Implementation Of Evidence-based Policies Research Articles

Deaths from Excessive Alcohol Use - United States, 2016-2021.

Deaths from causes fully attributable to alcohol use have increased during the past 2 decades in the United States, particularly from 2019 to 2020, concurrent with the onset of the COVID-19 pandemic. However, previous studies of trends have not assessed underlying causes of deaths that are partially attributable to alcohol use, such as injuries or certain types of cancer. CDC's Alcohol-Related Disease Impact application was used to estimate the average annual number and age-standardized rate of deaths from excessive alcohol use in the United States based on 58 alcohol-related causes of death during three periods (2016-2017, 2018-2019, and 2020-2021). Average annual number of deaths from excessive alcohol use increased 29.3%, from 137,927 during 2016-2017 to 178,307 during 2020-2021; age-standardized alcohol-related death rates increased from 38.1 to 47.6 per 100,000 population. During this time, deaths from excessive alcohol use among males increased 26.8%, from 94,362 per year to 119,606, and among females increased 34.7%, from 43,565 per year to 58,701. Implementation of evidence-based policies that reduce the availability and accessibility of alcohol and increase its price (e.g., policies that reduce the number and concentration of places selling alcohol and increase alcohol taxes) could reduce excessive alcohol use and alcohol-related deaths.

Does teachers’ motivation have an impact on students’ scientific literacy and motivation? An empirical study in Colombia with data from PISA 2015

In this study we use data from the Programme for International Student Assessment (PISA) to investigate the effect of teachers’ motivation on students’ scientific literacy and motivation in Colombia. These relationships are explored using a multilevel modeling framework and through the lens of Self-Determination Theory. Although difficulties in achieving education quality in developing and emerging economies are commonly attributed to teacher motivation issues, and important policy measures are implemented based on this assumption, this topic remains largely empirically unexplored. The purpose of the study is to contribute to fill this gap and provide empirically based insights for a broader and more informed dialogue regarding the effect of motivation in the development of scientific literacy, and to the design and implementation of evidence-based policies, instructional practices, and interventions. In this analysis, we did not find a significant relationship between teacher motivation and either students’ scientific literacy or motivation. However, students’ interest in science and sense of self-efficacy were significantly associated with their own achievement. The results also show that teacher-directed instruction is the strongest predictor of scientific literacy as opposed to inquiry-based teaching. However, inquiry-based teaching was found to be a positive predictor of increased students’ motivation.

ANALISIS RENCANA PEMBANGUNAN JANGKA MENENGAH DAERAH KABUPATEN TUBAN TAHUN 2021-2026 DALAM PERSPEKTIF EVIDENCE BASED POLICY

The application of Evidence-Based in policy formulation and development planning in Indonesia is still new and important to be implemented to reduce the dominance of political interests and prioritize public interests in the policy-making process. The implementation of evidence-based policy is an urgency in the regional development planning agenda, especially in Tuban Regency. This study aims to understand the evidence-based policies that have been implemented in the RPJMD of Tuban Regency for 2021-2026. This type of research is descriptive qualitative research with a secondary data analysis method. The results showed that this planning document has implemented evidence-based planning development in Tuban Regency. However, the quality of evidence still needs to be improved, especially at the top level, which are the use of research and scientific articles to be considered in determining regional development policies. Evidence-based development can improve the accuracy of development programs and increase the effectiveness of policy implementation in implementing public services. With the awareness and willingness to implement evidence-based policy, stakeholders can use data and information as evidence that is more focused, concrete, grounded, and sensitive to society issues.

