Exacerbation Of Chronic Disease Research Articles

Serum metabolites associate with physical performance among middle-aged adults: Evidence from the Bogalusa Heart Study.

Age-related declines in physical performance predict cognitive impairment, disability, chronic disease exacerbation, and mortality. We conducted a metabolome-wide association study of physical performance among Bogalusa Heart Study participants. Bonferroni corrected multivariate-adjusted linear regression was employed to examine cross-sectional associations between single metabolites and baseline gait speed (N=1,227) and grip strength (N=1,164). In a sub-sample of participants with repeated assessments of gait speed (N=282) and grip strength (N=201), significant metabolites from the cross-sectional analyses were tested for association with change in physical performance over 2.9 years of follow-up. Thirty-five and seven metabolites associated with baseline gait speed and grip strength respectively, including six metabolites that associated with both phenotypes. Three metabolites associated with preservation or improvement in gait speed over follow-up, including: sphingomyelin (40:2) (P=2.6×10-4) and behenoyl sphingomyelin (d18:1/22:0) and ergothioneine (both P<0.05). Seven metabolites associated with declines in gait speed, including: 1-carboxyethylphenylalanine (P=8.8×10-5), and N-acetylaspartate, N-formylmethionine, S-adenosylhomocysteine, N-acetylneuraminate, N2,N2-dimethylguanosine, and gamma-glutamylphenylalanine (all P<0.05). Two metabolite modules reflecting sphingolipid and bile acid metabolism associated with physical performance (minimum P=7.6×10-4). These results add to the accumulating evidence suggesting an important role of the human metabolome in physical performance and specifically implicate lipid, nucleotide, and amino acid metabolism in early physical performance decline.

Features of the influence of Оmega-3 fatty acids on the course of inflammatory and immune reactions

Under the influence of polyunsaturated fatty acids in the human body are complex biochemical processes. Their influence on the functioning of cells is to ensure the stability of the cell membrane, maintaining the energy balance in the cell, the influence on the synthesis of specific substances - eicosanoids and more. Omega-3 PUFAs reduce the activity of the inflammatory process, as they produce specific mediators to reduce inflammation, and also have a depressant effect on the synthesis of proinflammatory substances (cyclooxygenase 2, nitric oxide synthase, tumor necrosis factor (TNF), interleukins 1, 6 and 12 in endothelial cells, etc.). Due to these properties of Omega-3 fatty acids promote an active immune response to external stimuli, as well as accelerate recovery from exacerbations of chronic diseases. In particular, in the exacerbation of Chronic obstructive pulmonary disease (COPD), the appointment of Оmega-3, due to its anti-inflammatory properties, helps to quickly reduce the effects of endobronchitis. Adding Оmega-3 to the diet has a positive effect on the immune system and prevents the development of exacerbations of chronic diseases.

Operation Navajeevan: A Public-Private Partnership Model for Disaster Relief in Kozhikode, India.

In August 2018, India's southern state of Kerala experienced its worst flooding in over a century. This report describes the relief efforts in Kozhikode, a coastal region of Kerala, where Operation Navajeevan was initiated. Data were collected from a centralized database at the command center in the District Medical Office as well as first-hand accounts from providers who participated in the relief effort. From August 15 through September 8, 2018, 36,846 flood victims were seen at 280 relief camps. The most common cause for presentation was exacerbation of an on-going chronic medical condition (18,490; 50.2%). Other common presentations included acute respiratory infection (7,451; 20.2%), traumatic injuries (3,736; 10.4%), and psychiatric illness (5,327; 14.5%). The prevalence of chronic disease exacerbation as the primary presentation during Operation Navajeevan represents an epidemiologic shift in disaster relief in India. It is foreseeable that as access to health care improves in low- and middle-income countries (LMICs), and climate change increases the prevalence of extreme weather events around the world, that this trend will continue.

