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By: I. Hogar, M.A., M.D.

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More details on the exact definition of these concepts are available at blood pressure medication good for kidneys cheap atenolol 50mg visa. Complete projects refer to construction or civil projects completed in recipient countries supported by Chinese grants or interest-free loans diastolic blood pressure 0 atenolol 100mg sale. Shared Responsibilities for Health: A Coherent Global Framework for Health Financing pulse pressure definition medical generic 50 mg atenolol amex. Consultative Expert Working Group on Research and Development: Financing and Coordination prehypertension blood pressure symptoms cheap atenolol 50mg on-line. Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination. Evidence suggests that the likelihood of pandemics has increased over the past century because of increased global travel and integration, urbanization, changes in land use, and greater exploitation of the natural environment (Jones and others 2008; Morse 1995). Significant policy attention has focused on the need to identify and limit emerging outbreaks that might lead to pandemics and to expand and sustain investment to build preparedness and health capacity (Smolinsky, Hamburg, and Lederberg 2003). The international community has made progress toward preparing for and mitigating the impacts of pandemics. International donors also have begun to invest in improving preparedness through refined standards and funding for building health capacity (Wolicki and others 2016). Despite these improvements, significant gaps and challenges exist in global pandemic preparedness. Multiple outbreaks, notably the 2014 West Africa Ebola epidemic, have exposed gaps related to the timely detection of disease, availability of basic care, tracing of contacts, quarantine and isolation procedures, and preparedness outside the health sector, including global coordination and response mobilization (Moon and others 2015; Pathmanathan and others 2014). These gaps are especially evident in resource-limited settings and have posed challenges during relatively localized epidemics, with dire implications for what may happen during a full-fledged global pandemic. For the purposes of this chapter, an epidemic is defined as "the occurrence in a community or region of cases of an illness. A pandemic is defined as "an epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people" (Porta 2014). Pandemics are, therefore, identified by their geographic scale rather than the severity of illness. This chapter does not consider endemic diseases- those that are constantly present in particular localities or regions. Additionally, given the lack of historical data and extreme uncertainty regarding bioterrorism, this chapter does not specifically consider bioterrorism-related events, although bioterrorism could hypothetically lead to a pandemic. In these contexts, outbreak response measures such as quarantines have sparked violence and tension between states and citizens. However, there are also common prerequisites for effective preparedness and response. This is a tenable strategy during localized outbreaks, but global surge capacity has limits that likely will be reached during a full-scale global pandemic as highercapacity states focus on their own populations. Because the definition of pandemic primarily is geographic, it groups together multiple, distinct types of events and public health threats, all of which have their own severity, frequency, and other disease characteristics. Each type of event requires its own optimal preparedness and response strategy; however this chapter also discusses common prerequisites for effective response. The variety of pandemic threats is driven by the great diversity of pathogens and their interaction with humans. Pathogens vary across multiple dimensions, including the mechanism and dynamics of disease transmission, severity, and differentiability of associated morbidities. These and other factors determine whether cases will be identified and contained rapidly or whether an outbreak will spread (Fraser and others 2004).

