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Dugee O, Munaa E, Sakhiya A, Mahal A. Mongolia's Public Spending On Noncommunicable Diseases Is Similar To The Spending Of Higher-Income Countries. Health Aff (Millwood) 2018; 36:918-925. [PMID: 28461360 DOI: 10.1377/hlthaff.2016.0711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although there is increased recognition of the global challenge posed by noncommunicable diseases (NCDs), translating that awareness into resources for action requires better data than typically available in low- and middle-income countries. One middle-income country that does have good-quality information is Mongolia. Using detailed administrative data from Mongolia and supplementary survey-based information, we estimated public spending on four NCDs in Mongolia and reached four main conclusions. First, Mongolia's public spending patterns on NCDs are similar to NCD spending observed in countries with much higher per capita incomes. Second, public spending for NCDs is low relative to the NCD disease burden in Mongolia. Third, public-sector NCD spending is dominated by inpatient care and hospital-based specialist outpatient services, which suggests inefficiency in resource use. Finally, while public spending on cardiovascular disease is evenly distributed across regions, for cancers it is heavily concentrated in the nation's capital.
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Affiliation(s)
- Otgontuya Dugee
- Otgontuya Dugee is a doctoral student in the School of Public Health and Preventive Medicine at Monash University, in Melbourne, Australia; and a researcher in the Public Health Institute of the Ministry of Health of Mongolia, in Ulaanbaatar
| | - Enkhtuya Munaa
- Enkhtuya Munaa is director of the Monitoring and Evaluation Department in the Social Insurance General Office, in Ulaanbaatar
| | - Ariuntuya Sakhiya
- Ariuntuya Sakhiya is head of the Statistics and Monitoring Division of the Ulaanbaatar City Health Department
| | - Ajay Mahal
- Ajay Mahal is a professor of health economics and health systems at the Nossal Institute for Global Health, University of Melbourne; and an adjunct professor in the School of Public Health and Preventive Medicine, Monash University
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102
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Lin TK, Teymourian Y, Tursini MS. The effect of sugar and processed food imports on the prevalence of overweight and obesity in 172 countries. Global Health 2018; 14:35. [PMID: 29653543 PMCID: PMC5899384 DOI: 10.1186/s12992-018-0344-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/14/2018] [Indexed: 12/18/2022] Open
Abstract
Background Studies find that economic, political, and social globalization – as well as trade liberalization specifically – influence the prevalence of overweight and obesity in countries through increasing the availability and affordability of unhealthful food. However, what are the mechanisms that connect globalization, trade liberalization, and rising average body mass index (BMI)? We suggest that the various sub-components of globalization interact, leading individuals in countries that experience higher levels of globalization to prefer, import, and consume more imported sugar and processed food products than individuals in countries that experience lower levels of globalization. Method This study codes the amount of sugar and processed food imports in 172 countries from 1995 to 2010 using the United Nations Comtrade dataset. We employ country-specific fixed effects (FE) models, with robust standard errors, to examine the relationship between sugar and processed foods imports, globalization, and average BMI. To highlight further the relationship between the sugar and processed food import and average BMI, we employ a synthetic control method to calculate a counterfactual average BMI in Fiji. Conclusion We find that sugar and processed food imports are part of the explanation to increasing average BMI in countries; after controlling for globalization and general imports and exports, sugar and processed food imports have a statistically and substantively significant effect in increasing average BMI. In the case of Fiji, the increased prevalence of obesity is associated with trade agreements and increased imports of sugar and processed food. The counterfactual estimates suggest that sugar and processed food imports are associated with a 0.5 increase in average BMI in Fiji. Electronic supplementary material The online version of this article (10.1186/s12992-018-0344-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tracy Kuo Lin
- University of California, San Francisco, USA. .,London School of Economics and Political Science, London, UK.
| | | | - Maitri Shila Tursini
- London School of Hygiene and Tropical Medicine & Homerton University Hospital, London, UK
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103
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Dugee O, Palam E, Dorjsuren B, Mahal A. Who is bearing the financial burden of non-communicable diseases in Mongolia? J Glob Health 2018; 8:010415. [PMID: 29564086 PMCID: PMC5857203 DOI: 10.7189/jogh.08.010415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Non-communicable diseases (NCDs) pose a formidable health and development challenge for low- and middle-income countries (LMICs). However, translating this challenge into resource allocation is seriously constrained by a lack of country specific evidence on NCD financing and its distributional implications. This study estimated expenditures associated with NCDs in Mongolia and their distributions across socioeconomic groups, focusing especially on private out-of-pocket (OOP) spending on the major NCDs. Methods Secondary data analysis of multiple data sources on NCD related health service use and expenditures including detailed administrative data, World Health Organization STEPwise approach to Surveillance (STEPs) survey for Mongolia, and household surveys. Sample-weighted estimates of OOP expenditures for NCDs were constructed using STEPs data. OOP payments per discharge and per outpatient visit were estimated by condition and type of service provider, and survey data on utilization, after adjusting for utilization in administrative records. Results NCDs in Mongolia accounted for more than one-third of total health expenditures in 2013. A significant fraction of this expenditure was borne by households in the form of OOP spending. CVD-related health spending is the major driver of NCD-spending in Mongolia, accounting for about 24.2% of total health expenditure. OOP health payments, largely driven by outpatient diagnostics and drugs, were incurred disproportionately by the better-off, seeking more specialist services and better quality private care. Conclusion A high share of OOP spending for NCDs in Mongolia, which ostensibly enjoys universal health coverage, provides a cautionary tale for LMICs in a similar situation. Improvement in the quality of services at the primary care level and rural health care facilities, where the poor mainly attend, is desirable together with an effective exemption policy for user fees at higher level hospitals.
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Affiliation(s)
- Otgontuya Dugee
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Public Health Institute of the Ministry of Health of Mongolia, Ulaanbaatar, Mongolia
| | - Enkhtuya Palam
- Public Health Institute of the Ministry of Health of Mongolia, Ulaanbaatar, Mongolia
| | - Bayarsaikhan Dorjsuren
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Ajay Mahal
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
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104
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Serrano NC, Guío E, Quintero-Lesmes DC, Becerra-Bayona S, Luna-Gonzalez ML, Herrera VM, Prada CE. Vitamin D deficiency and pre-eclampsia in Colombia: PREVitD study. Pregnancy Hypertens 2018; 14:240-244. [PMID: 29588145 DOI: 10.1016/j.preghy.2018.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/10/2018] [Accepted: 03/12/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Pre-eclampsia is a multisystem disorder characterized by new-onset hypertension and proteinuria during pregnancy. Pre-eclampsia remains a major cause of maternal death in low-income countries. Vitamin D has a very diverse biological role in cardiovascular diseases. This study will evaluate the association of vitamin D levels and relevance to pre-eclampsia. METHODS We conducted a case-control study of women recruited from the GenPE (Genetics and Pre-eclampsia) Colombian registry. This is a multicenter case-control study conducted in eight Colombian cities. 25-Hydroxyvitamin D (25(OH)D) concentration was measured using liquid-chromatography-tandem mass spectrometry from 1013 women with pre-eclampsia and 1015 mothers without pre-eclampsia (controls). RESULTS Fifty-two percent of women with pre-eclampsia were vitamin D deficient. The 25(OH)D concentrations were significantly lower in the pre-eclampsia (mean 29.99 ng/mL; 95% CI: 29.40-30.58 ng/mL) group compared to controls (mean 33.7 ng/mL; 95% CI: 33.20-34.30 ng/mL). In the unadjusted model, maternal vitamin D deficiency, defined by maternal 25(OH)D concentration <30 ng/mL, was associated with an increased probability of suffering from pre-eclampsia (OR 2.10; 95% CI, 1.75-2.51). After adjusting for covariates, a similarly increased probability of having pre-eclampsia was observed (OR 2.18; 95% CI, 1.80-2.64) among women with vitamin D deficiency, relative to controls. CONCLUSION Although the results suggest that low maternal concentrations of 25(OH)D increase pre-eclampsia risk, this evidence may not be indicative of a causal association. Future studies are needed to confirm a definite causal relationship between concentrations of vitamin D and the risk of pre-eclampsia, by means of powered clinical trials.
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Affiliation(s)
- Norma C Serrano
- Fundación Cardiovascular de Colombia FCV, Colombia; Fundación Universitaria FCV, Colombia.
| | | | | | | | | | | | - Carlos E Prada
- Fundación Cardiovascular de Colombia FCV, Colombia; Fundación Universitaria FCV, Colombia; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, United States; Division of Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
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105
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Abstract
Syndecan-1 (Sdc1) is a major cell surface heparan sulfate (HS) proteoglycan of epithelial cells, a cell type targeted by many bacterial pathogens early in their pathogenesis. Loss of Sdc1 in mice is a gain-of-function mutation that significantly decreases the susceptibility to several bacterial infections, suggesting that subversion of Sdc1 is an important virulence strategy. HS glycosaminoglycan (GAG) chains of cell surface Sdc1 promote bacterial pathogenesis by facilitating the attachment of bacteria to host cells. Engagement of cell surface Sdc1 HS chains by bacterial adhesins transmits signal through the highly conserved Sdc1 cytoplasmic domain, which can lead to uptake of intracellular bacterial pathogens. On the other hand, several bacteria that do not require Sdc1 for their attachment and invasion stimulate Sdc1 shedding and exploit the capacity of Sdc1 ectodomain HS GAGs to disarm innate defense mechanisms to evade immune clearance. Recent data suggest that select HS sulfate motifs, and not the overall charge of HS, are important in the inhibition of innate immune mechanisms. Here, we discuss several examples of Sdc1 subversion in bacterial infections.
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Sum G, Hone T, Atun R, Millett C, Suhrcke M, Mahal A, Koh GCH, Lee JT. Multimorbidity and out-of-pocket expenditure on medicines: a systematic review. BMJ Glob Health 2018; 3:e000505. [PMID: 29564155 PMCID: PMC5859814 DOI: 10.1136/bmjgh-2017-000505] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 01/11/2023] Open
Abstract
Background Multimorbidity, the presence of two or more non-communicable diseases (NCD), is a costly and complex challenge for health systems globally. Patients with NCDs incur high levels of out-of-pocket expenditure (OOPE), often on medicines, but the literature on the association between OOPE on medicines and multimorbidity has not been examined systematically. Methods A systematic review was conducted via searching medical and economics databases including Ovid Medline, EMBASE, EconLit, Cochrane Library and the WHO Global Health Library from year 2000 to 2016. Study quality was assessed using Newcastle-Ottawa Scale. PROSPERO: CRD42016053538. Findings 14 articles met inclusion criteria. Findings indicated that multimorbidity was associated with higher OOPE on medicines. When number of NCDs increased from 0 to 1, 2 and ≥3, annual OOPE on medicines increased by an average of 2.7 times, 5.2 times and 10.1 times, respectively. When number of NCDs increased from 0 to 1, 2, ≥2 and ≥3, individuals spent a median of 0.36% (IQR 0.15%–0.51%), 1.15% (IQR 0.62%–1.64%), 1.41% (IQR 0.86%–2.15%), 2.42% (IQR 2.05%–2.64%) and 2.63% (IQR 1.56%–4.13%) of mean annual household net adjusted disposable income per capita, respectively, on annual OOPE on medicines. More multimorbidities were associated with higher OOPE on medicines as a proportion of total healthcare expenditures by patients. Some evidence suggested that the elderly and low-income groups were most vulnerable to higher OOPE on medicines. With the same number of NCDs, certain combinations of NCDs yielded higher medicine OOPE. Non-adherence to medicines was a coping strategy for OOPE on medicines. Conclusion Multimorbidity of NCDs is increasingly costly to healthcare systems and OOPE on medicines can severely compromise financial protection and universal health coverage. It is crucial to recognise the need for better equity and financial protection, and policymakers should consider health system financial options, cost sharing policies and service patterns for those with NCD multimorbidities.
