This Week in PLOS Medicine: The “Wicked” Problem of Inactivity, Stroke Care, BMI & Heart Failure, & a Rural Container Clinic

This week PLOS Medicine publishes the following new articles:

Image Credit: Maggie Winker, PLOS

Image Credit: Maggie Winker, PLOS

Physical inactivity is the fourth leading global risk factor for death, and also a major cause of non-communicable diseases (chronic diseases such as heart disease and diabetes), the leading cause of death around the world. The PLOS Medicine Editors spotlight the urgent need to address the “wicked” problem of physical inactivity. Addressing this challenge is complex, as governments are often the target of extensive lobbying by parties with vested interests (see the PLOS Medicine Big Food series). Urban planning, where the needs of car drivers are often prioritized over those of pedestrians and cyclists, is also an issue. The editors call for more robust research into the policies addressing physical inactivity and argue that the designs of clinical trials can also be applied to policies.

In a systematic review of qualitative research, Francis Mair and colleagues examine the treatment burden after stroke from the patient perspective. Patients who have experienced a stroke spend a substantial amount of time and effort seeking out, processing, and reflecting on information about the management of their condition because the information provided by health services worldwide is currently inadequate. Fragmented care and poor communication between stroke patients and clinicians, as well as between health-care providers, can mean that patients are ill-equipped to organize their care and develop coping strategies. This makes it less likely that stroke patients will adhere to the prescribed management of their condition.

Prokopenko and colleagues investigated whether adiposity is causally related to various cardiometabolic traits using a Mendelian randomization analysis (in which the variation in genes associated with conditions is used to assess the causal relationship between conditions). The study provides novel evidence that supports a causal relationship between higher BMI and heart failure, and between higher BMI and increased liver enzymes. The study also supports several previously shown causal associations, such as those between adiposity and type 2 diabetes, metabolic syndrome, dyslipidemia, and hypertension.

Creating functional health infrastructures in low and middle income countries is difficult, were lag time is long, adequate installation is unverified, on-site medical manpower is scarce, and quality of health care is difficult to assess. Anurag Agrawal and colleagues describe their experience of implementing a rapidly deployable health center constructed from two half sized cargo containers in rural India. The health center, which provides primary healthcare, is staffed by medical interns (as part compulsory rural service), student nurses, and one full time nurse (the only permanent staff member). The center is connected to tertiary hospitals via the nearest mobile phone tower, which enables data sharing and monitoring as well as access to remote specialists.



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