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National health systems need strengthening if they are to meet the growing challenge of chronic diseases in low-income and middle-income countries. By application of an accepted health-systems framework to the evidence, we report that the factors that limit countries' capacity to implement proven strategies for chronic diseases relate to the way in which(More)
OBJECTIVE Epilepsy is a common and often highly stigmatized disorder. Several international organizations indicate a need to assess the stigma that exists and to develop and evaluate interventions to dispel myths about epilepsy. METHODS A stratified cluster randomized controlled trial evaluated whether an epilepsy education program (intervention)(More)
OBJECTIVE Epilepsy is the most common neurological disorder in the world, yet it is still widely misunderstood. A lack of knowledge and negative attitudes about epilepsy are largely blamed for the stigma felt by people with epilepsy and their families. Recent calls for research into stigma have been made by the World Health Organization and international(More)
BACKGROUND Some motor vehicle crashes, particularly single-vehicle crashes, may result from intentional self-harm. We conducted a prospective cohort study to assess the risk that intentional self-harm poses for motor vehicle crashes among young drivers. METHODS We prospectively linked survey data from newly licensed drivers aged 17-24 years to data on(More)
BACKGROUND It is necessary to select a range of consistently identified prognostic factors from exploratory studies to include in multivariate models of confirmatory studies. We illustrate a systematic approach to selecting consistently identified prognostic factors using the example of predictors of remission in newly diagnosed epilepsy. METHODS Medline(More)
BACKGROUND AND PURPOSE Women are relatively protected from cardiovascular events; they are 3 times as likely as men to survive to age 90 years. Although clinical trials show an excess of thrombotic events with estrogen/progestin hormone replacement therapy, much experimental and epidemiological evidence suggests that estrogen may have beneficial effects on(More)
BACKGROUND Tobacco will soon be the biggest cause of death worldwide, with the greatest burden being borne by low and middle-income countries where 8/10 smokers now live. OBJECTIVE This study aimed to quantify the direct burden of smoking for cardiovascular diseases (CVD) by calculating the population attributable fractions (PAF) for fatal ischaemic heart(More)
BACKGROUND As low- and middle-income countries face continued shortages of human resources for health and the double burden of infectious and chronic diseases, there is renewed international interest in the potential for community health workers to assume a growing role in strengthening health systems. A growing list of tasks, some of them complex, is being(More)
BACKGROUND Current antiretroviral treatment (ART) models in Africa are labour intensive and require a high number of skilled staff. In the context of constraints in human resources for health, task shifting is considered a feasible alternative for ART service delivery. In 2006, Dignitas International in partnership with the Malawi Ministry of Health trained(More)
Although there is evidence that non-government health system actors can individually or collectively develop practical strategies to address primary health care (PHC) challenges in the community, existing frameworks for analysing health system governance largely focus on the role of governments, and do not sufficiently account for the broad range of(More)