ABSTRACT
Socio-economic determinants of health (SDoH) include various nonmedical factors in the socio-economic sphere with a potentially significant impact on health outcomes. Their effects manifest through several mediators/moderators (behavioral characteristics, physical environment, psychosocial circumstances, access to care, and biological factors). Various critical covariates (age, gender/sex, race/ethnicity, culture/acculturation, and disability status) also interact. Analyzing the effects of these factors is challenging due to their enormous complexity. Although the significance of SDoH for cardiovascular diseases is well documented, research regarding their impact on peripheral artery disease (PAD) occurrence and care is less well documented. This narrative review explores to what extent SDoH are multifaceted in PAD and how they are associated with its occurrence and care. Additionally, methodological issues that may hamper this effort are addressed. Finally, the most important question, whether this association may contribute to reasonable interventions aimed at SDoH, is analyzed. This endeavor requires attention to the social context, a whole systems approach, multilevel-thinking, and a broader alliance that reaches out to more stakeholders outside the medical sphere. More research is needed to justify the power in this concept to improve PAD-related outcomes like lower extremity amputations. At the present time, some evidence, reasonable consideration, and intuitive reasoning support the implementation of various interventions in SDoH in this field.
Subject(s)
Peripheral Arterial Disease , Humans , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/epidemiology , Peripheral Arterial Disease/therapy , Amputation, Surgical , Ethnicity , Socioeconomic FactorsABSTRACT
COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH.
Subject(s)
COVID-19/diagnosis , Cardiology , Cardiovascular Diseases/diagnosis , SARS-CoV-2/physiology , Anticoagulants/therapeutic use , COVID-19/epidemiology , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/epidemiology , Europe , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Inflammation , Practice Guidelines as Topic , Risk Factors , Rivaroxaban/therapeutic use , Societies, Medical , Thrombophilia , Thrombosis , COVID-19 Drug TreatmentABSTRACT
Se presenta la evaluación nutricional de 50 pacientes ingresados al Hospital por diversas causas. Se clasificaron los enfermos en eunutridos, desnutridos proteicos, calóricos o mixtos. Se analizan los resultados dividiendo los pacientes en agudos y crónicos. Se concluye que la desnutrición es un hallazgo frecuente en los internados, principalmente en los pacientes oncológicos y mayores de 65 años. El tiempo de internación está en relación directa
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Nutrition for Vulnerable Groups , Nutritional Status , InpatientsABSTRACT
Se presenta la evaluación nutricional de 50 pacientes ingresados al Hospital por diversas causas. Se clasificaron los enfermos en eunutridos, desnutridos proteicos, calóricos o mixtos. Se analizan los resultados dividiendo los pacientes en agudos y crónicos. Se concluye que la desnutrición es un hallazgo frecuente en los internados, principalmente en los pacientes oncológicos y mayores de 65 años. El tiempo de internación está en relación directa (AU)