Primary Palliative Care for Emergency Medicine (PRIM-ER): Applying form and function to a theory-based complex intervention

BackgroundEmergency departments are seeing an increase in acute exacerbations of chronic disease in the older-adult population. The delivery of palliative care in the emergency department can increase goal-concordant care at the end-of-life for this population. New interventions in palliative care for emergency medicine require large, pragmatic, complex health interventions due to the heterogeneous and dynamic environment of emergency departments. These complex interventions must balance fidelity with adaptability, while being rooted in theory, to produce an intervention that can be applied in a variety of contexts. MethodsPrimary Palliative Care for Emergency Medicine (PRIM-ER) is a large, pragmatic, complex health intervention. This paper outlines the conceptual theory-based design as well as the study form and functions of PRIM-ER to exemplify how this complex intervention has balanced fidelity with adaptability. ResultsA form and function matrix was created to highlight the key objectives and tailored intervention components of PRIM-ER. Each intervention component was also linked to one or more elements of the Theory of Planned Behavior to support provider behavior change and the delivery of palliative care services and referrals. ConclusionThe application of theory and delineation of forms and functions, as well prospective adaptation monitoring of large complex interventions can support the balance of fidelity with adaptability to encourage successful interventions among a variety of clinical environments.

Epidemiological parallels of community-acquired pneumonia, influenza and ARVI in Moscow

The problem of community-acquired pneumonia continues to be urgent due to high incidence, hospital admission rates, and mortality. The objective of the study is to characterize epidemiological parameters of incidence and mortality of community-acquired pneumonia, influenza, and ARVI in Moscow. Subjects and methods . The incidence and mortality of community-acquired pneumonia, influenza, and ARVI among different population groups in Moscow were analyzed. The Pearson correlation coefficient (rxy) was calculated to assess the relationship between incidence of pneumonia, influenza, and ARVI. Data were analyzed using IBM SPSS Statistics IBM statistics, version 23.0. Results. Over the studied period of long-term changes in the incidence of community-acquired pneumonia among all population groups, a pronounced upward trend is observed. The highest incidence rates of community-acquired pneumonia in Moscow are registered among under in infants one year, 1-2 years old and 3-6 years old pediatric patients. The months of the maximum incidence of community-acquired pneumonia in adults coincide with the months of the maximum incidence of influenza (January - February). The maximum incidence of community-acquired pneumonia among children 15-17 years old and 0-14 years old is registered 2 months earlier than with influenza. The highest mortality of pneumonia is observed after 1-2 months after the maximum incidence of ARVI and influenza, which is due to delayed mortality as a result of the exacerbation of chronic diseases. The authors suggest considering simultaneous vaccinations against influenza and pneumococcal infection among people over 65 years old and high-risk groups during the pre-season vaccination against influenza.

Changes in Emergency Department Care Intensity from 2007-16: Analysis of the National Hospital Ambulatory Medical Care Survey

IntroductionEmergency departments (ED) in the United States (US) have increasingly taken the central role for the expedited diagnosis and treatment of acute episodic illnesses and exacerbations of chronic diseases, allowing outpatient management to be possible for many conditions that traditionally required hospitalization and inpatient care. The goal of this analysis was to examine the changes in ED care intensity in this context through the changes in ED patient population and ED care provided.MethodsWe analyzed the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2007–2016. Incorporating survey design and weight, we calculated the changes in ED patient characteristics and ED care provided between 2007 and 2016. We also calculated changes in the proportion of visits with low-severity illnesses that may be safely managed at alternative settings. Lastly, we compared ED care received and final ED dispositions by calculating adjusted relative risk (aRR) comparing ED visits in 2007 to 2016, using survey weighted multivariable logistic regression.ResultsNHAMCS included 35,490 visits in 2007 and 19,467 visits in 2016, representing 117 million and 146 million ED visits, respectively. Between 2007 and 2016, there was an increase in the proportion of ED patients aged 45–64 (21.0% to 23.6%) and 65–74 (5.9% to 7.5%), while visits with low-severity illnesses decreased from 37.3% to 30.4%. There was a substantial increase in the proportion of Medicaid patients (22.2% to 34.0%) with corresponding decline in the privately insured (36.2% to 28.3%) and the uninsured (15.4% to 8.6%) patients. After adjusting for patient and visit characteristics, there was an increase in the utilization of advanced imaging (aRR 1.29; 95% confidence interval [CI], 1.17–1.41), blood tests (aRR 1.16; 95% CI, 1.10–1.22), urinalysis (aRR 1.22; 95% CI, 1.13–1.31), and visits where the patient received four or more medications (aRR 2.17; 95% CI, 1.88–2.46). Lastly, adjusted hospitalization rates declined (aRR 0.74; 95% CI, 0.64–0.84) while adjusted discharge rates increased (aRR 1.06; 95%CI 1.03–1.08).ConclusionFrom 2007 to 2016, ED care intensity appears to have increased modestly, including aging of patient population, increased illness severity, and increased resources utilization. The role of increased care intensity in the decline of ED hospitalization rate requires further study.