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Affiliation(s)
- Grace Sum
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Thomas Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Rifat Atun
- Harvard T.H Chan, School of Public Health, and Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, England, UK.,Luxembourg Institute for Socio-economic Research, Luxembourg, Europe
| | - Ajay Mahal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - John Tayu Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Abstract
Globally, 32.4 million individuals are blind and 191 million have moderate or severe visual impairment (MSVI); 80% of cases of blindness and MSVI are avoidable. However, great efforts are needed to tackle blindness and MSVI, as eye care in most places is delivered in isolation from and without significant integration with general health sectors. Success stories, including control of vitamin A deficiency, onchocerciasis, and trachoma, showed that global partnerships, multisectoral collaboration, public-private partnerships, corporate philanthropy, support from nongovernmental organizations-both local and international-and governments are responsible for the success of these programs. Hence, the World Health Organization's universal eye health global action plan for 2014-2019 has a goal of reducing the public health problem of blindness and ensuring access to comprehensive eye care; the plan aims to integrate eye health into health systems, thus providing universal eye health coverage (UEHC). This article discusses the challenges faced by low- and middle-income countries in strengthening the six building blocks of the health system. It discusses how the health systems in these countries need to be geared toward tackling the issues of emerging noncommunicable eye diseases, existing infectious diseases, and the common causes of blindness and visual impairment, such as cataract and refractive error. It also discusses how some of the comprehensive eye care models in the developing world have addressed these challenges. Moving ahead, if we are to achieve UEHC, we need to develop robust, sustainable, good-quality, comprehensive eye care programs throughout the world, focusing on the areas of greatest need. We also need to develop public health approaches for more complex problems such as diabetic retinopathy, glaucoma, childhood blindness, corneal blindness, and low vision. There is also a great need to train high-level human resources of all cadres in adequate numbers and quality. In addition to this, we need to exploit the benefits of modern technological innovations in information, communications, biomedical technology, and other domains to enhance quality of, access to, and equity in eye care.
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Affiliation(s)
- Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad 500034, India.,Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Gullapalli N Rao
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad 500034, India
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108
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Ligita T, Wicking K, Harvey N, Mills J. The profile of diabetes healthcare professionals in Indonesia: a scoping review. Int Nurs Rev 2018; 65:349-360. [PMID: 29318607 DOI: 10.1111/inr.12418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To explore and synthesize evidence of the literature about healthcare professionals involved in the provision of diabetes management within an Indonesian context. BACKGROUND Indonesia is challenged to control the major burden of diabetes prevalence rate that requires a multidimensional approach with the aim to optimize existing health services by involving healthcare professionals who can promote access and provide diabetes management. METHODS This literature review, which is integrated with a scoping study framework, used the electronic databases including CINAHL, PubMed, Scopus and Web of Science to locate papers particular to the Indonesian context. From the total of 568 papers found, 20 papers were selected. RESULTS The literature review identified physicians, nurses, pharmacists, dieticians and diabetes educators as the providers of diabetes care and management in Indonesia. Collaborative management involving either interdisciplinary or intradisciplinary teams was mentioned in several papers. Internal challenges included limited skills and knowledge. External challenges included high patient volumes; a shortage of healthcare professionals and reduced funding. CONCLUSIONS Overcoming the challenges cannot be undertaken with a workforce dominated by any one single healthcare professional. Coordinating with the government to improve the implementation of different roles in diabetes management will improve patient outcomes and thus reduce the burden of diabetes. IMPLICATION FOR NURSING AND HEALTH POLICY Health policy reform should support nurses and other healthcare professionals in their professional development at all levels of health care. Policy makers can use the review findings to modify the current healthcare system to address key issues in workforce development; funding for services and medications; and fostering multidisciplinary care for diabetes management.
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Affiliation(s)
- T Ligita
- College of Healthcare Sciences, James Cook University, Cairns, QLD, Australia
| | - K Wicking
- Nursing, Midwifery and Nutrition, College of Healthcare Sciences, James Cook University, Cairns, QLD, Australia
| | - N Harvey
- Medicine, College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - J Mills
- Centre for Nursing, Midwifery and Nutrition Research, James Cook University, Cairns, QLD, Australia.,College of Health, Massey University, Auckland, New Zealand
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Min J, Zhao Y, Slivka L, Wang Y. Double burden of diseases worldwide: coexistence of undernutrition and overnutrition-related non-communicable chronic diseases. Obes Rev 2018; 19:49-61. [PMID: 28940822 PMCID: PMC5962023 DOI: 10.1111/obr.12605] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/13/2017] [Accepted: 08/02/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This systematic examination and meta-analysis examined the scope and variation of the worldwide double burden of diseases and identified related socio-demographic factors. DESIGN We searched PubMed for studies published in English from January 1, 2000, through September 28, 2016, that reported on double disease burden. Twenty-nine studies from 18 high-income, middle-income and low-income countries met inclusion criteria and provided 71 obesity-undernutrition ratios, which were included in meta-regression analysis. RESULTS All high-income countries had a much higher prevalence of obesity than undernutrition (i.e. all the obesity/undernutrition ratios >1); 55% of the ratios in lower middle-income and low-income countries were <1, but only 28% in upper middle-income countries. Meta-analysis showed a pooled obesity-undernutrition ratio of 4.3 (95% CI = 3.1-5.5), which varied by country income level, subjects' age and over time. The average ratio was higher in high-income rather than that in lower middle-income and low-income countries (β [SE] = 10.8 [2.6]), in adults versus children (7.1 [2.2]) and in data collected since 2000 versus before 2000 (5.2 [1.5]; all P values < 0.05). CONCLUSIONS There are considerable differences in the obesity versus undernutrition ratios and in their prevalence by country income level, age groups and over time, which may be a consequence of the cumulative exposure to an obesogenic environment.
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Affiliation(s)
- Jungwon Min
- Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN, USA
| | - Yaling Zhao
- Global Health Institute, Health Science Center, Xi'an Jiaotong University, Xi'an, China.,School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Lauren Slivka
- School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY, USA
| | - Youfa Wang
- Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN, USA.,Global Health Institute, Health Science Center, Xi'an Jiaotong University, Xi'an, China.,School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China.,Department of Nutrition and Health Sciences, College of Health, Ball State University, Muncie, IN, USA
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Abstract
AbstractOut-of-home foods (takeaway, take-out and fast foods) have become increasingly popular in recent decades and are thought to be a key driver in increasing levels of overweight and obesity due to their unfavourable nutritional content. Individual food choices and eating behaviours are influenced by many interrelated factors which affect the results of nutrition-related public health interventions. While the majority of research based on out-of-home foods comes from Australia, the UK and USA, the same issues (poor dietary habits and increased prevalence of non-communicable disease) are of equal concern for urban centres in developing economies undergoing ‘nutrition transition’ at a global scale. The present narrative review documents key facets, which may influence out-of-home food consumption, drawn from biological, societal, environmental, demographic and psychological spheres. Literature searches were performed and references from relevant papers were used to find supplementary studies. Findings suggest that the strongest determinants of out-of-home food availability are density of food outlets and deprivation within the built environment; however, the association between socio-economic status and out-of-home food consumption has been challenged. In addition, the biological and psychological drives combined with a culture where overweight and obesity are becoming the norm makes it ‘fashionable’ to consume out-of-home food. Other factors, including age group, ethnicity and gender demonstrate contrasting effects and a lack of consensus. It is concluded that further consideration of the determinants of out-of-home food consumption within specific populations is crucial to inform the development of targeted interventions to reduce the impact of out-of-home foods on public health.
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111
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Leow CH, Fischer K, Leow CY, Cheng Q, Chuah C, McCarthy J. Single Domain Antibodies as New Biomarker Detectors. Diagnostics (Basel) 2017; 7:diagnostics7040052. [PMID: 29039819 PMCID: PMC5745390 DOI: 10.3390/diagnostics7040052] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 01/02/2023] Open
Abstract
Biomarkers are defined as indicators of biological processes, pathogenic processes, or pharmacological responses to a therapeutic intervention. Biomarkers have been widely used for early detection, prediction of response after treatment, and for monitoring the progression of diseases. Antibodies represent promising tools for recognition of biomarkers, and are widely deployed as analytical tools in clinical settings. For immunodiagnostics, antibodies are now exploited as binders for antigens of interest across a range of platforms. More recently, the discovery of antibody surface display and combinatorial chemistry techniques has allowed the exploration of new binders from a range of animals, for instance variable domains of new antigen receptors (VNAR) from shark and variable heavy chain domains (VHH) or nanobodies from camelids. These single domain antibodies (sdAbs) have some advantages over conventional murine immunoglobulin owing to the lack of a light chain, making them the smallest natural biomarker binders thus far identified. In this review, we will discuss several biomarkers used as a means to validate diseases progress. The potential functionality of modern singe domain antigen binders derived from phylogenetically early animals as new biomarker detectors for current diagnostic and research platforms development will be described.
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Affiliation(s)
- Chiuan Herng Leow
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Penang 11800, Malaysia.
| | - Katja Fischer
- Bacterial Pathogenesis and Scabies Laboratory, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia.
| | - Chiuan Yee Leow
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Kelantan 16150, Malaysia.
| | - Qin Cheng
- Department of Drug Resistance and Diagnostics, Australian Army Malaria Institute, Brisbane 4051, Australia.
| | - Candy Chuah
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan 16150, Malaysia.
| | - James McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane 4029, Australia.