Correlates of substance misuse among college-going male students in Chandigarh

Background: The World Health Organization (WHO) defines substance misuse as “consistent or occasional use of a drug inconsistent with or unrelated to acceptable medical practice”. The implementation of evidence-based policies, rules, and interventions targeted at preventing substance abuse and promoting healthier campus settings can result from an understanding of the specific issues associated with substance mis-use among children, particularly college students. Methods: A cross-sectional study was conducted among 256 college students in Chandigarh, selected through stratified multi-stage random sampling. A self-administered, semi-structured, and validated questionnaire was used for collecting data. The data was analyzed using SPSS-26.0. Results: Out of 256 respondents, 157 (61.3%) reported not using any substance. The prevalence of substance use among them was found 38.7%. Among substance users, smoking was the most commonly used (82.8%) followed by drinking (75.7%) and chewing (26.2%). Inhaling was also emerging as substance misuse (4.0%). Prevalence rates among different disciplines varied significantly, law students (100.0%) followed by arts (40.0%), commerce (36.4%), medical (34.9%), and engineering (32.3%). Students irrespective of socio-demographic factors were at equal risk of substance misuse based on the logistic regression. Conclusions: Based on the study’s findings in demographics, it was determined that age, discipline, mother’s educational level, and current living situation have a significant association with substance misuse.

Relationship Between Physical Activity and Mental Health in Adults in Brazil

Purpose: The aim of the study was to investigate the relationship between physical activity and mental health in adults in Brazil.
 Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries.
 Findings: Research on the relationship between physical activity and mental health in adults consistently demonstrates a strong and positive association. Multiple studies have revealed that engaging in regular physical activity is linked to improved mental well-being. It has been found that individuals who participate in physical activity, such as aerobic exercises, walking, or sports, often experience reduced symptoms of anxiety, depression, and stress. Moreover, physical activity appears to enhance mood and self-esteem, contributing to better overall mental health. These findings underscore the significant role of exercise as a preventive and therapeutic measure for promoting mental well-being in adults.
 Unique Contribution to Theory, Practice and Policy: Self-Determination Theory (SDT), Social Cognitive Theory and Biopsychosocial Model may be used to anchor future studies on the relationship between physical activity and mental health in adults. Mental health practitioners should incorporate physical activity interventions into mental health treatment plans. policy level, governments and public health agencies should prioritize the development and implementation of evidence-based policies that promote physical activity as a means to improve mental health outcomes.

Application of human biomonitoring data to support policy development, raise awareness and environmental public health protection among countries within the HBM4EU project

Most countries have acknowledged the importance of assessing and quantifying their population's internal exposure from chemicals in air, water, soil, food and other consumer products due to the potential health and economic impact. Human biomonitoring (HBM) is a valuable tool which can be used to quantify such exposures and effects. Results from HBM studies can also contribute to improving public health by providing evidence of individuals' internal chemical exposure as well as data to understand the burden of disease and associated costs thereby stimulating the development and implementation of evidence-based policy. To have a holistic view on HBM data utilisation, a multi-case research approach was used to explore the use of HBM data to support national chemical regulations, protect public health and raise awareness among countries participating in the HBM4EU project. The Human Biomonitoring for Europe (HBM4EU) Initiative (https://www.hbm4eu.eu/) is a collaborative effort involving 30 countries, the European Environment Agency (EEA) and the European Commission (contracting authority) to harmonise procedures across Europe and advance research into the understanding of the health impacts of environmental chemical exposure. One of the aims of the project was to use HBM data to support evidence based chemical policy and make this information timely and directly available for policy makers and all partners. The main data source for this article was the narratives collected from 27 countries within the HBM4EU project. The countries (self-selection) were grouped into 3 categories in terms of HBM data usage either for public awareness, policy support or for the establishment HBM programme. Narratives were analysed/summarised using guidelines and templates that focused on ministries involved in or advocating for HBM; steps required to engage policy makers; barriers, drivers and opportunities in developing a HBM programme. The narratives reported the use of HBM data either for raising awareness or addressing environmental/public health issues and policy development. The ministries of Health and Environment were reported to be the most prominent entities advocating for HBM, the involvement of several authorities/institutions in the national hubs was also cited to create an avenue to interact, discuss and gain the attention of policy makers. Participating in European projects and the general population interest in HBM studies were seen as drivers and opportunities in developing HBM programmes. A key barrier that was cited by countries for establishing and sustaining national HBM programmes was funding which is mainly due to the high costs associated with the collection and chemical analysis of human samples. Although challenges and barriers still exist, most countries within Europe were already conversant with the benefits and opportunities of HBM. This article offers important insights into factors associated with the utilisation of HBM data for policy support and public awareness.