Main directions of optimization of recreation and health activities of the elderly

Recreational well-being in the elderly contributes to the preservation and enhancement of health, improving the adaptive capacity of their body, reducing the frequency of exacerbations of chronic diseases and improving the psycho-emotional sphere of man. The purpose of the research is to synthesize the basic directions of optimization of the recreational and health activity of elderly people on the basis of theoretical analysis. Research methods: study and analysis of scientific and methodological literature, induction and deduction, comparison and generalization. Results: On the basis of theoretical analysis of scientific and methodological literature and our own experience, we have synthesized the main directions of recreational and recreational activity of the elderly, namely: places of mass rest, University of the Third Age, All-Ukrainian Center for Physical Health of the Population "Sport for All", fitness -club, sanatorium and recreational establishments, health groups, interest groups in sports facilities, health groups in medical institutions. In places of mass recreation, namely in parks of culture and recreation, by place of residence, elderly people can engage in recreational and recreational activities without taking into account their social, material status. Within the walls of a third-century university, recreational and recreational activities are a form of cognition, education and socialization for students of this institution. The "Recreation and Recreation Activities for Older Age" also includes "Sport for All", which helps to engage people in physical activity during leisure activities to promote health. In health resorts and recreational establishments, recreational and recreational activities are implemented in the rest mode, taking into account his health status and recreational resource of the establishment.

EVALUATION OF THE GENERAL CLIMATE COMFORT IN THE VOLGA REGION, THE REPUBLIC OF ALTAI AND THE REPUBLIC OF KHAKASSIA

Introduction. The problem of the impact of climatic environmental factors on the state of public health and, as a consequence, the exacerbation of chronic diseases in meteosensitive people is considered. Aim of thу study to assess the overall comfort of the climate in the territories of the Volga region (Mari El Republic, Chuvash Republic, and Nizhny Novgorod Region), the Altai Republic and the Khakassia Republic. Material and methods. In order to identify interregional differences in the living conditions of the population, an assessment of the degree of overall climate comfort in the study areas were performed on the most significant climatic and bioclimatic indices. They include: the average temperature in the warm months (July, August) and the coldest month of the year (January), the number of contrasting changes of periods with the same type of weather, the index of weather variability, the severity weather of January by Bodman, the number of days with strong wind of six or more meters per second. Results. The obtained data on the degree of climate comfort was processed using a 5-point scale which highlighted the following intervals: values (Km) ranging from 3.51 to 5 - the most comfortable climatic conditions, (Km) values ranging from 2.86 to 3.5 - comfortable enough climatic conditions, (Km) values in the range from 2.3 to 2.85 - the least comfortable climatic conditions. Conclusions. On the territory of the Volga region, the Altai Republic, and the Khakassia Republic, there are two degrees of comfort conditions: the most comfortable and reasonably comfortable, non-voltage compensatory-adaptive mechanisms in people with diseases of the cardiovascular and respiratory systems. Climatic conditions are the risk factors for the development of cardiorespiratory disease and the burden of existing chronic diseases, their assessment is necessary for the development of preventive measures.