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Awotidebe TO, Adeyeye VO, Ogunyemi SA, Bisiriyu LA, Adedoyin RA, Balogun MO, Adebayo RA, Amosun OD. Joint predictability of physical activity and body weight status on health-related quality of life of patients with hypertension. J Exerc Rehabil 2017; 13:588-598. [PMID: 29114535 PMCID: PMC5667607 DOI: 10.12965/jer.1735088.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/08/2017] [Indexed: 11/22/2022] Open
Abstract
This study investigated the predictability of physical activity (PA) and body weight status (BWS) on health-related quality of life (HRQoL) of patients with hypertension. A cross-sectional study involved 250 patients with hypertension (≥140/90≤179/109 mmHg) selected from government hospitals in Osun State, Nigeria. Purposive sampling technique was used to select participants. Socio-demographic characteristics and cardiovascular parameters were recorded. PA and HRQoL were assessed using the International Physical Activity Questionnaire and Short Form health survey questionnaire respectively. Sufficient PA equals ≥150 min/wk while BWS was defined using body mass index classification. Data were analyzed using descriptive and inferential statistics. Alpha level was set at P<0.05. Of all participants, 63.6% reported sufficient PA and 78.4% was either overweight or obese. The HRQoL of participants become poorer in all domains with higher body weight. The HRQoL including role limitation due to physical health (RLdPhp) and emotional problems (RLdEmp) had worst scores. Participants in the categories of normal and overweight/obese with sufficient PA demonstrated higher (better) HRQoL in all domains than those with insufficient PA (P<0.05). When adjusted for body weight, significant differences were found in all domains of HRQoL except in RLdPhp, RldEmp, and bodily pain (P>0.05). There were significant correlations between PA and all domains of HRQoL except in RldEmp, emotional well-being and bodily pain (P>0.05). Regression models established PA as a significant predictor of HRQoL. Sufficient PA is a better predictor of HRQoL among patients with hypertension irrespective of BWS. Regular PA is recommended for improving HRQoL among patients with hypertension.
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Affiliation(s)
- Taofeek O. Awotidebe
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile - Ife, Nigeria
| | - Victor O. Adeyeye
- Cardiac Care Unit, Medical Out-Patient Department, Ife Hospital Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile - Ife, Nigeria
| | - Suraj A. Ogunyemi
- Cardiac Care Unit, Medical Out-Patient Department, Ife Hospital Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile - Ife, Nigeria
- Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile - Ife, Nigeria
| | - Luqman A. Bisiriyu
- Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile - Ife, Nigeria
| | - Rufus A. Adedoyin
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile - Ife, Nigeria
| | - Michael O. Balogun
- Cardiac Care Unit, Medical Out-Patient Department, Ife Hospital Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile - Ife, Nigeria
- Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile - Ife, Nigeria
| | - Rasaaq A. Adebayo
- Cardiac Care Unit, Medical Out-Patient Department, Ife Hospital Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile - Ife, Nigeria
- Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile - Ife, Nigeria
| | - Omolara D. Amosun
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile - Ife, Nigeria
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Tamanji MT, Ngwakum DA, Mbouemboue OP. A Profile of Renal Function in Northern Cameroonians with Essential Hypertension. Cardiorenal Med 2017; 7:324-333. [PMID: 29118771 PMCID: PMC5662973 DOI: 10.1159/000455680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/12/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM The two-way cause and effect relationship existing between high blood pressure and kidney dysfunction is currently a well-documented phenomenon with patients in either category being almost equally predisposed to the other pathology. Our goal was to assess the renal function capacity of hypertensive patients in our setting. METHODS This cross-sectional descriptive study involved the determination of blood pressure levels and the collection of blood and urine samples for the measurement of renal function markers. Hypertensive patients who came for medical follow-up constituted the study participants, and were enrolled consecutively into the study from February to May 2015. Data analysis was performed using the SPSS 20.0 software, and significant differences were determined at p < 0.05. RESULTS The prevalence of elevated creatinine and urea levels were 35 and 27%. Eighty percent of the participants had a decreased glomerular filtration rate (≤90 mL/min/1.73 m3), with at least 36% recording less than 60 mL/min/1.73 m3. Proteinuria and glucosuria were recorded in 15% and 8% of the participants, respectively. The mean diastolic pressure was observed to be significantly higher in participants with proteinuria (p = 0.016), and participants' weight directly correlated with systolic blood pressure (p = 0.015). Furthermore, the mean estimated glomerular filtration rate was relatively lower in participants >60 years compared to those <60 years (p < 0.001). CONCLUSION Renal function is often perturbed in hypertensive patients, and good blood pressure control may reduce the progression of renal impairment. Thus, a systematic evaluation of renal function in addition to blood pressure control in hypertensive patients is indispensable towards effectively reducing the occurrence of renal events and preventing end-stage renal disease.
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Affiliation(s)
- Marcel Tangyi Tamanji
- Faculty of Science, University of Buea, Buea, Cameroon
- Medical Laboratory Service, University of Ngaoundere, Ngaoundere, Cameroon
| | | | - Olivier Pancha Mbouemboue
- General Medicine Service, Regional Hospital Ngaoundere, University of Ngaoundere, Ngaoundere, Cameroon
- Department of Biomedical Sciences, University of Ngaoundere, Ngaoundere, Cameroon
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Stuart-Shor EM, Cunningham E, Foradori L, Hutchinson E, Makwero M, Smith J, Kasozi J, Johnston EM, Khaki A, Vandervort E, Moshi F, Kerry VB. The Global Health Service Partnership: An Academic-Clinical Partnership to Build Nursing and Medical Capacity in Africa. Front Public Health 2017; 5:174. [PMID: 28791282 PMCID: PMC5522849 DOI: 10.3389/fpubh.2017.00174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 06/29/2017] [Indexed: 12/02/2022] Open
Abstract
The World Health Organization estimates a global deficit of about 12.9 million skilled health professionals (midwives, nurses, and physicians) by 2035. These shortages limit the ability of countries, particularly resource-constrained countries, to deliver basic health care, to respond to emerging and more complex needs, and to teach, graduate, and retain their future health professionals—a vicious cycle that is perpetuated and has profound implications for health security. The Global Health Service Partnership (GHSP) is a unique collaboration between the Peace Corps, President’s Emergency Plan for AIDS Relief, Seed and host-country institutions, which aims to strengthen the breadth and quality of medical and nursing education and care delivery in places with dire shortages of health professionals. Nurse and physician educators are seconded to host institutions to serve as visiting faculty alongside their local colleagues. They serve for 1 year with many staying longer. Educational and clinical best practices are shared, emphasis is placed on integration of theory and practice across the academic–clinical domains and the teaching and learning environment is expanded to include implementation science and dissemination of locally tailored and sustainable practice innovations. In the first 3 years (2013–2016) GHSP placed 97 nurse and physician educators in three countries (Malawi, Tanzania, and Uganda). These educators have taught 454 courses and workshops to 8,321 trainees, faculty members, and practicing health professionals across the curriculum and in myriad specialties. Mixed-methods evaluation included key stakeholder interviews with host institution faculty and students who indicate that the addition of GHSP enhanced clinical teaching (quality and breadth) resulting in improved clinical skills, confidence, and ability to connect theory to practice and critical thinking. The outputs and outcomes from four exemplars which focus on the translation of evidence to practice through implementation science are included. Findings from the first 3 years of GHSP suggest that an innovative, locally tailored and culturally appropriate multi-country academic–clinical partnership program that addresses national health priorities is feasible and generated new knowledge and best practices relevant to capacity building for nursing and medical education. This in turn has implications for improving the health of populations who suffer a disproportionate burden of global disease.
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Affiliation(s)
- Eileen M Stuart-Shor
- Seed Global Health, Boston, MA, United States.,Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, United States.,College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
| | | | | | - Elizabeth Hutchinson
- Seed Global Health, Boston, MA, United States.,Department of Family Medicine, Swedish Family Medicine-First Hill, University of Washington, Seattle, WA, United States
| | - Martha Makwero
- Department of Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Jill Smith
- Seed Global Health, Boston, MA, United States
| | - Jane Kasozi
- School of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Esther M Johnston
- Seed Global Health, Boston, MA, United States.,Wright Center National Family Medicine Residency at HealthPoint, Auburn, WA, United States
| | - Aliasgar Khaki
- Department of Medicine, Herbert Kairuki Memorial University, College of Medicine, Dar es Salaam, Tanzania
| | - Elisa Vandervort
- School of Nursing, University of Utah, Salt Lake City, UT, United States.,Grounds for Health, Williston, VT, United States
| | - Fabiola Moshi
- School of Nursing, University of Dodoma, Dodoma, Tanzania
| | - Vanessa B Kerry
- Seed Global Health, Boston, MA, United States.,Mass General Global Health, Massachusetts General Hospital, Boston, MA, United States.,Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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Kebede Y, Andargie G, Gebeyehu A, Awoke T, Yitayal M, Mekonnen S, Wubshet M, Azmeraw T, Lakew Y, Alemu K. Tuberculosis and HIV are the leading causes of adult death in northwest Ethiopia: evidence from verbal autopsy data of Dabat health and demographic surveillance system, 2007-2013. Popul Health Metr 2017; 15:27. [PMID: 28716042 PMCID: PMC5513201 DOI: 10.1186/s12963-017-0139-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 06/23/2017] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Reliable data on causes of death form the basis for building evidence on health policy, planning, monitoring, and evaluation. In Ethiopia, the majority of deaths occur at home and civil registration systems are not yet functional. The main objective of verbal autopsy (VA) is to describe the causes of death at the community or population level where civil registration and death certification systems are weak and where most people die at home without having had contact with the health system. METHODS Causes of death were classified and prepared based on the International Classification of Diseases (ICD-10). The cause of a death was ascertained based on an interview with next of kin or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history, and circumstances preceding death. The cause of death, or the sequence of causes that led to death, is assigned based on the data collected by the questionnaire. The complete VA questionnaires were given to two blinded physicians and reviewed independently. A third physician was assigned to review the case when disagreements in diagnosis arose. RESULTS Communicable diseases (519 deaths [48.0%]), non-communicable diseases (377 deaths [34.8%]), and external causes (113 deaths [10.4%]) were the main causes of death between 2007 and 2013. Of communicable diseases, tuberculosis (207 deaths [19.7%]), HIV/AIDS (96 deaths [8.9%]) and meningitis (76 deaths [7.0%]) were the most common causes of death. CONCLUSION Tuberculosis, HIV/AIDS, and meningitis were the most common causes of deaths among adults. Death due to non-communicable diseases showed an increasing trend. Increasing community awareness of infections and their interrelationships, tuberculosis case finding, effective local TB programs, successful treatment, and interventions for HIV are supremely important.
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Affiliation(s)
- Yigzaw Kebede
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, PoBox, 196, Gondar, Ethiopia
| | - Gashaw Andargie
- Department of Health Service Management, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Abebaw Gebeyehu
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, PoBox, 196, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Department of Health Service Management, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mamo Wubshet
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Temesgen Azmeraw
- Dabat Health and Demographic Surveillance Site, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Yihunie Lakew
- Ethiopian Public Health Association, Addis Ababa, Ethiopia
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, PoBox, 196, Gondar, Ethiopia.