WASTAGE AND STAGNATION OF GOVERNMENT PRIMARY SCHOOLS IN MANIPUR: A CRITICAL ANALYSIS

Wastage and stagnation in government primary schools have been persistent concerns in the educational landscape of Manipur. This critical analysis aims to examine the causes and consequences of wastage and stagnation in government primary schools, shedding light on the complex factors that contribute to these issues. Through a comprehensive review of relevant literature and analysis of available data, this study explores the underlying causes of wastage and stagnation in government primary schools in Manipur. Factors such as low enrolment rates, high dropout rates, inadequate infrastructure, teacher shortages, and socio-economic disparities are identified as key contributors to the problem. Additionally, cultural and linguistic factors, lack of parental involvement, and ineffective pedagogical practices are also examined. The consequences of wastage and stagnation in government primary schools are multifaceted and far-reaching. Students who drop out or repeat grades are at a disadvantage in terms of their educational attainment and future prospects. The educational system as a whole suffers from inefficiencies and a lack of skilled human capital. The long-term socio-economic development of Manipur is hindered by the perpetuation of an undereducated workforce. To address these issues, a comprehensive approach is necessary. Strategies such as improving access to quality education, enhancing teacher training and support, strengthening community engagement, and addressing socio-economic disparities are crucial. Furthermore, the development and implementation of evidence-based policies and interventions tailored to the specific needs of Manipur's government primary schools are essential. This critical analysis emphasizes the urgency of addressing wastage and stagnation in government primary schools in Manipur. It highlights the need for collaborative efforts among government bodies, educational institutions, communities, and stakeholders to tackle this complex issue. By investing in the improvement of primary education, Manipur can nurture a generation of well-educated individuals equipped with the skills necessary for their personal growth and the overall development of the state. Further research should focus on evaluating the effectiveness of specific interventions aimed at reducing wastage and stagnation in government primary schools. Longitudinal studies tracking the educational trajectories of students and examining the long-term outcomes of interventions would provide valuable insights into the effectiveness of various strategies.

Comparison of Psychiatric Service Utilization Prior, During, and After COVID-19 Lockdown: A Retrospective Cohort Study.

Background COVID-19 pandemic represents a significant risk factor for developing, relapsing, or exacerbating pre-existing mental health conditions. This negative impact on mental health results in increasing demand for psychiatric services. This study aimed to explore the effects of COVID-19 pandemic lockdown on the utilization of mental health services in three periods - prior, during, and after the lockdown - compared to the matched weeks in the previous years 2018 and 2019. Materials and Method In this retrospective cohort, quantitative, single-center study, data were collected from electronic medical records, including all patients with referrals\consultations to the psychiatric section prior, during, and after COVID-19 lockdown. Results In total, 2,454 patients were either referred to psychiatric outpatient clinics or needed consultation as inpatients during the study periods. Only 2,326 patients were included in our study. The total number of inpatient consultations was 1,410, with a statistically significant increase during the lockdown (p-value<0.001) and post-lockdown (p<0.016) in comparison to previous years. A significant reduction in outpatient referrals was observed during the lockdown (p=0.005) and post-lockdown period. Psychiatric disorders were identified in most patients (N=1,599), representing 65%, 54%, and 74% of patients in pre-lockdown, lockdown, and post-lockdown periods compared to 71%, 71%, and 76%, respectively, in the previous years. A total of 821 patients manifested symptoms of depression, constituting the largest proportion among all reasons for referral\consultations. The number of patients referred for substance/alcohol use disorders during the lockdown increased compared to patients in the same period in 2019. Suicidal behavior was identified in 70 patients across all study periods, with the lowest number observed in 2020. Conclusion Our findings indicate that during the COVID-19 lockdown, a significant increase in inpatient psychiatric services utilization was observed. Outpatient psychiatric service utilizations were significantly reduced. Implementation of evidence-based policy and protocol to guide mental health challenges in future health emergencies is needed.