Health-Related Quality of Life of Nurses Working Night Shifts

Research justifcation. Physical and mental fatigue and emotional exhaustion experienced by night nurses are key factors affecting their health and quality of life. Sleeplessness not only increases the risk of various diseases, but also leads to an exacerbation of chronic diseases. The goal of research was to analyse the health-related quality of life of nurses working night shifts. The methods of research. Sixty night shift nurses were investigated. The 36-item Short Form Survey (SF-36) was used in the work. Statistical data was processed by using Microsoft Excel 2007 Spreadsheet and SPSS 17 for Windows. The survey was done in accordance with ethical principles. The results of research. Night nurses who used sleeping pills had low physical activity level; their duties were seriously restricted due to physical and emotional problems or physical pain. Moreover, they performed a lower social function and had worse health assessment in comparison with nurses who never or hardly ever took sedatives. The quality of life of night shift nurses was directly related to physical and psycho-emotional health. Physical activity was much better assessed by younger nurses than older ones, especially when comparing the 50–59-year-old nurses with other age groups; 30–39-year-old nurses were less restricted by pain; general health was evaluated better by 30–39-year-old nurses than the older ones. While evaluating the quality of life related to mental health, the radical difference was noticed in social function assessment based on the age of nurses, i.e. 30–39-year-old nurses assessed the social function better than the older ones. Conclusion. Physical and psycho-emotional health influences the quality of life of night shift nurses.Keywords: the quality of life, psycho-emotional health, physical health, sleep disorders, nursing.

Utility of FEV1/FEV6 index in patients with multimorbidity hospitalized for decompensation of chronic diseases.

Spirometry remains essential for the diagnosis of airway obstruction. Nevertheless, its performance in elderly hospitalized patients with multimorbidity can be difficult. The aim of this study is to assess the utility of the COPD-6 portable device in this population. We included all patients hospitalized for exacerbation of chronic diseases in a medical ward specialized in the care of multimorbidity patients, between September 2017 and May 2018. A questionnaire including sociodemographic, cognitive and functional impairment, among other variables, was completed the last day of admission. Subsequently, patients attempted to perform three valid respiratory manoeuvres with the COPD-6 device and then conventional spirometry. A total of 184 patients were included (mean age of 79.61 years, 55% men). Forty-seven (25.54%) patients were able to perform complete spirometric manoeuvres and 99 (53.8%) could perform a valid FEV1/FEV6 determination. The inability to perform a valid spirometry was related with the patient’s age, functional physical disability, cognitive impairment or the presence of delirium or dysphagia during admission. Only 9% of patients with a Mini Mental Cognitive Examination (MMEC) lower than 24 points could perform a valid spirometry. Of the patients with an MMEC < 24 points and unable to perform spirometry, 34% were able to complete the FEV1/FEV6 manoeuvres. No differences were found in the Charlson index, multimorbidity scale, number of domiciliary drugs, or length of stay between those patients able and those not able to perform respiratory manoeuvres. The agreement between the values for FEV1 measured with COPD-6 and those observed in the spirometry was good (r: 0.71; p<0.0001). Inability to perform a valid spirometry during hospitalization in elderly patients with multimorbidity is frequent and related with functional and cognitive impairment. FEV1/FEV6 determination using the COPD-6 portable device allows an important percentage of the patients with limitations to complete spirometric measurement.

Primary Palliative Care for Emergency Medicine (PRIM-ER): Protocol for a Pragmatic, Cluster-Randomised, Stepped Wedge Design to Test the Effectiveness of Primary Palliative Care Education, Training and Technical Support for Emergency Medicine

IntroductionEmergency departments (ED) care for society’s most vulnerable older adults who present with exacerbations of chronic disease at the end of life, yet the clinical paradigm focuses on treatment of...

Disaster-Related Shelter Surveillance During the Hurricane Harvey Response - Texas 2017.