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Human infectious diseases and risk of preeclampsia: an updated review of the literature. Infection 2017; 45:589-600. [PMID: 28577241 DOI: 10.1007/s15010-017-1031-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/25/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Preeclampsia (PE) is one of the major causes of maternal and perinatal morbidity and mortality, especially in low- and middle-income countries. In recent years, a growing body of literatures suggests that infections by bacteria, viruses, and parasites and their related inflammations play an important role in the pathogenesis of PE. METHODS We searched PubMed, Google scholar, and Cochrane databases using the following search words: "infection and preeclampsia," "bacterial infection and preeclampsia," "viral infection and preeclampsia" and "parasitic infection and preeclampsia." RESULTS The literature review revealed that many bacteria including Helicobacter pylori, Chlamydia pneumonia, and those are involved in periodontal disease or urinary tract infections (UTIs) and some viral agents such as Cytomegalovirus, herpes simplex virus type-2, human immunodeficiency virus, and some parasites especially Plasmodium spp. and Toxoplasma gondii can be effective in development of PE. Inflammation responses against infections has major role in the inducement of PE. The shift of immunological cytokine profile of Th2 toward Th1 and high levels of pro-inflammatory cytokines (TNF-ɑ, IL-12, IFN-γ, etc.), increase of oxidative stress, increase of anti-angiogenic proteins, increase of vascular endothelial growth factor receptor 1 (sVEGFR1), and complement C5a are the main potential mechanisms related to infections and enhanced development of PE. CONCLUSION Thus, early diagnosis and treatment of bacterial, viral, and parasitic infections could be an effective strategy to reduce the incidence of PE.
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van Crevel R, van de Vijver S, Moore DAJ. The global diabetes epidemic: what does it mean for infectious diseases in tropical countries? Lancet Diabetes Endocrinol 2017; 5:457-468. [PMID: 27499355 PMCID: PMC7104099 DOI: 10.1016/s2213-8587(16)30081-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 02/06/2023]
Abstract
Tropical countries are experiencing a substantial rise in type 2 diabetes, which is often undiagnosed or poorly controlled. Since diabetes is a risk factor for many infectious diseases, this increase probably adds to the large infectious disease burden in tropical countries. We reviewed the literature to investigate the interface between diabetes and infections in tropical countries, including the WHO-defined neglected tropical diseases. Although solid data are sparse, patients with diabetes living in tropical countries most likely face increased risks of common and health-care-associated infections, as well as infected foot ulcers, which often lead to amputation. There is strong evidence that diabetes increases the severity of some endemic infections such as tuberculosis, melioidosis, and dengue virus infection. Some HIV and antiparasitic drugs might induce diabetes, whereas helminth infections appear to afford some protection against future diabetes. But there are no or very scarce data for most tropical infections and for possible biological mechanisms underlying associations with diabetes. The rise in diabetes and other non-communicable diseases puts a heavy toll on health systems in tropical countries. On the other hand, complications common to both diabetes and some tropical infections might provide an opportunity for shared services-for example, for eye health (trachoma and onchocerciasis), ulcer care (leprosy), or renal support (schistosomiasis). More research about the interaction of diabetes and infections in tropical countries is needed, and the infectious disease burden in these countries is another reason to step up global efforts to improve prevention and care for diabetes.
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Affiliation(s)
- Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands.
| | - Steven van de Vijver
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam Medical Center, University of Amsterdam, Netherlands
| | - David A J Moore
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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118
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Conalogue DM, Kinn S, Mulligan JA, McNeil M. International consultation on long-term global health research priorities, research capacity and research uptake in developing countries. Health Res Policy Syst 2017; 15:24. [PMID: 28327164 PMCID: PMC5361834 DOI: 10.1186/s12961-017-0181-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/14/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In recognition of the need for long-term planning for global health research, and to inform future global health research priorities, the United Kingdom Department for International Development (DfID) carried out a public consultation between May and June 2015. The consultation aimed to elicit views on the (1) the long-term future global health research priorities; (2) areas likely to be less important over time; (3) how to improve research uptake in low-income countries; and (4) how to build research capacity in low-income countries. METHODS An online consultation was used to survey a wide range of participants on global health research priorities. The qualitative data was analysed using a thematic analysis, with frequency of codes in responses tabulated to approximate relative importance of themes and sub-themes. RESULTS The public consultation yielded 421 responses. The survey responses confirmed the growing importance of non-communicable disease as a global health research priority, being placed above infectious diseases. Participants felt that the key area for reducing funding prioritisation was infectious diseases. The involvement of policymakers and other key stakeholders was seen as critical to drive research uptake, as was collaboration and partnership. Several methods to build research capacity in low-income countries were described, including capacity building educational programmes, mentorship programmes and research institution collaboration and partnership. CONCLUSIONS The outcomes from this consultation survey provide valuable insights into how DfID stakeholders prioritise research. The outcomes from this survey were reviewed alongside other elements of a wider DfID consultation process to help inform long-term research prioritisation of global health research. There are limitations in this approach; the opportunistic nature of the survey's dissemination means the findings presented may not be representative of the full range of stakeholders or views.
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Affiliation(s)
- David Mc Conalogue
- Department for International Development, Abercrombie House, Eaglesham Rd, East Kilbride, Glasgow, G75 8EA United Kingdom
| | - Sue Kinn
- Department for International Development, Abercrombie House, Eaglesham Rd, East Kilbride, Glasgow, G75 8EA United Kingdom
| | - Jo-Ann Mulligan
- Department for International Development, Abercrombie House, Eaglesham Rd, East Kilbride, Glasgow, G75 8EA United Kingdom
| | - Malcolm McNeil
- Department for International Development, Abercrombie House, Eaglesham Rd, East Kilbride, Glasgow, G75 8EA United Kingdom
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González-González C, Palloni A, Wong R. Mortality and its association with chronic and infectious diseases in Mexico: A panel data analysis of the elderly. SALUD PUBLICA DE MEXICO 2017; 57 Suppl 1:S39-45. [PMID: 26172233 DOI: 10.21149/spm.v57s1.7588] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/29/2014] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study examines the relationship between chronic and infectious diseases on mortality risks under conditions of accelerated aging.The main hypothesis is that individuals who report both types of diseases experience higher mortality risks than those reporting only chronic diseases. MATERIALS AND METHODS We used a nationally representative sample of 12 128 individuals aged 50 years and over included in the three waves of the Mexican Health and Aging Study. We estimated Cox regression models to assess the combined effect of self-reported chronic and infectious diseases on subsequent mortality. RESULTS In the period under study there were 2 723 deaths, 22.5% of the baseline sample. Having reported chronic and infectious diseases significantly increases mortality risks compared to having reported only chronic diseases. CONCLUSION In a context of socioeconomic inequality and a mixed epidemiological regime it is crucial to understand how diseases combine to generate excess mortality risks among the elderly.
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Affiliation(s)
| | - Alberto Palloni
- University of Wisconsin, Madison, Wisconsin, Estados Unidos de América
| | - Rebeca Wong
- University of Texas Medical Branch, Galveston, Texas, Estados Unidos de América
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Cai J, Ma A, Wang Q, Han X, Zhao S, Wang Y, Schouten EG, Kok FJ. Association between body mass index and diabetes mellitus in tuberculosis patients in China: a community based cross-sectional study. BMC Public Health 2017; 17:228. [PMID: 28245792 PMCID: PMC5331649 DOI: 10.1186/s12889-017-4101-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 02/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We planned to determine the association of body mass index (BMI) with diabetes mellitus (DM) and impaired fasting glucose (IFG) in Chinese pulmonary tuberculosis (PTB) patients. METHODS 3,505 newly-diagnosed PTB patients registered in PTB clinics in Linyi of China between September 2010 and March 2013 were enrolled. DM and IFG were identified based on fasting plasma glucose levels. ROC analysis was used to predict the ability of screening of BMI for DM and IFG in PTB patients. RESULTS Compared with 18.5-23.9 kg/m2, patients with DM and IFG had significantly increased trends when BMI ≥ 24.0 kg/m2, and aORs were 2.28 (95%CI 1.44-3.60) and 1.30 (95%CI 1.04-1.64), respectively. After adjustment for age, gender, and educational level, there was an increased odd in BMI ≥ 23.41 kg/m2 for IFG, and a decreased odd in BMI < 19.82 kg/m2 for DM (p < 0.05). The cut-offs of BMI for screening IFG and DM in PTB patients were 22.22 kg/m2 (AUC 0.56) and 22.34 kg/m2 (AUC 0.59). CONCLUSIONS In PTB patients, BMI is significantly associated with IFG and DM. However, the predictive power of BMI was not sufficient, so it may only be a limited screening tool for DM and IFG among PTB patients in China.
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Affiliation(s)
- Jing Cai
- The College of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong Province, 266021, People's Republic of China
| | - Aiguo Ma
- The College of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong Province, 266021, People's Republic of China.
| | - Qiuzhen Wang
- The College of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong Province, 266021, People's Republic of China
| | - Xiuxia Han
- The College of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong Province, 266021, People's Republic of China
| | | | - Yu Wang
- The Department of Public Health, Lanzhou University, 222 Tianshui South Road, Lanzhou, 730000, China
| | - Evert G Schouten
- Division of Human Nutrition, Wageningen University, Wageningen, 6700, The Netherlands
| | - Frans J Kok
- Division of Human Nutrition, Wageningen University, Wageningen, 6700, The Netherlands
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Wu T, Perrings C, Kinzig A, Collins JP, Minteer BA, Daszak P. Economic growth, urbanization, globalization, and the risks of emerging infectious diseases in China: A review. AMBIO 2017; 46:18-29. [PMID: 27492678 PMCID: PMC5226902 DOI: 10.1007/s13280-016-0809-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/16/2016] [Accepted: 07/18/2016] [Indexed: 05/17/2023]
Abstract
Three interrelated world trends may be exacerbating emerging zoonotic risks: income growth, urbanization, and globalization. Income growth is associated with rising animal protein consumption in developing countries, which increases the conversion of wild lands to livestock production, and hence the probability of zoonotic emergence. Urbanization implies the greater concentration and connectedness of people, which increases the speed at which new infections are spread. Globalization-the closer integration of the world economy-has facilitated pathogen spread among countries through the growth of trade and travel. High-risk areas for the emergence and spread of infectious disease are where these three trends intersect with predisposing socioecological conditions including the presence of wild disease reservoirs, agricultural practices that increase contact between wildlife and livestock, and cultural practices that increase contact between humans, wildlife, and livestock. Such an intersection occurs in China, which has been a "cradle" of zoonoses from the Black Death to avian influenza and SARS. Disease management in China is thus critical to the mitigation of global zoonotic risks.