Patient outcomes in public sector hepatitis C treatment programmes: a retrospective cohort analysis across five low- and middle-income countries

ObjectivesGiven limited data on factors associated with hepatitis C virus (HCV) treatment discontinuation and failure in low- and middle-income countries, we aimed to describe patient populations treated for HCV in...

Cervical cancer programme, Kenya, 2011-2020: lessons to guide elimination as a public health problem.

BackgroundCervical cancer is the leading cause of cancer mortality in Kenya, with an estimated 3,200 deaths in 2020. Kenya has implemented cervical cancer interventions for more than a decade. We describe the evolution of the cervical cancer programme over the last 20 years and assess its performance.MethodsWe searched the Ministry of Health’s archives and website (2000–2021) for screening policy documents and assessed them using seven items: situational analysis, objectives, key result areas, implementation framework, resource considerations, monitoring and evaluation and definition of roles/responsibilities. In addition, a trend analysis was performed targeting screening and disease burden indicators in the period 2011–2020, using data from Kenya Health Information System and the Global Burden of Disease database.FindingsPolicy guidance improved over time, but the implementation of screening was poor. Before 2016, a clear leadership and accountability structure was lacking; improvement occurred after the establishment of the National Cancer Control Program. The main health system gaps included the lack of a trained healthcare workforce and poor data collection. Annual screening coverage varied between <1% and 36% of the target population for the year for HIV-negative women and between <1% and 7% for HIV-positive women, from 2011 to 2020. Test positivity for visual inspection with acetic acid was below 5% for most of the period. Compliance to treatment of precancerous lesions ranged between 22% and 39%. The detection rate of cervical cancer ranged between 0.5% and 1.0%. The burden of invasive cervical cancer did not change significantly: world age-standardised incidence and mortality rates of 26.3–27.4 and 16.6–18.0/100,000 women-years, respectively; disability-adjusted life years of 579–624/100,000 life years.ConclusionThe Kenyan cervical cancer control programme suffered from inadequate health system strengthening and poor quality implementation. Evidence-based policy implementation and sustained health system strengthening are necessary to move towards cervical cancer elimination as a public health problem.

Burden of diseases and injuries attributable to risk factors in the European Union in 2019

Abstract Background In addition to information on mortality and morbidity from diseases and injuries, it is important to identify the attributable burden of risk factors to allow for health planning and prioritization. Methods For the whole EU and each country, using estimates and 95% uncertainty intervals from the GBD 2019 study, we report attributable (all-cause and by level 2 risk factors) age-standardized death and DALY rates, as well as summary exposure values (SEV). We evaluate trends by comparing estimates for the year 2019 with those for the year 2010. Results Age-standardized death and DALY rates attributable to risk factors declined by 10.7% (95%UI 13.8%-7.6%) and 9.1% (95%UI 12.0%-6.3%), between 2010 and 2019 in the EU. While there was a decreasing trend for both age-standardized death and DALY rates for almost all risk factors, some showed an increasing trend on SEV, including low physical activity and intimate partner violence. Conclusions Despite the improvement of health metrics attributable to risk factors, several modifiable behavioral and metabolic risk factors remain unchanged over the years. It is crucial to ensure a swift implementation of evidence-based policies and interventions in EU member states to achieve the targets of the Sustainable Development Goals.

Impact of the COVID-19 Pandemic on Child and Adolescent Mental Health Policy and Practice Implementation.