The torture this man evokes on himself adds tremendously to the tone of the story heart attack 86 years old generic atenolol 100 mg mastercard. Just as Poe creates an eerie arrhythmia fatigue purchase atenolol american express, intense blood pressure pictures buy cheap atenolol 50mg online, and twisted tone to his fiction pulse pressure tamponade purchase atenolol visa, authors can lead their readers to feel certain emotions through their writing. I personally have been frightened, brought to tears, extremely angry, and have laughed out loud simply by the way an author creates the tone of a story. I recall one work I read by Edgar Allen Poe called the Telltale Heart, which has a bizarre, twisted tone. However, the tone of the story became strange when the tenant stares at his landlord while he sleeps. Sample 1 Score Tone is like when the writor makes you feel good when you read books. In the novel, the Lord of the Flies, by William Golding, a group of boys are stranded on a remote island to fend for themselves. I feel as if the producers of the popular television show "Survivor" used this novel as the framework of their show. When the show "Survivor" premiered, I immediately thought of the novel the Lord of the Flies. The novel is about a group of schoolboys who are shipwrecked on a deserted island. The boys attempt to create a "civilization," but 147 501 Writing Prompts ultimately transform into mere savages. There is a true need for structure and control in any society, but the means of that control makes this novel all the more interesting. Some of the other boys such as Simon and Piggy try to do what is safe and conservative. Throughout the novel, the boys engage in a power struggle and end up destroying one another. Similar to the television show "Survivor", the boys hold council meetings, use objects as a symbol of strength, and use fire as a symbol of hope. I remember watching the show and observing a contestant who won a physical contest against the other players. Alliances were formed and these alliances pitted the contestants against each other. Ultimately the winner was the most cunning player who could convince the other members to follow them. Sample 4 Score In William Goldings the Lord of the Flies, I can draw many parallels between the group of boys in the story and the basis for the television show "Survivor". In "Survivor", contestants are forced to live together on a deserted island for a prolonged period of time. I think the show "Survivor" and the Lord of the Flies tell about human nature and how societies are formed. Sample 1 Score I like survivor on tv and it reminds me of that book about the boys who were the lords of the flies. In the book, boys have to come together to live on an island which is like castaway. Using a specific literary work, explain how a novel might influence change in society. Sample 6 Score Have you ever read a story that ultimately changed the way in which you thought about the world So often we form our opinions and lifestyles from our families and what we observe around us. I was raised to accept people for their differences and judge people solely on their character. In her novel, Lee makes it apparent that the color of skin was a determinant of social stature, no matter your character. I felt that having a first person narrator, told from the perspective of a young girl in the South was a brilliant way to tell this story.

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Examples of public health actions range from the need to pay for sewers and waterworks to the need to enact and enforce restrictions on tobacco arteriogram definition generic atenolol 100 mg overnight delivery, food labeling blood pressure higher at night buy cheapest atenolol and atenolol, and road safety what us prehypertension purchase 100 mg atenolol with visa. Solutions are often political arteria lingual purchase cheap atenolol, and vertical approaches are only partial responses. The inability to sustain a local consensus and to mobilize community buy-in regarding the health risks leads to difficulty in imposing the measures needed to control health threats. Essential Public Health Functions To improve public health functioning, between 1989 and 1994, groups at the Centers for Disease Control and Prevention and the U. Public Health Service developed a list of 10 essential public health functions to benchmark the quality of practice in public health agencies (Dyal 1995). The consensus was that country health ministries and regional offices needed to define nationallevel lists of functions and items deemed essential and that the lists should be country specific (Bettcher, Sapirie, and Goon 1998). Countries and regions have adapted their own priority lists of essential public health functions on the basis of local stakeholder input (Bishai and others 2016). Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Engage in disaster preparedness to reduce the impact of emergencies and disasters on health. The best community health platforms successfully make their populations healthy by understanding what constitutes health threats and by sharing this information with community members from multiple sectors. Community health platforms mobilize parts of a coherent solution using the strengths and resources present in the community. Health Care and Health Facilities the care of the sick and the delivery of health commodities are integral parts of public health practice and are parts of the work plan of community health platforms. When community health platforms fulfill their Community Platforms for Public Health Interventions 269 mandate to provide essential public health functions like those mentioned earlier, interventions based in facilities and involving community health workers become integrated and sustained by local support and action. The likelihood that community engagement will result in improved health outcomes depends on many factors. Cyril and others (2015) identified the following components of success: engaging in real power sharing, building collaborative partnerships, providing bidirectional learning, incorporating the voice and agency of beneficiary communities in research protocol, and using multicultural health care workers for intervention delivery. Draper, Hewitt, and Rifkin (2010) suggested a continuum of process measures for use in evaluating community participation in a health system context (table 14. Measuring health outcomes associated with community participation can be difficult, but community participation in public health generally leads to improvements in health knowledge, service quality, and health-related outcomes (Kenny and others 2013; Russell and others 2008). The degree to which a community health platform is high functioning lies along a continuum. At the other end is facilitation of an active community through an engagement platform whereby communities are informed and enabled to take shared responsibility for addressing their changing health risks and concerns (Beracochea 2015; Cyril and others 2015; Dooris and Heritage 2013; Draper, Hewitt, and Rifkin 2010; George and others 2015; McCoy, Hall, and Ridge 2012; Raeburn and others 2006; Rosato and others 2008; Russell and others 2008). The breadth of the literature on community health platforms demonstrates the range of ways that the Table 14. Local leadership does not necessarily try to widen the decision-making base in the community. Values for collaboration Collaborative decision making occurs between health professionals and community leaders. Values for empowering Program is led by community members who are selected through a representative process. Partnerships between communities and health professionals are created and institutionalized. Professionals facilitate, and the community defines priorities and manages the program. Activities reflect community priorities and involve local people and existing community organizations. Funding comes from outside the community and is controlled by health professionals. Values for collaboration Women actively participate in some aspects of the program, but they have minor decisionmaking roles. The majority of funding comes from outside the community, but local people are asked to contribute time, money, and materials.