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Affiliation(s)
- Tong Wu
- School of Life Sciences, Arizona State University, LSA 123, 427 East Tyler Mall, Tempe, AZ 85287 USA
| | - Charles Perrings
- School of Life Sciences, Arizona State University, LSA 127, 427 East Tyler Mall, Tempe, AZ 85287 USA
| | - Ann Kinzig
- School of Life Sciences, Arizona State University, LSA 124, 427 East Tyler Mall, Tempe, AZ 85287 USA
- Global Institute of Sustainability, Arizona State University, 800 South Cady Mall, Tempe, AZ 85287 USA
| | - James P. Collins
- School of Life Sciences, Arizona State University, LSC 402, 427 East Tyler Mall, Tempe, AZ 85287 USA
| | - Ben A. Minteer
- School of Life Sciences, Arizona State University, LSA 262, 427 East Tyler Mall, Tempe, AZ 85287 USA
| | - Peter Daszak
- EcoHealth Alliance, 460 West 34th Street - 17th Floor, New York, NY 10001 USA
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Abstract
OBJECTIVES The widespread, chronic use of antiretroviral therapy raises questions concerning the metabolic consequences of HIV infection and treatment. Antiretroviral therapy, and specifically protease inhibitors, has been associated with hyperglycemia. As pregnant women are vulnerable to development of hyperglycemia, the objective of this study was to explore existing literature on the relationship between HIV infection, HIV treatment, and gestational diabetes mellitus (GDM). METHODS A systematic search was conducted in six databases for articles providing data on HIV-positivity, protease inhibitor exposure, and GDM or glucose intolerance development in pregnancy. The quality of articles was evaluated using an adapted Cochrane Collaboration bias assessment tool. Risk ratios were generated from pooled data using meta-analysis by the Mantel-Haenszel method. RESULTS Of 891 references screened, six studies on the role of HIV-positivity, 10 on protease inhibitor use, and two on both were included. Meta-analysis showed no significant relationship between HIV infection and the development of GDM [risk ratio 0.80, 95% confidence interval (CI): 0.47-1.37, I = 0%]. Meta-analysis of protease inhibitor exposure showed increased GDM in studies using first-generation protease inhibitors (risk ratio 2.29, 95% CI: 1.46-3.58) and studies using the strictest diagnosis criteria, the National Diabetes Data Group criteria for 3-h oral glucose tolerance test (risk ratio 3.81, 95% CI: 2.18-6.67). CONCLUSION Meta-analysis showed no significant association between HIV-positivity and GDM. Significance of protease inhibitor use was limited to studies using the strictest diagnostic criteria for GDM. Results are limited by high risk of bias. Well designed prospective studies are needed to further clarify this relationship and its consequences for clinical practice.
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Zeltner T, Riahi F, Huber J. Acute and Chronic Health Challenges in Sub-Saharan Africa: An Unfinished Agenda. AFRICA'S POPULATION: IN SEARCH OF A DEMOGRAPHIC DIVIDEND 2017. [PMCID: PMC7122485 DOI: 10.1007/978-3-319-46889-1_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
The concept of a “Double Burden of Disease” conceived in the second half of the last century has by now turned into a success story in sub-Saharan Africa. It has been instrumental in creating the regional and global political momentum to address the “unfinished agenda of infectious diseases” and to fight against HIV/AIDS, Tuberculosis and Malaria in a concerted and sustainably financed action. An estimated three million children under the age of five have been saved from malaria, and the incidence of new HIV cases in sub-Saharan Africa has fallen by more than half between 2001 and 2012. The concept also created an awareness of the rising epidemic of non-communicable diseases (NCDs) in this part of the world. It is too early to predict whether or not this success in the area of infectious disease will repeat itself in the domain of non-communicable diseases. There are some obstacles to overcome. The countries of SSA have to integrate the two separately conceived policies and their different funding into one and to avoid competition in resource allocation between the two areas. They need to develop integrated strategies that begin in the primary health care sector and finally they need to define strategies on how to engage constructively with the private sector.
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A Community-Based Assessment of Hypertension and Some Other Cardiovascular Disease Risk Factors in Ngaoundéré, Cameroon. Int J Hypertens 2016; 2016:4754636. [PMID: 28097019 PMCID: PMC5206854 DOI: 10.1155/2016/4754636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/15/2016] [Indexed: 02/02/2023] Open
Abstract
Background and Objective. Cardiovascular diseases are primary causes of death worldwide with well documented risk factors whose varying impacts added to the complexity in CVD management dictate the need for region-specific studies. We aimed at investigating the interactions between CVD risk factors and hypertension in Ngaoundéré. Methods. A cross-sectional survey was carried out from March to August 2014. Sociodemographic, fasting blood glucose, blood pressure, and anthropometric data were recorded. Statistical analyses were carried out using SAS software version 9.1. Results. 700 adults resident in Ngaoundéré for at least two years consented and were included in the survey. Abdominal obesity, physical inactivity, and hypertension were the dominant risk factors recording 51.1%, 35.4%, and 20.4%, respectively. The prevalence of hyperglycaemia, tobacco consumption, obesity, and alcohol consumption was 5.6%, 8.3%, 9.6%, and 18.1%, respectively. Advanced age, hyperglycaemia, a divorced marital status, and alcohol consumption were independent determinants of high blood pressure. Conclusion. Physical inactivity, abdominal obesity, and hypertension were the most prevalent CVD risk factors, and the role of advanced age and hyperglycaemia in the occurrence of high blood pressure was reiterated. Health programs need to focus on effective screening, prevention, and control of CVDs in the Adamawa Region and Cameroon at large.
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Ossip DJ, Quiñones Z, Diaz S, Thevenet-Morrison K, Fisher S, Holderness H, Cai X, McIntosh S, Dozier A, Chin N, Weber E, Sanchez JJ, Bautista A, Héctor A. Tobacco Cessation in Economically Disadvantaged Dominican Republic Communities: Who are the Ex-Users? J Smok Cessat 2016; 11:239-249. [PMID: 28025600 PMCID: PMC5181849 DOI: 10.1017/jsc.2015.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Tobacco use and harm continue to increase in low- and middle income countries (LMICs) globally. Smoking cessation is the most effective means of reducing morbidity and mortality from tobacco use. Increasing the prevalence of ex-users is an indicator of population cessation. AIMS This study provides the first examination of factors associated with ex-tobacco use status in the Dominican Republic (DR), a LMIC in the Latin America and Caribbean region. METHODS Baseline surveillance was conducted for 1177 randomly selected households in 7 economically disadvantaged DR communities (total N=2680 adult household members). RESULTS Ex-user prevalence was 10.6% (1.0%-18.5% across communities), 14.8% were current users (9.1-20.4), and quit ratios were 41.7% (9.7%-52.7%). Among ever-users, females (OR 2.02, 95% CI 1.41, 2.90), older adults (45-64: OR 1.75, 95% CI 1.12, 2.74; 65+: OR 2.09, 95% CI 1.29, 3.39), and those who could read/write (OR 1.64, 95% CI 1.08, 2.50), had health conditions (OR 1.63, 95% CI 1.11, 2.41), and lived with ex-users (OR 1.70, 95% CI 1.12, 2.58) were over 60% to two times as likely to be ex-users. Those from remote communities (OR 0.52, 95% CI 0.36, 0.74), using chewed tobacco (OR 0.14, 95% CI 0.04, 0.48) and living with tobacco users (OR 0.55, 95% CI 0.37, 0.81) were less likely to be ex-users. CONCLUSIONS Ex-user prevalence and quit ratios were lower than for high income countries. Implementing broad tobacco control measures, combined with clinically targeting vulnerable groups, may increase tobacco cessation to most effectively reduce this public health crisis.
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Affiliation(s)
- Deborah J. Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Zahíra Quiñones
- Pontificia Universidad Católica Madre y Maestra, Santiago, Dominican Republic
| | - Sergio Diaz
- Pontificia Universidad Católica Madre y Maestra, Santiago, Dominican Republic
- Hospital Regional Universitario José Maria Cabral y Baez, Santiago, Dominican Republic
| | - Kelly Thevenet-Morrison
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Susan Fisher
- Department of Clinical Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Heather Holderness
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Xeuya Cai
- Department of Biostatistics, University of Rochester Medical Center, Rochester, NY, USA
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Ann Dozier
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Nancy Chin
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Emily Weber
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Jose Javier Sanchez
- Pontificia Universidad Católica Madre y Maestra, Santiago, Dominican Republic
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Stoler J, Awandare GA. Febrile illness diagnostics and the malaria-industrial complex: a socio-environmental perspective. BMC Infect Dis 2016; 16:683. [PMID: 27855644 PMCID: PMC5114833 DOI: 10.1186/s12879-016-2025-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/14/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Global prioritization of single-disease eradication programs over improvements to basic diagnostic capacity in the Global South have left the world unprepared for epidemics of chikungunya, Ebola, Zika, and whatever lies on the horizon. The medical establishment is slowly realizing that in many parts of sub-Saharan Africa (SSA), particularly urban areas, up to a third of patients suffering from acute fever do not receive a correct diagnosis of their infection. MAIN BODY Malaria is the most common diagnosis for febrile patients in low-resource health care settings, and malaria misdiagnosis has soared due to the institutionalization of malaria as the primary febrile illness of SSA by international development organizations and national malaria control programs. This has inadvertently created a "malaria-industrial complex" and historically obstructed our complete understanding of the continent's complex communicable disease epidemiology, which is currently dominated by a mélange of undiagnosed febrile illnesses. We synthesize interdisciplinary literature from Ghana to highlight the complexity of communicable disease care in SSA from biomedical, social, and environmental perspectives, and suggest a way forward. CONCLUSION A socio-environmental approach to acute febrile illness etiology, diagnostics, and management would lead to substantial health gains in Africa, including more efficient malaria control. Such an approach would also improve global preparedness for future epidemics of emerging pathogens such as chikungunya, Ebola, and Zika, all of which originated in SSA with limited baseline understanding of their epidemiology despite clinical recognition of these viruses for many decades. Impending ACT resistance, new vaccine delays, and climate change all beckon our attention to proper diagnosis of fevers in order to maximize limited health care resources.