Background: The impact of the 2019 coronavirus pandemic on the mental health of millions worldwide has been well documented, but its impact on prevention and treatment of mental and behavioral health conditions is less clear. The COVID-19 pandemic also created numerous challenges and opportunities to implement health care policies and programs under conditions that are fundamentally different from what has been considered to be usual care. Methods: We conducted a qualitative study to determine the impact of the COVID-19 pandemic on implementation of evidence-based policy and practice by State Mental Health Authorities (SMHA) for prevention and treatment of mental health problems in children and adolescents. Semi-structured interviews were conducted with 29 SMHA representatives of 21 randomly selected states stratified by coronavirus positivity rate and rate of unmet services need. Data analysis with SMHA stakeholders used procedures embedded in the Rapid Assessment Procedure—Informed Community Ethnography methodology. Results: The need for services increased during the pandemic due primarily to family stress and separation from peers. States reporting an increase in demand had high coronavirus positivity and high unmet services need. The greatest impacts were reduced out-of-home services and increased use of telehealth. Barriers to telehealth services included limited access to internet and technology, family preference for face-to-face services, lack of privacy, difficulty using with young children and youth in need of substance use treatment, finding a Health Insurance Portability and Accountability Act (HIPAA)-compliant platform, training providers and clients, and reimbursement challenges. Policy changes to enable reimbursement, internet access, training, and provider licensing resulted in substantially fewer appointment cancellations or no-shows, greater family engagement, reduction in travel time, increased access for people living in remote locations, and increased provider communication and collaboration. States with high rates of coronavirus positivity and high rates of unmet need were most likely to continue use of telehealth post-pandemic. Despite these challenges, states reported successful implementation of policies designed to facilitate virtual services delivery with likely long-term changes in practice. Conclusions: Policy implementation during the pandemic provided important lessons for planning and preparedness for future public health emergencies. Successful policy implementation requires ongoing collaboration among policy makers and with providers.

Economía del comportamiento, políticas conductuales y nudges

Las políticas conductuales, en general, y los nudges, en particular, forman parte de la caja de herramientas que nos permite mejorar el diseño y la aplicación de políticas basadas en la evidencia. Las propuestas de las nuevas ciencias del comportamiento son un complemento de las más tradicionales basadas en incentivos. En este artículo discuto tres ámbitos de aplicación de las políticas conductuales, así como su relación con intervenciones más clásicas, en situaciones que incorporan un nivel de complejidad creciente. Primero, me detendré en situaciones donde nos enfrentamos a problemas de decisión individual. Segundo, en situaciones que tienen en cuenta a otras personas. Por último, abordaré situaciones donde existe interacción social entre personas.

Nigeria, a high burden state of obstetric fistula: a contextual analysis of key drivers.

Obstetric fistula (OF) remain a source of public health concern and one of the most devastating maternal morbidities afflicting about two million women, mostly in developing countries. It is still prevalent in Nigeria due to the existence of socio-cultural beliefs/practices, socio-economic state and poor health facilities. The country's estimated annual 40,000 pregnancy-related deaths account for about 14% of the global maternal mortality, placing it among the top 10 most dangerous countries in the world for a woman to give birth. However, maternal morbidities including OF account for 20 to 30 times the number of maternal mortalities. This review substantiates why OF is yet to be eliminated in Nigeria as one of the countries with the largest burden of obstetric fistula. There is need for coordinated response to prevent and eliminate this morbidity via political commitment, implementation of evidence-based policy and execution of prevention programs.

