Wyber Rosemary
Telethon Institute for Child Health Research, Perth, Western Australia, Australia.
Glob Heart. 2013 Sep;8(3):241-6. doi: 10.1016/j.gheart.2013.07.003. Epub 2013 Sep 26.
The World Health Organization, World Heart Federation, and other organizations recommend comprehensive control programs for rheumatic fever (RF) and rheumatic heart disease (RHD). However, advice on components of control programs are simple lists, with little guidance on program structure or priorities. In particular, there are limited recommendations on "stepwise" implementation and few guidelines on which program components should take temporal priority. An evidence-based framework for describing, prioritizing, and implementing comprehensive RF/RHD control programs is needed. A literature review of existing RF/RHD control program recommendations generated a list of program components. Descriptions and analysis of RF/RHD control programs informed temporal prioritizing of component parts. Relevant programmatic research from other vertical disease control programs was reviewed for generalizable implementation experiences. Twenty-five individual components of comprehensive RF/RHD control programs were identified. These fell into "baseline" program requirements (including burden of disease data, treatment guidelines, and human resources) and requirements for providing primary, secondary, and tertiary interventions. Primordial prevention and research priorities were overarching themes. These components were developed into a conceptual framework schema. Existing literature contains valuable lessons on the design and implementation of comprehensive RF/RHD control programs. Fashioning these guidelines and programmatic experiences into a conceptual framework schema benefits clinicians, policy makers, and RHD advocates.
世界卫生组织、世界心脏联盟及其他组织推荐了针对风湿热（RF）和风湿性心脏病（RHD）的综合防控项目。然而，关于防控项目组成部分的建议只是简单罗列，在项目结构或优先事项方面几乎没有指导。特别是，关于“逐步”实施的建议有限，对于哪些项目组成部分应具有时间上的优先性几乎没有指导方针。因此需要一个基于证据的框架来描述、确定优先次序并实施综合的RF/RHD防控项目。对现有RF/RHD防控项目建议进行文献综述，得出了一份项目组成部分清单。对RF/RHD防控项目的描述和分析为各组成部分的时间优先排序提供了依据。对其他垂直疾病防控项目的相关规划研究进行了综述，以获取可推广的实施经验。确定了综合RF/RHD防控项目的25个独立组成部分。这些组成部分分为“基线”项目要求（包括疾病负担数据、治疗指南和人力资源）以及提供一级、二级和三级干预措施的要求。初级预防和研究重点是总体主题。这些组成部分被构建成一个概念框架图式。现有文献包含了关于综合RF/RHD防控项目设计和实施的宝贵经验教训。将这些指导方针和规划经验形成一个概念框架图式，对临床医生、政策制定者和RHD倡导者有益。