Hurricane Harvey left a path of destruction in its wake, resulting in over 100 deaths and damaging critical infrastructure. During a disaster, public health surveillance is necessary to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The Centers for Disease Control and Prevention (CDC) and American Red Cross collaborate on shelter surveillance to monitor the health of the sheltered population and help guide response efforts. We analyzed data collected from 24 Red Cross shelters between August 25, 2017, and September 14, 2017. We described the aggregate morbidity data collected during Harvey compared with previous hurricanes (Gustav, Ike, and Sandy). Over one-third (38%) of reasons for visit were for health care maintenance; 33% for acute illnesses, which includes respiratory conditions, gastrointestinal symptoms, and pain; 19% for exacerbation of chronic disease; 7% for mental health; and 4% for injury. The Red Cross treated 41% of clients within the shelters; however, reporting of disposition was often missed. These results are comparable to previous hurricanes. The capacity of Red Cross shelter staff to address the acute health needs of shelter residents is a critical resource for local public health agencies overwhelmed by the disaster. However, there remains room for improvement because reporting remained inconsistent.

Improving the delivery of primary care for older people.

Improving the delivery of primary care for older people.

THE ANALYSIS OF FUNCTIONING OF MEDICAL COMMISSION OF THE LARGE HOSPITAL POLYCLINIC ASSOCIATION RELATED TO PROLONGATION OF MEDICAL CERTIFICATES

The feature of expertise of temporary disability is that expert decisions are considered according legislation as a basis of providing patients with various types of social protection and, in particular, exemption from work during acute period of disease. Since this is an issue of spending budget funds and extra-budgetary funds for these activities, all the procedures of expertise of temporary disability are regulated by legislative and regulatory acts that not always clearly define actions of doctors in various situations, and sometimes do not correspond to constantly changing conditions in the system of medical organizations functioning. The recent alterations in the legislative base led to a significant increase of burden on medical commission of the prolongation of medical certificates, which was already high enough due to appeals related to referral of patients to medical social expertise, medical examination of citizens, etc. The article presents the analysis of medical commission functioning of a large hospital-polyclinic association related to prolongation of medical certificates. The authors pursued the goal of identifying unfavorable trends in the medical commission functioning and identify ways to optimize it. The assessment of current status of the medical commission functioning demonstrated that prevention of injuries, especially domestic ones, as well as prevention of exacerbations of chronic diseases, including within the framework of dispensary observation of corresponding contingents of patients are of great importance for reducing the temporary disability of citizens.

Supported accommodation for people with schizophrenia

Background: As a result of deinstitutionalization of psychiatric treatment and care, many people with severe mental illness have been offered supported accommodation. However, research on this costly intervention in Norway has been scarce.Aims: The aim of this study was to prospectively investigate the clinical and demographic factors associated with allocation to supported accommodation for people with schizophrenia.Methods: The study was a prospective cohort study of 334 people with schizophrenia acutely admitted to Haukeland University Hospital between 2005 and 2010. Information concerning allocation to supported accommodation in their residential municipalities was collected retrospectively. Univariate and multivariate statistical methods were used to assess the association of clinical and demographical variables with allocation to supported accommodation.Results: Supported accommodation was allocated to 29.6% of the participants during the study period. Age, gender, implementation of compulsory mental health care, substance abuse, symptom burden and suicidality were not associated with allocation to supported accommodation. Functional impairment, especially difficulties with activities of daily living, experiencing exacerbation in the course of chronic disease, being medicated and of Norwegian origin, favoured supported accommodation.Conclusions: Our results supported the hypothesis that people with severe mental illness presenting the greatest need for supported accommodation, based on functional difficulties and exacerbation of chronic disease were allocated supported accommodation. Symptom burden was not associated with allocation.Clinical implications: Further research is needed to examine the impact of supported accommodation on the outcomes for people with schizophrenia.

The Future of Disaster Medicine is Based on Primary Care Involvement

Introduction:When disasters happen, people experience broad environmental, physical, and psychosocial effects that can last for years. Researchers continue to focus on the acute physical injuries and aspects of patient care without considering the person as a whole. People who experience disasters also experience acute injury, exacerbations of chronic disease, mental and physical health effects, effects on social determinants of health, disruption to usual preventative care, and local community ripple effects. Researchers tend to look at these aspects of care separately, yet an individual can experience them all at once. The focus needs to change to address all the healthcare needs of an individual, rather than the likely needs of groups. Mental and physical care should not be separated, nor the determinants of health. The person, not the population, should be at the center of care. Primary care, poorly integrated into disaster management, can provide that focus with a "business as usual" mindset. This requires comprehensive, holistic coordination of care for people and families in the context of their local community.Aim:To examine how Family Doctors (FDs) actually contribute to disaster response.Methods:Thirty-seven disaster-experienced FDs were interviewed about how they contributed to response and recovery when disasters struck their communities.Results:FDs reported being guided by the usual evidence-based care characteristics of primary practice. The majority provided holistic comprehensive medical care and did not feel they needed many extra clinical training or skills. However, they did wish to understand the systems of disaster management, where they fit in, and their link to the broader disaster response.Discussion:The contribution of FDs to healthcare systems brings strengths of preventative care, early intervention, and ongoing local surveillance by a central, coordinating, and trusted health professional. There is no reason to not include disaster management in primary care.