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Affiliation(s)
- Justin Stoler
- Department of Geography and Regional Studies, University of Miami, Coral Gables, FL USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL USA
- Abess Center for Ecosystem Science and Policy, University of Miami, Coral Gables, FL USA
| | - Gordon A. Awandare
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
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Ampadu HH, Hoekman J, de Bruin ML, Pal SN, Olsson S, Sartori D, Leufkens HGM, Dodoo ANO. Adverse Drug Reaction Reporting in Africa and a Comparison of Individual Case Safety Report Characteristics Between Africa and the Rest of the World: Analyses of Spontaneous Reports in VigiBase®. Drug Saf 2016; 39:335-45. [PMID: 26754924 PMCID: PMC4796322 DOI: 10.1007/s40264-015-0387-4] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Following the start of the World Health Organization (WHO) Programme for International Drug Monitoring (PIDM) by 10 member countries in 1968, it took another 24 years for the first two African countries to join in 1992, by which time the number of member countries in the PIDM had grown to 33. Whilst pharmacovigilance (PV), including the submission of individual case safety reports (ICSR) to VigiBase®, the WHO global ICSR database, is growing in Africa, no data have been published on the growth of ICSR reporting from Africa and how the features of ICSRs from Africa compare with the rest of the world (RoW). Objective The objective of this paper was to provide an overview of the growth of national PV centres in Africa, the reporting of ICSRs by African countries, and the features of ICSRs from Africa, and to compare ICSRs from Africa with the RoW. Methods The search and analysis interface of VigiBase®—VigiLyze®—was used to characterise ICSRs submitted by African countries and the RoW. The distribution of ICSRs by African countries was listed and characterised by anatomic therapeutic chemical (ATC) code, Medical Dictionary for Regulatory Activities (MedDRA®) system organ class (SOC) classification, and patient age and sex. The case-defining features of ICSRs between Africa and the RoW were also compared. Results The number of African countries in the PIDM increased from 2 in 1992 to 35 at the end of September 2015, and African PIDM members have cumulatively submitted 103,499 ICSRs (0.88 % of global ICSRs) to VigiBase®. The main class of products in African ICSRs are nucleoside and nucleotide reverse transcriptase inhibitors (14.04 %), non-nucleoside reverse transcriptase inhibitors (9.09 %), antivirals for the treatment of HIV infections (5.50 %), combinations of sulfonamides and trimethoprim (2.98 %) and angiotensin-converting enzyme (ACE) inhibitors (2.42 %). The main product classes implicated in ICSRs from the RoW are tumour necrosis factor-α (TNFα) inhibitors (5.29 %), topical nonsteroidal anti-inflammatory preparations (2.26 %), selective immunosuppressants (2.08 %), selective serotonin reuptake inhibitors (2.04 %) and HMG CoA reductase inhibitors (1.85 %). The main SOCs reported from Africa versus the RoW include skin and subcutaneous tissue disorders (31.14 % vs. 19.58 %), general disorders and administration site conditions (20.91 % vs. 30.49 %) and nervous system disorders (17.48 % vs. 19.13 %). The 18–44 years age group dominated ICSRs from Africa, while the 45–64 years age group dominated the RoW. Identical proportions of females (57 % Africa and the RoW) and males (37 % Africa and the RoW) were represented. Conclusions As at the end of September 2015, 35 of 54 African countries were Full Member countries of the PIDM. Although the number of ICSRs from Africa has increased substantially, ICSRs from Africa still make up <1 % of the global total in VigiBase®. The features of ICSRs from Africa differ to those from the RoW in relation to the classes of products as well as age group of patients affected. The gender of patients represented in these ICSRs are identical.
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Affiliation(s)
- Haggar H Ampadu
- WHO Collaborating Centre for Advocacy and Training in Pharmacovigilance, School of Medicine and Dentistry, University of Ghana, P.O Box GP 4236, Accra, Ghana. .,Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Jarno Hoekman
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Marieke L de Bruin
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Shanthi N Pal
- Safety and Vigilance, World Health Organization, Geneva, Switzerland
| | | | | | - Hubert G M Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Alexander N O Dodoo
- WHO Collaborating Centre for Advocacy and Training in Pharmacovigilance, School of Medicine and Dentistry, University of Ghana, P.O Box GP 4236, Accra, Ghana
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Finding the "Right-Size" Physical Therapy Workforce: International Perspective Across 4 Countries. Phys Ther 2016; 96:1597-1609. [PMID: 27149960 DOI: 10.2522/ptj.20160014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/28/2016] [Indexed: 02/09/2023]
Abstract
Finding the "right-size" physical therapy workforce is an increasingly important issue, but it has had limited study, particularly across nations. This perspective article provides a comprehensive examination of physical therapy workforce issues across 4 countries (United States, Singapore, Portugal, and Bangladesh), which were deliberately selected to allow consideration of key contextual factors. This investigation provides a theoretical model uniquely adapted to focus on variables most likely to affect physical therapy workforce needs. This theoretical model was used to guide acquisition of public domain data across the respective countries. The data then were used to provide a contextualized interpretation about the physical therapy workforce supply (ie, physical therapists per capita) across the 4 countries in light of the following factors: indicators of physical therapy need, financial and administrative barriers affecting physical therapy access and demand, the proportion of physical therapy graduates (with varying trends over time across the countries), and the role of emigration/immigration in supply inequalities among countries of lower and higher income. In addition, both the physical therapy workforce supply and scope of practice were analyzed in the context of other related professions across the 4 countries. This international comparison indicated that there may not be a "one-size-fits-all" recommendation for physical therapy workforce supply across countries or an ideal formula for its determination. The optimal, country-specific physical therapy workforce supply appears to be affected by discipline-specific health care and contextual factors that may vary across countries, and even within the same country. This article provides a conceptual framework and basis for such contextualized evaluations of the physical therapy workforce.
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Rodriguez-Fernandez R, Ng N, Susilo D, Prawira J, Bangs MJ, Amiya RM. The double burden of disease among mining workers in Papua, Indonesia: at the crossroads between Old and New health paradigms. BMC Public Health 2016; 16:951. [PMID: 27609056 PMCID: PMC5016925 DOI: 10.1186/s12889-016-3630-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/02/2016] [Indexed: 12/21/2022] Open
Abstract
Background As the global shift toward non-communicable diseases overlaps with the unfinished agenda of confronting infectious diseases in low- and middle-income countries, epidemiological links across both burdens must be recognized. This study examined the non-communicable disease-infectious disease overlap in the specific comorbidity rates for key diseases in an occupational cohort in Papua, Indonesia. Methods Diagnosed cases of ischaemic heart disease, stroke, hypertension, diabetes (types 1 and 2), chronic obstructive pulmonary disease, asthma, cancer, HIV and AIDS, tuberculosis, and malaria were extracted from 22,550 patient records (21,513 men, 1037 women) stored in identical electronic health information systems from two clinic sites in Papua, Indonesia. Data were collected as International Classification of Diseases, 10th Revision, entries from records spanning January-December 2013. A novel application of Circos software was used to visualize the interconnectedness between the disease burdens as overlapping prevalence estimates representing comorbidities. Results Overall, NCDs represented 38 % of all disease cases, primarily in the form of type 2 diabetes (n = 1440) and hypertension (n = 1398). Malaria cases represented the largest single portion of the disease burden with 5310 recorded cases, followed by type 2 diabetes with 1400 cases. Tuberculosis occurred most frequently alongside malaria (29 %), followed by chronic obstructive pulmonary disease (19 %), asthma (17 %), and stroke (12 %). Hypertension-tuberculosis (4 %), tuberculosis-cancer (4 %), and asthma-tuberculosis (2 %) comorbidities were also observed. Conclusions The high prevalence of multimorbidity, preponderance of non-communicable diseases, and extensive interweaving of non-communicable and infectious disease comorbidities highlighted in this cohort of mining workers in Papua, Indonesia reflect the markedly double disease burden increasingly plaguing Indonesia and other similar low- and middle-income countries – a challenge with which their over-stretched, under-resourced health systems are ill-equipped to cope. Integrated, person-centered treatment and control strategies rooted in the primary healthcare sector will be critical to reverse this trend.
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Affiliation(s)
| | - Nawi Ng
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Dwidjo Susilo
- Center for Health Policy and Management, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - John Prawira
- Center for Health Policy and Management, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Rachel M Amiya
- Freeport Public Health and Malaria Control, International SOS, Papua, Indonesia.,Department of Family Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,NCD Asia Pacific Alliance, Tokyo, Japan
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Kalra A, Pokharel Y, Glusenkamp N, Wei J, Kerkar PG, Oetgen WJ, Virani SS. Gender disparities in cardiovascular care access and delivery in India: Insights from the American College of Cardiology's PINNACLE India Quality Improvement Program (PIQIP). Int J Cardiol 2016; 215:248-51. [DOI: 10.1016/j.ijcard.2016.04.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/11/2016] [Indexed: 11/25/2022]
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131
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Herrick C. Global Health, Geographical Contingency, and Contingent Geographies. ANNALS OF THE AMERICAN ASSOCIATION OF GEOGRAPHERS 2016; 106:672-687. [PMID: 27611662 PMCID: PMC4959113 DOI: 10.1080/24694452.2016.1140017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 06/01/2023]
Abstract
Health geography has emerged from under the "shadow of the medical" to become one of the most vibrant of all the subdisciplines. Yet, this success has also meant that health research has become increasingly siloed within this subdisciplinary domain. As this article explores, this represents a potential lost opportunity with regard to the study of global health, which has instead come to be dominated by anthropology and political science. Chief among the former's concerns are exploring the gap between the programmatic intentions of global health and the unintended or unanticipated consequences of their deployment. This article asserts that recent work on contingency within geography offers significant conceptual potential for examining this gap. It therefore uses the example of alcohol taxation in Botswana, an emergent global health target and tool, to explore how geographical contingency and the emergent, contingent geographies that result might help counter the prevailing tendency for geography to be side-stepped within critical studies of global health. At the very least, then, this intervention aims to encourage reflection by geographers on how to make explicit the all-too-often implicit links between their research and global health debates located outside the discipline.
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132
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Reubi D, Herrick C, Brown T. The politics of non-communicable diseases in the global South. Health Place 2016; 39:179-87. [PMID: 26365886 PMCID: PMC4889786 DOI: 10.1016/j.healthplace.2015.09.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/28/2015] [Accepted: 09/01/2015] [Indexed: 11/26/2022]
Abstract
In this paper, we explore the emergence of non-communicable diseases (NCDs) as an object of political concern in and for countries of the global South. While epidemiologists and public health practitioners and scholars have long expressed concern with the changing global distribution of the burden of NCDs, it is only in more recent years that the aetiology, politics and consequences of these shifts have become an object of critical social scientific enquiry. These shifts mark the starting point for this special issue on 'The Politics of NCDs in the Global South' and act as the basis for new, critical interventions in how we understand NCDs. In this paper, we aim not only to introduce and contextualise the six contributions that form this special issue, but also to identify and explore three themes - problematisation, care and culture - that index the main areas of analytical and empirical concern that have motivated analyses of NCDs in the global South and are central to critical engagement with their political contours.
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Affiliation(s)
- David Reubi
- Social Science, Health and Medicine, King's College London, United Kingdom.
| | | | - Tim Brown
- Geography, Queen Mary University of London, United Kingdom.
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Dare AJ, Lee KC, Bleicher J, Elobu AE, Kamara TB, Liko O, Luboga S, Danlop A, Kune G, Hagander L, Leather AJM, Yamey G. Prioritizing Surgical Care on National Health Agendas: A Qualitative Case Study of Papua New Guinea, Uganda, and Sierra Leone. PLoS Med 2016; 13:e1002023. [PMID: 27186645 PMCID: PMC4871553 DOI: 10.1371/journal.pmed.1002023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 04/07/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the social and political factors that influence priority setting for different health services in low- and middle-income countries (LMICs), yet these factors are integral to understanding how national health agendas are established. We investigated factors that facilitate or prevent surgical care from being prioritized in LMICs. METHODS AND FINDINGS We undertook country case studies in Papua New Guinea, Uganda, and Sierra Leone, using a qualitative process-tracing method. We conducted 74 semi-structured interviews with stakeholders involved in health agenda setting and surgical care in these countries. Interviews were triangulated with published academic literature, country reports, national health plans, and policies. Data were analyzed using a conceptual framework based on four components (actor power, ideas, political contexts, issue characteristics) to assess national factors influencing priority for surgery. Political priority for surgical care in the three countries varies. Priority was highest in Papua New Guinea, where surgical care is firmly embedded within national health plans and receives significant domestic and international resources, and much lower in Uganda and Sierra Leone. Factors influencing whether surgical care was prioritized were the degree of sustained and effective domestic advocacy by the local surgical community, the national political and economic environment in which health policy setting occurs, and the influence of international actors, particularly donors, on national agenda setting. The results from Papua New Guinea show that a strong surgical community can generate priority from the ground up, even where other factors are unfavorable. CONCLUSIONS National health agenda setting is a complex social and political process. To embed surgical care within national health policy, sustained advocacy efforts, effective framing of the problem and solutions, and country-specific data are required. Political, technical, and financial support from regional and international partners is also important.