Explaining variation in evidence-based policy making in the American states

Background: Though evidence-based policy (EBP) has attracted considerable attention from the public, academics, and governments, prior studies have revealed little about how political parties, institutions, and policy context shape the adoption and implementation of these policies in the American states. Aims and objectives: Develop objective criteria for measuring these policies, as well as a hierarchy which describes the features that make some policies more advanced. This paper presents the first comprehensive study on EBP in the American states. Methods: Using assessments by the Pew and MacArthur foundations to measure EBP in the states for four topics: criminal justice, juvenile justice, behavioural health, and child welfare. Assess the relationship between EBP use and state political and institutional factors. Results: Democratic governors, Republican legislatures, state innovativeness are significant predictors of EBP engagement. Discussion and conclusions: This research makes a substantial contribution to the study of EBP and opens new avenues for future research on the political, cultural, and institutional factors that influence EBP adoption and implementation. In an era of extreme partisanship, our study finds that EBP is a policy niche where actors and institutions across political parties use research evidence to inform effective and efficient policies in ways that maximise the electoral incentives that such policies can offer.

Advancing public health policy making through research on the political strategies of alcohol industry actors.

Development and implementation of evidence-based policies is needed in order to ameliorate the rising toll of non-communicable diseases (NCDs). Alcohol is a key cause of the mortality burden and alcohol policies are under-developed. This is due in part to the global influence of the alcohol industry. We propose that a better understanding of the methods and the effectiveness of alcohol industry influence on public health policies will support efforts to combat such influence, and advance global health. Many of the issues on the research agenda we propose will inform, and be informed by, research into the political influence of other commercial actors.

Challenges to the implementation of malaria policies in Malawi

BackgroundDespite malaria prevention initiatives, malaria remains a major health problem in Malawi, especially for pregnant mothers and children under the age of five. To reduce the malaria burden, Malawi established its first National Malaria Control Programme in 1984. Implementation of evidence-based policies contributed to malaria prevalence dropping from 43% in 2010 to 22% in 2017. In this study, we explored challenges to implementing malaria policies in Malawi from the perspective of key stakeholders in the country.MethodsIn this qualitative study, we conducted in-depth interviews with 27 key informants from April to July 2015. We stopped sampling new participants when themes became saturated. Purposive and snowballing sampling techniques were used to identify key informants including malaria researchers that were policy advisors, policy makers, programme managers, and other key stakeholders. Interviews were conducted in English, recorded and transcribed, and imported into QSR Nvivo 11 for coding and analysis. Data were analysed using the qualitative content analysis approach.ResultsParticipants identified three main categories of challenges to the implementation of malaria policies. First structural challenges include inadequate resources, unavailability of trained staff, poor supervision and mentorship of staff, and personnel turnover in government. The second challenge is unilateral implementation of policies. The third category is the inadequately informed policy development and includes lack of platforms to engage with communities, top-down approach in policy formulation and lack of understanding of socio-cultural factors affecting policy uptake by communities.ConclusionsPolicy makers should recognize that inadequate support of policy objectives leads to an implementation gap. Therefore, policy development and implementation should not be viewed as distinct, but rather as interactive processes shaping each other. Support for health policy and systems research should be mobilized to strengthen the health system. Detailed assessment of implementation challenges to specific malaria policies should also be conducted to address these challenges and support the shift from the paradigm of malaria prevention and control to elimination in Malawi.

CDC's Prevention Status Reports: Monitoring the Status of Public Health Policies and Practices for Improved Performance and Accountability.