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Die Welt thus maintained its position as one of the newspapers in our sample most focused on the detail of policy debates hypertension yoga poses cheap atenolol 50mg amex. This increased prominence can largely be explained by the strong focus on smuggling/trafficking as the key target for a political response blood pressure of 120/80 purchase 50mg atenolol amex. However blood pressure medication memory loss order atenolol 100mg amex, it has to be noted that the focus on combating people smugglers was not necessarily endorsed by the paper itself blood pressure kit target buy atenolol 50 mg online. For instance, an opinion piece on 25 April 2015 argued: the sea rescue operation will not improve the situation substantially, because the radius of operation-in difference to the previous Mare Nostrum mission-is too small. The more intensive fight against traffickers will- should it succeed at all-not reduce the rush of refugees: People will look for a different route to Europe. Only two out of 17 mentioned the impact of wars or conflict and none mentioned poverty or other economic factors. Here the most prominent solutions were to take action against smugglers (up to 35. There was also substantial space given over to arguments for taking in more refugees or creating more legal routes for migration. Die Welt also featured three articles where conflict resolution was discussed as a solution to the conflict. The issue of foreign policy and how it might help resolve the conflict was also discussed in two articles. In line with the Spanish coverage, German reporting of the conflict was again not heavily focused on domestic political sources and did not generate a great deal of national political controversy. The decision not to politic over the issue probably reflects the fact that, due to historical factors, there is marked unwillingness on the part of mainstream German politicians to take a hard line against immigration and asylum issues. The rise of far-right groups such Pegida and the fire bombings of refugee homes indicate that extreme anti-immigrant views are not uncommon. Furthermore, there continued to be a dearth of discussion of how to address the push factors which were driving population movements, although this later sample did see a greater focus on policy responses. There was relatively little in the way of analysis or a deeper engagement with key debates. It was more likely than the other newspapers to feature extended discussion of refugee perspectives and also more likely to focus on issues such as how best to integrate refugees into German society, though coverage in this news sample was more focused on events in the Mediterranean (as opposed to Germany) than the earlier one. It also featured fewer migrant and refugee perspectives than the other two newspapers. It is published seven days a week and follows a classic tabloid format with a focus on entertainment and celebrity news, crime, sport, culture and comment. Both papers have stated editorial positions as independent liberal and are owned by the Bonnier Group, the dominant actor on the Swedish newspaper market. In all of the articles the refugee crisis is, however, the main theme and the issue was primarily covered in opeds (5 articles) and in-depth news features (4 articles). The editorial stance adopted by Aftonbladet is clearly stated in their editorial pieces. The editorials repeatedly called for compassion and understanding on the part of European citizens and action on the part of European leaders. In some cases the criticism took on the form of emotional indignation, and harsh language was sometimes used. The reporter went on to argue that `the awful truth is that many European leaders see the dangerous boat trips as a way to discourage other refugees from taking this route into Europe. Furthermore, the editorials often took an emotional and personal tone, which highlighted the sentiments of the individual journalist: I think of how many of them must have been trapped below deck. She highlighted the efforts of the Swedish Church, along with other European churches, working on the ground in the conflict zones and argued that they should be part of the immediate priority to build stronger and more effective rescue systems and relief aid. This pattern of sourcing indicates that journalists in Sweden increasingly turned to other journalistic sources in their foreign correspondence, as a consequence of recent cutbacks within the newspaper industry in Sweden. Economic restructuring has led to a drastic cut in the numbers of foreign correspondents, which has forced journalists to increasingly rely on news agencies or other journalists from competing news media to act as sources for their stories. This tendency indicates how at this point in time, before the surge in refugees arriving in Sweden via over land routes (August-September 2015), the matter was still considered primarily an international rather than a domestic issue.