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Affiliation(s)
- Anna J. Dare
- King’s Centre for Global Health, King’s College London and King’s Health Partners, London, United Kingdom
| | - Katherine C. Lee
- Global Health Group, Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Josh Bleicher
- Global Health Group, Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Alex E. Elobu
- Department of Surgery, Mulago Hospital, Kampala, Uganda
| | - Thaim B. Kamara
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Osborne Liko
- Department of Surgery, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Samuel Luboga
- Department of Anatomy, Makerere University College of Health Sciences, Kampala, Uganda
| | - Akule Danlop
- Department of Surgery, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Gabriel Kune
- Department of Surgery, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Lars Hagander
- Department of Clinical Sciences–Lund, Lund University, Lund, Sweden
| | - Andrew J. M. Leather
- King’s Centre for Global Health, King’s College London and King’s Health Partners, London, United Kingdom
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
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Nielsen J, Bahendeka SK, Bygbjerg IC, Meyrowitsch DW, Whyte SR. Accessing diabetes care in rural Uganda: Economic and social resources. Glob Public Health 2016; 12:892-908. [PMID: 27079255 DOI: 10.1080/17441692.2016.1172100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Non-communicable diseases including type 2 diabetes (T2D) are increasing rapidly in most Sub-Saharan African (SSA) countries like Uganda. Little attention has been given to how patients with T2D try to achieve treatment when the availability of public health care for their disease is limited, as is the case in most SSA countries. In this paper we focus on the landscape of availability of care and the therapeutic journeys of patients within that landscape. Based on fieldwork in south-western Uganda including 10 case studies, we explore the diabetes treatment options in the area and what it takes to access the available treatment. We analyse the resources patients need to use the available treatment options, and demonstrate that the patients' journeys to access and maintain treatment are facilitated by the knowledge and support of their therapy management groups. Patients access treatment more effectively, if they and their family have money, useful social relations, and knowledge, together with the capacity to communicate with health staff. Patients coming from households with high socio-economic status (SES) are more likely to have all of these resources, while for patients with low or medium SES, lack of economic resources increases the importance of connections within the health system.
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Affiliation(s)
- Jannie Nielsen
- a Department of Public Health , Global Health Section, University of Copenhagen , Copenhagen , Denmark
| | | | - Ib C Bygbjerg
- a Department of Public Health , Global Health Section, University of Copenhagen , Copenhagen , Denmark
| | - Dan W Meyrowitsch
- a Department of Public Health , Global Health Section, University of Copenhagen , Copenhagen , Denmark
| | - Susan R Whyte
- c Department of Anthropology , University of Copenhagen , Copenhagen , Denmark
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Suk WA, Mishamandani S. Changing exposures in a changing world: models for reducing the burden of disease. REVIEWS ON ENVIRONMENTAL HEALTH 2016; 31:93-96. [PMID: 26887030 DOI: 10.1515/reveh-2015-0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
Environmental exposures are changing dramatically in location, intensity, and frequency. Many developing countries are undergoing a transition in which they face the double burden of infectious diseases as well as chronic diseases. Noncommunicable diseases have emerged as the leading cause of death and disability in developing countries. Globally, pollution is insufficiently appreciated and inadequately quantified as a cause of disease. The health burden from both noninfectious diseases and infectious disease, especially parasites, is high among exposed people. Mothers and children are particularly vulnerable to pollution-related diseases in developing countries. Exposures to pollution can cause protracted noncommunicable diseases across their life span. A global initiative to promote human health sciences and technologies would enhance collaborations and communications amongst investigators and public environmental health officials. Existing models that facilitate the transfer of information and research results exist and can provide insight into building such an international network, allowing better prediction of disease risk and provide ways to reduce exposure to environmental contaminants. A global network would bring together scientists from multiple disciplines and countries to work toward a better understanding of the double burden of disease, especially in low and middle income countries, and promote ways to improve public health.
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136
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Harrington JM, Young DJ, Fry RC, Weber FX, Sumner SS, Levine KE. Validation of a Metallomics Analysis of Placenta Tissue by Inductively-Coupled Plasma Mass Spectrometry. Biol Trace Elem Res 2016; 169:164-73. [PMID: 26155965 PMCID: PMC4763796 DOI: 10.1007/s12011-015-0431-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/29/2015] [Indexed: 01/05/2023]
Abstract
Trace elements can play an important role in maternal health and fetal development, and deficiencies in some essential minerals including zinc and copper have been correlated in some individuals to the development of birth defects and adverse health outcomes later in life. The exact etiology of conditions like preeclampsia and the effects of fetal exposure to toxic metals has not been determined, making the assessment of trace element levels crucial to the elucidation of the causes of conditions like preeclampsia. Previous studies analyzing serum and placenta tissue have produced conflicting findings, suggesting the need for a robust, validated sample preparation and analysis method for the determination of trace elements in placenta. In this report, an acid digestion method and analysis by ICP-MS for a broad metallomics/mineralomics panel of trace elements is developed and validated over three experimental days for inter- and intraday precision and accuracy, linear range, matrix impact, and dilution verification. Spike recovery experiments were performed for the essential elements chromium (Cr), iron (Fe), cobalt (Co), nickel (Ni), copper (Cu), and zinc (Zn), and the toxic elements arsenic (As), cadmium (Cd), and lead (Pb) at levels equal to and in excess of native concentrations in control placenta tissue. The validated method will be essential for the development of scientific studies of maternal health and toxic metal exposure effects in childhood.
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Affiliation(s)
- James M Harrington
- Trace Inorganics Department, Technologies for Industry and the Environment, RTI International, Durham, NC, 27709, USA
| | - Daniel J Young
- Trace Inorganics Department, Technologies for Industry and the Environment, RTI International, Durham, NC, 27709, USA
| | - Rebecca C Fry
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Frank X Weber
- Trace Inorganics Department, Technologies for Industry and the Environment, RTI International, Durham, NC, 27709, USA
| | - Susan S Sumner
- Discovery Science Technology, RTI International, Research Triangle Park, NC, 27709, USA
| | - Keith E Levine
- Trace Inorganics Department, Technologies for Industry and the Environment, RTI International, Durham, NC, 27709, USA.
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Kibret KT, Mesfin YM. Prevalence of hypertension in Ethiopia: a systematic meta-analysis. Public Health Rev 2015; 36:14. [PMID: 29450042 PMCID: PMC5804492 DOI: 10.1186/s40985-015-0014-z] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/25/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hypertension has been increasing in developing countries including Ethiopia. Other than smaller studies, there is no national prevalence study on hypertension in Ethiopia. These smaller studies reported varied prevalence of hypertension. This study is intended to summarize and pool the results of smaller region based studies to provide a national level estimate of the prevalence of hypertension. METHODS The studies were identified through internet search using the data base of MEDLINE/PubMed, Google scholar, EMBASE, HINARI, Cochrane library and reference lists of previous prevalence studies. We also made manual searches to identify relevant articles. Descriptive information for the original studies is presented in a table and the quantitative results were presented in forest plots. The Cochrane Q test and I2 test statistic were used to test heterogeneity across studies. The Pooled estimate of prevalence of hypertension was computed by a random effects model. RESULTS One hundred eight titles were identified through electronic searching using keywords. Of these, nine studies were meet the inclusion criteria. A random effect meta-analysis of the results from these 9 studies was conducted to provide an estimate of the prevalence of hypertension in the Ethiopian population. The analysis showed that the prevalence of hypertension among Ethiopian population was estimated to be 19.6 % (95 % CI: 13.7 %, 25.5 %). Subgroup analyses indicated that the prevalence of hypertension is higher in the urban population (23.7 %) than rural and urban combined (14.7 %). The prevalence of hypertension among males (20.6 %) and females (19.2 %) was similar. CONCLUSION This study found that the prevalence of hypertension in Ethiopia is increasing. This evidence suggests that attention has to be given to primary prevention of hypertension in the Ethiopian adult population, especially in the urban population by integrating it with health extension programs.
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138
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From covalent bonds to eco-physiological pharmacology of secondary plant metabolites. Biochem Pharmacol 2015; 98:269-77. [DOI: 10.1016/j.bcp.2015.07.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 01/08/2023]
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139
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Kraemer MUG, Hay SI, Pigott DM, Smith DL, Wint GRW, Golding N. Progress and Challenges in Infectious Disease Cartography. Trends Parasitol 2015; 32:19-29. [PMID: 26604163 DOI: 10.1016/j.pt.2015.09.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/30/2015] [Accepted: 09/17/2015] [Indexed: 02/02/2023]
Abstract
Quantitatively mapping the spatial distributions of infectious diseases is key to both investigating their epidemiology and identifying populations at risk of infection. Important advances in data quality and methodologies have allowed for better investigation of disease risk and its association with environmental factors. However, incorporating dynamic human behavioural processes in disease mapping remains challenging. For example, connectivity among human populations, a key driver of pathogen dispersal, has increased sharply over the past century, along with the availability of data derived from mobile phones and other dynamic data sources. Future work must be targeted towards the rapid updating and dissemination of appropriately designed disease maps to guide the public health community in reducing the global burden of infectious disease.