Increasing the adoption and implementation of evidence-based policies and practices is a key strategy for improving public health. Although there is widespread agreement about the importance of implementing evidence-based public health policies and practices, there are gaps between what has been shown to be effective and what is implemented at the state level. The Centers for Disease Control and Prevention (CDC) developed the Prevention Status Reports (PSRs), a performance measurement system, to highlight evidence-based public health policies and practices and catalyze state performance and quality improvement efforts across the nation. CDC selected a set of 10 topics representing some of the most important public health challenges in the nation. Stakeholders, including state health departments and other partners, helped conceptualize the PSRs and informed the development of the PSR framework, which provides an organizational structure for the system. CDC subject matter experts developed criteria for selecting policies and practices, indicators for each policy and practice, and a criteria-based rating system for each indicator. The PSRs were developed for all 50 states and the District of Columbia. The PSRs were developed and serve as a performance measurement system for monitoring the adoption, reach, and implementation fidelity of evidence-based public health policies and practices nationwide. The PSRs include 33 policy and practice indicators across the 10 health topics. They use a simple 3-level rating system-green, yellow, and red-to report the extent to which each state (and the District of Columbia) has implemented the policy or practice in accordance with supporting evidence or expert recommendations. Results from aggregate analyses show positive change or improvement. The PSRs are a unique part of CDC's work to improve the performance and accountability of the public health system, serving as both a monitoring tool and a call to action to improve health outcomes. The PSRs can be used to track the reach of and fidelity to evidence-based policies and practices nationally over time, as well as inform state efforts to improve their use of evidence-based policies and practice.

Outcome of Evidence-based Allocation of Single-dose Antibiotic extended to Three-dose Antibiotic Prophylaxis in Surgical Site Infection

Abstract Aim: To study the outcome of evidence-based allocation of single-dose antibiotic extended to three-dose antibiotics prophylaxis in surgical site infection (SSI). Materials and methods: A total of 183 clean surgical procedures in all age groups and of both genders with encountered comorbidities were included in the study. Surgical procedures like inguinal hernia, primary vaginal hydrocele, congenital hernia and hydrocele, fibroadenoma, and other surface swellings were targeted procedures. These procedures were of &lt;1 hour duration and American Society of Anesthesiologists (ASA) grades I and II in study population. Ceftriaxone with sulbactam 1.5 gm was prophylactic antibiotic given 1 hour prior to incision. Excess local signs for inflammation were observed strictly for extension of antibiotics to three doses or multiple doses. Results: Success of evidence-based policy of randomization to single or three doses was 76.5% in all patients, and converting to three doses was 85.7%. Favorable outcome was seen in the patients with comorbidities—76.19% in hypertension, 57.14% in diabetes, and 28.57% in obesity. Only 14.3% of overall patients required extended multiple dose antibiotic therapy, which clearly projects that evidence-based policy implementation was effective in reducing number of doses. Conclusion: Evidence-based flexible antibiotic dose is effective in commonly performed procedures even with comorbidities. Flexibility depending on local signs to modify dose policy gives piece of mind with excellent outcome. Clinical significance: Adopting flexible antibiotic dosing reduces cost of antibiotics therapy with positive mindset for accepting reduced numbers of doses without affecting the outcome of surgical procedure.

Reducing the Global Burden of Cardiovascular Disease, Part 1: The Epidemiology and Risk Factors.

Current global health policy goals include a 25% reduction in premature mortality from noncommunicable diseases by 2025. In this 2-part review, we provide an overview of the current epidemiological data on cardiovascular diseases (CVD), its risk factors, and describe strategies aimed at reducing its burden. In part 1, we examine the global epidemiology of cardiac conditions that have the greatest impact on CVD mortality; the predominant risk factors; and the impact of upstream, societal health determinants (eg, environmental factors, health policy, and health systems) on CVD. Although age-standardized mortality from CVD has decreased in many regions of the world, the absolute number of deaths continues to increase, with the majority now occurring in middle- and low-income countries. It is evident that multiple factors are causally related to CVD, including traditional individual level risk factors (mainly tobacco use, lipids, and elevated blood pressure) and societal level health determinants (eg, health systems, health policies, and barriers to CVD prevention and care). Both individual and societal risk factors vary considerably between different regions of the world and economic settings. However, reliable data to estimate CVD burden are lacking in many regions of the world, which hampers the establishment of nationwide prevention and management strategies. A 25% reduction in premature CVD mortality globally is feasible but will require better implementation of evidence-based policies (particularly tobacco control) and integrated health systems strategies that improve CVD prevention and management. In addition, there is a need for better health information to monitor progress and guide health policy decisions.