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Background: Cardiovascular disease disproportionately affects persons living in low- and middle-income countries and heart failure (HF) is thought to be a leading cause. Population-based studies characterizing the epidemiology of HF in these settings are lacking. We describe the age-standardized prevalence, survival, subtypes, risk factors, and 1-year mortality of HF in the population-based Haiti Cardiovascular Disease Cohort.Methods: Participants were recruited using multistage cluster-area random sampling in Port-au-Prince, Haiti. A total of 2981 completed standardized history and exam, laboratory measures, and cardiac imaging. Clinical HF was defined by Framingham criteria. Kaplan-Meier and Cox proportional hazard regression assessed mortality among participants with and without HF; logistic regression identified associated factors.Results: Among all participants, the median age was 40 years (interquartile range, 27-55), and 58.2% were female. Median follow-up was 15.4 months (interquartile range, 9-22). The age-standardized HF prevalence was 3.2% (93/2981 [95% CI, 2.6-3.9]). The average age of participants with HF was 57 years (interquartile range, 45-65), and 67.7% were female. The first significant increase in HF prevalence occurred between 30 to 39 and 40 to 49 years (1.1% versus 3.7%, P=0.003). HF with preserved ejection fraction was the most common HF subtype (71.0%). Age (adjusted odds ratio, 1.36 [1.12-1.66] per 10-year increase), hypertension (2.14 [1.26-3.66]), obesity (3.35 [95% CI, 1.99-5.62]), poverty (2.10 [1.18-3.72]), and renal dysfunction (5.42 [2.94-9.98]) were associated with HF. One-year HF mortality was 6.6% versus 0.8% (hazard ratio, 7.7 [95% CI, 2.9-20.6]; P<0.0001).Conclusions: The age-standardized prevalence of HF in this low-income setting was alarmingly high at 3.2%-5-fold higher than modeling estimates for low- and middle-income countries. Adults with HF were two decades younger and 7.7× more likely to die at 1 year compared with those in the community without HF. Further research characterizing the population burden of HF in low- and middle-income countries can guide resource allocation and development of pragmatic HF prevention and treatment interventions, ultimately reducing global cardiovascular disease health disparities.Registration: URL: https://www.Clinicaltrials: gov; Unique identifier: NCT03892265. [ABSTRACT FROM AUTHOR]

The article describes the case of a 33-year-old pregnant woman who went for her first prenatal visit. Topics covered include the question whether the patient should be offered a hepatitis B virus screening based on the U.S. Preventive Services Task Force (USPSTF) recommendation statement, and the recommended interventions once the patient screens positive of HBV.

Aims: To identify the challenges and opportunities among primary health care nurses and general practitioners (GPs) in the care of older people with urinary incontinence (UI) and other chronic conditions in China. Background: UI is highly prevalent among community‐dwelling older people with chronic conditions but is underreported and poorly managed. Understanding the factors that affect primary health care professionals' practices in their care for this population is imperative to foster nurse‐led UI care services. Design: A qualitative descriptive study. Methods: Four focus groups were held with 24 primary health care nurses and GPs in Changsha, Hunan Province, China, between July and September 2021. A reflective thematic analysis was used to identify themes. Results: This study revealed misconceptions regarding older people living with UI and other chronic conditions in primary care health professional participants. Moreover, primary health care nurses had very limited autonomy in UI diagnosis and initiating care interventions for this patient population. By reflecting on practices, participants recognized various practical solutions to improve the detection and management of UI. Participants also identified barriers to accessing care services in older people with UI. They suggested changes in the health care system to achieve universal access to UI care services for older people. Conclusion: Nurse‐led UI care services in primary health care for community‐dwelling older people with chronic conditions are in high demand but are underdeveloped due to professional and health care system factors. Impact: Findings from this study provide new insights into challenges faced by primary health care professionals and illuminate practical solutions to address these challenges. Reporting Methods: Adherence to COREQ guidelines was maintained. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To synthesize research evidence on perceptions and help‐seeking behaviours in community‐dwelling older people with urinary incontinence based on the Capability‐Opportunity‐Motivation‐Behaviours model. Background: Urinary incontinence is highly prevalent in community‐dwelling older people, yet only a small proportion seek help from health professionals. Untreated urinary incontinence has a detrimental impact on older people's quality of life and distresses their caregivers. Design Systematic integrative review. Data sources Ten databases were searched systematically between 9 November 2020 and 17 December 2020 including Medline (PubMed), CINAHL, Ageline, Web of Science, Scopus, ProQuest, Psyclnfo, CNKI, Wanfang and Vip. Review methods: Quality appraisal was applied to assess the quality of selected articles. Data relevant to the review aim were extracted from included articles for analysis. Convergent qualitative synthesis was used to synthesize findings. Results: Twenty articles were included and two main themes with six sub‐themes were identified. Theme one described three common perceptions including urinary incontinence as a part of normal ageing, a stigma and a health problem. Each perception had a profound impact on older people's motivation to self‐report the problem to health professionals. Theme two revealed three main help‐seeking approaches comprising self‐help, help from friends and help from health professionals. Of these, self‐help was the dominant approach used to conceal urinary incontinence and contributed to social isolation. Conclusion: Improving urinary incontinence management in community‐dwelling older people requires the development of their capability and motivation, and increased opportunities to access and gain help from skilled health professionals. Impact Findings can facilitate resource development to improve health literacy for the general public pertinent to urinary incontinence and associated stigma. Moreover, findings can inform a user‐friendly reporting and referral system for the problem. In addition, findings can inform education and skill training for health professionals, older people and their caregivers to effectively manage the problem. [ABSTRACT FROM AUTHOR]