–3.5 mm diameter stent implantation.
Methods
We conducted a retrospective analysis of 1852 patients with moderate to severely calcified de novo severe coronary artery stenosis who underwent RA+CBA (n=372) or RA+PBA (n=1480) before 2.5–3.5 mm stent implantation. Death, myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST), and major adverse cardiovascular events (MACE) were calculated at 1-year. Standard multivariable covariate adjusted hazard ratios (HR) were performed.
Results
At 1-year follow-up, the unadjusted MACE [HR: 1.58 (1.14–2.21); p=0.007] was significant in RA+CBA group compared to RA+PBA group, even after adjusted for multiple variables [HR: 1.61 (1.11–2.35); p=0.013] (Figure 1A). This was mainly driven by TVR [Unadjusted HR: 1.76 (1.16–2.68); p=0.008 and adjusted HR: 1.64 (1.01–2.67); p=0.045] (Figure 1B). However, other adjusted outcomes including death [HR: 1.25 (0.63–2.50); p=0.521], MI [HR: 1.71 (0.77–3.77); p=0.188], and ST [HR: 2.11 (0.64–6.95); p=0.221] were not significant between both groups. There was no significant difference in complications including coronary artery dissection, side branch closure, coronary perforation, slow flow/no flow, abrupt vessel closure, post procedure MI, blood transfusion or bleeding in between the two groups.
Conclusion
In moderate to severely calcific de novo severe coronary artery stenosis lesion preparation before 2.5–3.5 mm stent implantation, RA+CBA strategy is associated with a higher risk of major adverse cardiovascular events compared to RA+PBA strategy at 1-year follow-up.
Funding Acknowledgement
Type of funding sources: None. Figure 1
Collapse
Affiliation(s)
- M G Gedela
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G G Giustino
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - H K Kyaw
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G J Johal
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A H Hooda
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S S Sartori
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - H Q Qiu
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R M Mehran
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A K Kini
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S S Sharma
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| |
Collapse
|