Pharmacists Transcend Disaster Health "Silos"

Introduction:Weather-related natural disasters are increasing in frequency and intensity, severely impacting communities. The patient demographic requiring assistance in a disaster is changing from acute traumas to chronic disease exacerbations. Adequate management requires a multidisciplinary healthcare approach. Pharmacists have been recorded in various disaster roles in literature. However, their roles within these disaster health teams are not well-established and do not fully utilize their skill sets.Aim:To identify where pharmacists roles are within the four phases of a disaster – prevention, preparedness, response, and recovery (PPRR), and to determine the barriers to pharmacists being better integrated into disaster teams.Methods:Semi-structured interviews were conducted with 28 international key stakeholders and pharmacists. Interviews were transcribed and analyzed using both open and axial manual coding, as well as the text-analytics software Leximancer®. The use of these two methods provided triangulation of methods for reliability of results. This research project was covered by QUT ethics approval number 1700000106.Results:The themes identified were community, government, "disaster management," "pharmacy," and "barriers and facilitators." The Leximancer® analysis compared the different disaster perspective and experience levels of the participants. The more experienced disaster health professionals who had worked closely with pharmacists believed they were capable of undertaking more roles in a disaster.Discussion:Pharmacists have been placed in the logistics "silo" for their role in disaster management supply chain operations. However, pharmacists have the expertise, knowledge, and skills which transcend this "silo" to work across the multiple health roles in disasters. Pharmacists are identified as a critical piece to the puzzle in the disaster management throughout the PPRR cycle. They are capable of undertaking more roles in disasters in addition to the established logistics role. The barriers identified need to be addressed for the better integration of pharmacists into disaster teams.

The compliance of patients under dispensary observation

The treatment compliance is a phenomenon actively studied, due to the proved significant impact on medical care effectiveness. Within the study framework, the treatment compliance in dispensary patients, its relationship with individual characteristics of patients and the effectiveness of dispensary observation were studied. The questionnaire survey in the format of face-to-face standardized interview was carried out. The questionnaire consisted of passport section to record social hygienic characteristics of patients. It also included questions concerning effectiveness of dispensary observation. The special section included the Morisky-Green scale to evaluate treatment compliance. The comparative analysis was implemented concerning the results of questionnaire survey, the data of dispensary observation control cards concerning time of planned visits and also data of outpatient medical records concerning prescriptions of medications. The statistical data processing was performed using software SPSS v. 22. The correlation coefficient was considered as significant at p<0.05. No correlation between individual characteristics of respondents and effectiveness of dispensary observation was established (p>0.05). No correlation between age, marital status, education, employment and treatment compliance according the Morisky-Green scale was established (p>0.05). The correlation coefficients were significant between treatment compliance according the Morisky-Green scale and well-being (r=0.46 p=0.003), fact of hospitalization because of exacerbation of chronic diseases (r=0.71, p<0,001), awareness of planned visit date (r=0.44, p=0,004) and fact of permanent application of medicinal therapy (r=0.62, p<0,001). The partial correlation was established between treatment compliance and planned visit date (r=0.27, p<0,001), fact of permanent application of medicinal therapy (r=0.06, p=0,73). However, partial correlation is absent in case of exclusion of such sign as fact of hospitalization. The negative correlation was established between treatment compliance and time period elapsed after hospitalization (r=-0.69, p<0,001).

