Carotid bruits

-
Why , to identify people at risk of cerebrovascular accidents, for medical (anticoagulant)or surgical (carotid endarterectomy)intervention.
How , auscultation (stethoscope)or Doppler ultrasound. Definitive diagnosis requires arteriography.
Resource levels required. Medium, high , or very high for detection. very high for intervention with carotid endarterectomy.

Recommendation on use of screening. Screening of asymptomatin adults is not recommended . accurate detection involves invasive tests that are expensive and have serious associated risks. intervention is extremely expensive and of uncertain long-term benefit. A recent large clinical trial in the USA found no evidence that vascular surgery prevents stroke in patients with asymptomatic carotid stenosis demonstrated on screening(pierce,1992).emphasis should be on primary prevention through reduction of risk factors for cerebrovascular disease (smoking prevention or cessation, diet, exercise)in the community.

Popular posts from this blog

Screening of children and adults to prevent and control communicable diseases

-
Image
Screening of children and adults to prevent and control communicable diseases This chapter discusses infectious diseases that endanger the health of the individual affected and sometimes others in the community. Because this material is generally relevant for all age groups , it was thought most convenient to present this as a separate chapter. Prevention and control of communicable diseases should be integral components of comprehensive primary health care programmes  for each general age group and should not be organized into separate vertical programmes focused on specific diseases. General comments on screening for communicable diseases In general, in dealing with highly prevalent communicable diseases that are a significant public health problem, the screening of asymptomatic persons will play a limited role and should be primarily an adjunct to other measures. Emphasis should be placed on primary prevention (often requiring environmental measures )and on public educatio
Read more

How do children get pneumonia?

-
Image
  Children can get pneumonia through various means, and the most common cause is infection with bacteria, viruses, or other microorganisms. The infection typically enters the lungs, causing inflammation of the air sacs and leading to the development of pneumonia. Here are some common ways children can contract pneumonia: Bacterial Infections: Bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus can cause bacterial pneumonia. These bacteria can be spread through respiratory droplets when an infected person coughs or sneezes. Viral Infections: Viruses, including respiratory syncytial virus (RSV), influenza (flu), and adenovirus, are common causes of viral pneumonia. Viruses can be transmitted through respiratory secretions or by touching surfaces contaminated with the virus. Aspiration: Inhaling foreign objects, such as food, liquids, or vomit, can lead to aspiration pneumonia. This is more common in young children who may not have fully developed
Read more

Is the cost of the screening and timely intervention operation warranted,given all the considerations covered in items 1-6 above, in comparison with alternative uses of the resources

-
Will the operation divert resources from other measures that are likely to be more effective? What other ways are there of addressing the problem that do not involve screening ? are these better? Will the screening operation divert health workers attention from more crucial efforts addressing the principal health problems of the population ? will it accomplish little but create the impression among the public that their problems are being dealt with and divert their attention from issues of higher priority ? In order to answer these questions , the costs and benefits of the proposed screening and intervention activities must be weighed against those of alternative strategies, taking into account both direct and indirect, as well as immediate and future , benefits . When planned thoughtfully and implemented in a population-based fashion, screening can provide a rational bases for resource allocation. it can be used to ensure that preventive measures are applied where they will have
Read more