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In monitoring progress hypertension 15090 cheap atenolol 50 mg on-line, including the effect of efforts to reach the Sustainable Development Goals heart attack buck generic atenolol 100mg with amex, priority should be given to Economic Burden of Chronic Ill Health and Injuries for Households in Low- and Middle-Income Countries 137 evaluating changes in financial protection among the population as a whole as well as within subgroups most at risk of catastrophic and impoverishing health expenditure heart attack one direction lyrics order atenolol online pills. In designing financial protection programs prehypertension 126 discount atenolol 100 mg with mastercard, policy makers need to give priority to covering populations and conditions associated with the greatest economic burden. Furthermore, needed health care services still remain out of reach for millions with disease who live in poverty. Strategies to enhance financial protection need to be implemented alongside broader poverty alleviation efforts, which collectively will generate the greatest gains in mitigating the household-level economic burden of chronic ill health globally. These types of studies, although few, have helped identify the determinants of recovery from an illness shock as well as factors that potentially enhance resilience to such shocks (Essue and others 2012; Heeley and others 2009; Jan and others 2015; Jan and others 2016; Kimman and others 2015). Prospective studies will also help distinguish between the effect and consequences of one shock versus cumulative expenditure as well as the potential for health interventions to improve household economic circumstances (Essue and others 2014; Kuper and others 2010). Therefore, declines over time do not necessarily mean that health care has become more affordable for all. Furthermore, the long-term effect on households of impoverishing health expenditure, distressed financing arrangements, changes in workforce participation, and treatment discontinuation are poorly understood. Such studies would support the design of financial protection programs and improve the targeting of interventions, because these indicators provide greater insights into the effect of illness and health care expenditure on the household economy. Although the effect of the social determinants of health is well understood (Friel and Marmot 2011), longer-term cohort studies are needed to assess how these economic consequences perpetuate the cycle of chronic ill health and social disadvantage (van Doorslaer and others 2006). Evidence on the link between the economic burden of disease, health outcomes, and social disadvantage would strengthen the economic case for improving access to affordable care. Search Strategy for Prospectively Designed Studies of Household Economic Effect of Chronic Disease. We also acknowledge the contribution of Melanie Bisnauth, who provided research assistance to support the analysis in this chapter. Economic Burden of Chronic Ill Health and Injuries for Households in Low- and Middle-Income Countries 139 Dalal, K. The Out-of-Pocket Burden Associated with Managing Chronic Obstructive Pulmonary Disease in Western Sydney, Australia. Price, Availability, and Affordability: An International Comparison of Chronic Disease Medicines. Cairo: World Health Organization Regional Office for the Eastern Mediterranean and Health Action International. Evidence from a Multi-Centre Intervention Study Conducted in Kenya, the Philippines, and Bangladesh. Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation. Economic Burden of Chronic Ill Health and Injuries for Households in Low- and Middle-Income Countries 141 Patel, V. The World Health Report: Health Systems Financing: the Path to Universal Coverage. From Burden to "Best Buys": Reducing the Economic Impact of Non-Communicable Diseases in Lowand Middle-Income Countries. However, cost-effectiveness is not the only important criterion for policy choice; sustainability, equity, and affordability, among others, also matter. Nevertheless, cost-effectiveness provides a useful and comprehensible reference point. Systematic searches were conducted in six major health areas, supplemented by expert surveys and existing published systematic surveys and reviews (Gaziano and others 2017; Holmes and others 2017b; Horton and Gauvreau 2015; Horton and Levin 2016; Levin and Chisholm 2015; Prinja and others 2015). The surveys covered literature from 2000 to mid2013 published in English, because the literature before 2000 had been reviewed previously (Laxminarayan, Chow, and Shahid-Salles 2006). Further details of the searches and summaries of the findings for the six major health areas are available (Gaziano and others 2017; Holmes and others 2017b; Horton and Gauvreau 2015; Horton and Levin 2016; Levin and Chisholm 2015; Prinja and others 2015). Although methods exist to make an approximate conversion, the additional information required is not always readily available from the original study, namely, the proportion of all costs (both of the intervention itself and, where relevant, of those costs averted by the intervention) accounted for by tradable and nontradable inputs. However, health interventions vary considerably, from those involving behavior change communication by community health workers (relying heavily on nontradable inputs) to vaccine delivery or use of rapid diagnostic tests (relying heavily on tradable inputs); no single conversion method is perfect. We opted for the exchange rate method because it is more readily understood by noneconomists, and it allows comparison with the earlier Disease Control Priorities work (Laxminarayan, Chow, and Shahid-Salles 2006).

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