Disaster-Related Surveillance Among US Virgin Islands (USVI) Shelters During the Hurricanes Irma and Maria Response.

Two Category 5 storms, Hurricane Irma and Hurricane Maria, hit the U.S. Virgin Islands (USVI) within 13 days of each other in September 2017. These storms caused catastrophic damage across the territory, including widespread loss of power, destruction of homes, and devastation of critical infrastructure. During large scale disasters such as Hurricanes Irma and Maria, public health surveillance is an important tool to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The USVI Department of Health (DoH) partnered with shelter staff volunteers to monitor the health of the sheltered population and help guide response efforts. Shelter volunteers collect data on the American Red Cross Aggregate Morbidity Report form that tallies the number of client visits at a shelter's health services every 24 hours. Morbidity data were collected at all 5 shelters on St. Thomas and St. Croix between September and October 2017. This article describes the health surveillance data collected in response to Hurricanes Irma and Maria. Following Hurricanes Irma and Maria, 1130 health-related client visits were reported, accounting for 1655 reasons for the visits (each client may have more than 1 reason for a single visit). Only 1 shelter reported data daily. Over half of visits (51.2%) were for health care management; 17.7% for acute illnesses, which include respiratory conditions, gastrointestinal symptoms, and pain; 14.6% for exacerbation of chronic disease; 9.8% for mental health; and 6.7% for injury. Shelter volunteers treated many clients within the shelters; however, reporting of the disposition (eg, referred to physician, pharmacist) was often missed (78.1%). Shelter surveillance is an efficient means of quickly identifying and characterizing health issues and concerns in sheltered populations following disasters, allowing for the development of evidence-based strategies to address identified needs. When incorporated into broader surveillance strategies using multiple data sources, shelter data can enable disaster epidemiologists to paint a more comprehensive picture of community health, thereby planning and responding to health issues both within and outside of shelters. The findings from this report illustrated that managing chronic conditions presented a more notable resource demand than acute injuries and illnesses. Although there remains room for improvement because reporting was inconsistent throughout the response, the capacity of shelter staff to address the health needs of shelter residents and the ability to monitor the health needs in the sheltered population were critical resources for the USVI DoH overwhelmed by the disaster. (Disaster Med Public Health Preparedness. 2019;13:38-43).

Сompatibility of Systemic Drugs and Local Antihypertensive Therapy in Patients with Primary Open-Angle Glaucoma (Analytical Review)

The review presents data of the most common comorbid diseases in patients with primary open-angle glaucoma, the features of local and general influence of antiglaucoma drugs, as well as information about the possible drug interactions of local antihypertensive and systemic medicines. Local antihypertensive drugs are often embedded in the daily patients regimen of systemic drugs use. Up to80 % of the active substances in ophthalmic drugs are absorbed systemically, while not subject to the primary stages of metabolism. Anti-glaucoma drugs can cause serious side effects: symptomatic bradycardia, various conduction disturbances in the heart muscle, orthostatic hypotension, syncope, dyspeptic symptoms, exacerbation of chronic diseases of the liver and kidneys, etc. In clinical studies, it was shown that the level of timolol in blood plasma correlates with the development of side effects from the cardiovascular system. In everyday ophthalmic practice, β-blockers are considered as drugs with a minimal number of adverse events, they are the most widely used in hypotensive glaucoma therapy. But another thing is also known: receptors for β-adrenergic blockers are present in almost all organs and tissues of the body. This circumstance determines the frequency, prevalence and nature of adverse events associated with β-blockers intake. with simultaneous systemic and topical application of β-blockers, mutual enhancement of effects is possible (additional IOP decrease and enhancement of β-adrenergic blocking effect on the cardiovascular system). If β₁-, β₂-adrenergic blockers and adrenergic psychotropic drugs should be used together with caution: the latter affect peripheral innervation, the α-adrenoblocking effect is most pronounced, resulting in a decrease in the strength of heart contractions, a drop in blood pressure until orthostatic hypotension develops. All mentioned above must be considered for choosing and prescribing antiglaucoma drugs. It increases compliance, patient’s quality of life and allows to stabilize the glaucomatous process.