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Affiliation(s)
- Moritz U G Kraemer
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK.
| | - Simon I Hay
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD 20892-2220, USA
| | - David M Pigott
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - David L Smith
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK; Fogarty International Center, National Institutes of Health, Bethesda, MD 20892-2220, USA; Sanaria Institute for Global Health and Tropical Medicine, Rockville, MD 20850, USA
| | - G R William Wint
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK; Environmental Research Group Oxford (ERGO), Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK
| | - Nick Golding
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
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140
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Matoto V, Viney K, Roseveare C, Colaguiri R, Marais BJ. Burden and spectrum of disease in people with diabetes in Tonga. Public Health Action 2015; 4:S44-9. [PMID: 26477287 DOI: 10.5588/pha.13.0080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 11/10/2013] [Indexed: 01/08/2023] Open
Abstract
SETTING National Diabetes Centre, Tonga. OBJECTIVE To describe the diabetes patient profile and disease spectrum, assess the impact of diabetic care and evaluate diabetes-attributable adverse outcomes. DESIGN Retrospective descriptive study of patients registered in the National Diabetes Registry from its inception in May 2004 to 2012, and review of the National Deaths Registry (2011-2012). RESULTS Of 4653 patients with diabetes mellitus (DM) identified, 95.8% had type 2 DM, 0.2% type 1, 1.2% gestational DM and 2.9% pre-DM. Of the 4409 patients with type 2 DM, 64.7% were female, 82.7% were aged ⩾40 years, 25.3% had hypertension and 53.3% were obese. Among those in care for >2 years, no positive impact on body mass index or glycosylated haemoglobin could be demonstrated, but there was significant improvement in hypertension control. Morbidity included lower limb amputations in 272 (6.1%) patients. DM was listed as a contributory cause of death due to sepsis (15/30, 50.0%), kidney failure (16/28, 57.1%), stroke (7/16, 43.8%) and ischaemic heart disease (20/59, 33.9%). CONCLUSION DM was associated with high levels of morbidity and mortality. DM care improved hypertension control, but had little impact on other comorbid conditions. Enhanced monitoring and greater patient involvement should improve care; creative strategies are required to prevent and reduce obesity.
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Affiliation(s)
- V Matoto
- National Diabetes Centre, Nuku'alofa, Tonga
| | - K Viney
- Secretariat of the Pacific Community, Noumea, New Caledonia
| | - C Roseveare
- Regional Public Health, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - R Colaguiri
- The Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
| | - B J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
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Nguyen N, Pezzella AT. Pediatric cardiac surgery in low- and middle-income countries or emerging economies: a continuing challenge. World J Pediatr Congenit Heart Surg 2015; 6:274-83. [PMID: 25870347 DOI: 10.1177/2150135115574312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A number of recent publications, addresses, seminars, and conferences have addressed the global backlog and increasing incidence of both congenital and acquired cardiac diseases in children, with reference to early and delayed recognition, late referral, availability of and access to services, costs, risks, databases, and early and long-term results and follow-up. A variety of proposals, recommendations, and projects have been outlined and documented. The ultimate goal of these endeavors is to increase the quality and quantity of pediatric cardiac care and surgery worldwide and particularly in underserved areas. A contemporary review of past and present initiatives is presented with a subsequent focus on the more challenging areas.
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Affiliation(s)
- Nguyenvu Nguyen
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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142
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Son JY, Kim H, Bell ML. Does urban land-use increase risk of asthma symptoms? ENVIRONMENTAL RESEARCH 2015; 142:309-318. [PMID: 26188632 DOI: 10.1016/j.envres.2015.06.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/03/2015] [Accepted: 06/29/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Global urbanization is increasing rapidly, especially in Asian countries. The health impacts of this unprecedented rate of urbanization are not well understood. Prevalence of asthma is also increasing, especially in cities. METHODS We explored the effects of urbanicity, based on urban land-use and traffic-related air pollutants (NO2, PM10), on asthma symptoms and diagnosis at a nationally representative level, using individual-level data from the 2008-2010 Community Health Survey data in Korea. We applied logistic regression, adjusting for sex, age, education, smoking status, and household income. To investigate whether different levels of urban intensity (i.e., degree of urbanization) affected the association, we stratified analysis by urban intensity for the subject's residential district: high (≥30% urban), medium (10-30%), and low intensity (<10%). RESULTS Increased urban land-use was significantly associated with increased risk of asthma symptoms and diagnosis. A 10% increase of urban land-use of a subject's residential district was associated with an odds ratio (OR) of 1.03 (95% CI: 1.02, 1.04) for self-reported physician-diagnosed asthma. However, increased urbanicity is associated with higher risk of asthma in areas with a baseline of low urbanicity, but not in areas with a baseline of high urbanicity. Significant positive associations were also observed for air pollution (PM10 and NO2) with asthma symptoms and diagnosis. CONCLUSIONS Our findings suggest that increases in urbanicity or air pollution are associated with increased risk of asthma, and that the level of urban intensity affected the associations.
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Affiliation(s)
- Ji-Young Son
- School of Forestry & Environmental Studies, Yale University, 195 Prospect Street, New Haven, CT 06511, USA
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Michelle L Bell
- School of Forestry & Environmental Studies, Yale University, 195 Prospect Street, New Haven, CT 06511, USA.
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143
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Yeates K, Lohfeld L, Sleeth J, Morales F, Rajkotia Y, Ogedegbe O. A Global Perspective on Cardiovascular Disease in Vulnerable Populations. Can J Cardiol 2015; 31:1081-93. [PMID: 26321432 DOI: 10.1016/j.cjca.2015.06.035] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/29/2015] [Accepted: 06/29/2015] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular disease (CVD) is a major contributor to the growing public health epidemic in chronic diseases. Much of the disease and disability burden from CVDs are in people younger than the age of 70 years in low- and middle-income countries, formerly "the developing world." The risk of CVD is heavily influenced by environmental conditions and lifestyle variables. In this article we review the scope of the CVD problem in low- and middle-income countries, including economic factors, risk factors, at-risk groups, and explanatory frameworks that hypothesize the multifactorial drivers. Finally, we discuss current and potential interventions to reduce the burden of CVD in vulnerable populations including research needed to evaluate and implement promising solutions for those most at risk.
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Affiliation(s)
- Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Lynne Lohfeld
- McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada
| | - Jessica Sleeth
- Office of Global Health, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Fernando Morales
- ICAP at Columbia University, Mailman School of Public Health, New York, New York
| | | | - Olugbenga Ogedegbe
- Division of Health an Behavior, Center for Healthful Behavior Change, College of Global Public Health, Center for Healthful Behavior Change, New York University, Langone Medical Center, New York, New York
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144
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Mattei J, Malik V, Wedick NM, Hu FB, Spiegelman D, Willett WC, Campos H. Reducing the global burden of type 2 diabetes by improving the quality of staple foods: The Global Nutrition and Epidemiologic Transition Initiative. Global Health 2015; 11:23. [PMID: 26040275 PMCID: PMC4489001 DOI: 10.1186/s12992-015-0109-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 05/26/2015] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes has been reaching epidemic proportions across the globe, affecting low/middle-income and developed countries. Two main contributors to this burden are the reduction in mortality from infectious conditions and concomitant negative changes in lifestyles, including diet. We aimed to depict the current state of type 2 diabetes worldwide in light of the undergoing epidemiologic and nutrition transition, and to posit that a key factor in the nutrition transition has been the shift in the type and processing of staple foods, from less processed traditional foods to highly refined and processed carbohydrate sources. DISCUSSION We showed data from 11 countries participating in the Global Nutrition and Epidemiologic Transition Initiative, a collaborative effort across countries at various stages of the nutrition-epidemiologic transition whose mission is to reduce diabetes by improving the quality of staple foods through culturally-appropriate interventions. We depicted the epidemiologic transition using demographic and mortality data from the World Health Organization, and the nutrition transition using data from the Food and Agriculture Organization food balance sheets. Main staple foods (maize, rice, wheat, pulses, and roots) differed by country, with most countries undergoing a shift in principal contributors to energy consumption from grains in the past 50 years. Notably, rice and wheat products accounted for over half of the contribution to energy consumption from staple grains, while the trends for contribution from roots and pulses generally decreased in most countries. Global Nutrition and Epidemiologic Transition Initiative countries with pilot data have documented key barriers and motivators to increase intake of high-quality staple foods. Global research efforts to identify and promote intake of culturally-acceptable high-quality staple foods could be crucial in preventing diabetes. These efforts may be valuable in shaping future research, community interventions, and public health and nutritional policies.
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Affiliation(s)
- Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Vasanti Malik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Nicole M Wedick
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Donna Spiegelman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Hannia Campos
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
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145
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Fu ZZ, Peng Y, Cao LY, Chen YS, Li K, Fu BH. Value of apparent diffusion coefficient (ADC) in assessing radiotherapy and chemotherapy success in cervical cancer. Magn Reson Imaging 2015; 33:516-24. [DOI: 10.1016/j.mri.2015.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 01/31/2015] [Accepted: 02/01/2015] [Indexed: 12/22/2022]
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147
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Htun NSN, Odermatt P, Eze IC, Boillat-Blanco N, D’Acremont V, Probst-Hensch N. Is diabetes a risk factor for a severe clinical presentation of dengue?--review and meta-analysis. PLoS Negl Trop Dis 2015; 9:e0003741. [PMID: 25909658 PMCID: PMC4409149 DOI: 10.1371/journal.pntd.0003741] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 04/06/2015] [Indexed: 12/14/2022] Open
Abstract
Background The mean age of acute dengue has undergone a shift towards older ages. This fact points towards the relevance of assessing the influence of age-related comorbidities, such as diabetes, on the clinical presentation of dengue episodes. Identification of factors associated with a severe presentation is of high relevance, because timely treatment is the most important intervention to avert complications and death. This review summarizes and evaluates the published evidence on the association between diabetes and the risk of a severe clinical presentation of dengue. Methodology/Findings A systematic literature review was conducted using the MEDLINE database to access any relevant association between dengue and diabetes. Five case-control studies (4 hospital-based, 1 population-based) compared the prevalence of diabetes (self-reported or abstracted from medical records) of persons with dengue (acute or past; controls) and patients with severe clinical manifestations. All except one study were conducted before 2009 and all studies collected information towards WHO 1997 classification system. The reported odds ratios were formally summarized by random-effects meta-analyses. A diagnosis of diabetes was associated with an increased risk for a severe clinical presentation of dengue (OR 1.75; 95% CI: 1.08–2.84, p = 0.022). Conclusions/Significance Large prospective studies that systematically and objectively obtain relevant signs and symptoms of dengue fever episodes as well as of hyperglycemia in the past, and at the time of dengue diagnosis, are needed to properly address the effect of diabetes on the clinical presentation of an acute dengue fever episode. The currently available epidemiological evidence is very limited and only suggestive. The increasing global prevalence of both dengue and diabetes justifies further studies. At this point, confirmation of dengue infection as early as possible in diabetes patients with fever if living in dengue endemic regions seems justified. The presence of this co-morbidity may warrant closer observation for glycemic control and adapted fluid management to diminish the risk for a severe clinical presentation of dengue. Both dengue and diabetes have reached epidemic dimensions and pose a joint threat to a large proportion of populations in low- and middle-income countries. Dengue is no longer a disease primarily affecting children. Therefore the influence of non-communicable diseases such as diabetes, which are increasingly prevalent in adults, on the clinical presentation of a dengue episode becomes a public health priority. We conducted a systematic literature review to assess the available evidence on the effect of diabetes mellitus (DM) on the clinical presentation of dengue. The meta-analysis of published evidence combined with supporting biological evidence point to an increased risk for potentially life threatening symptoms of dengue among patients with diabetes. The current evidence is limited by statistical power and other study limitations and does not allow conclusions about a causal effect of diabetes. Yet, based on the currently available evidence, diabetes patients with fever and living in a dengue endemic region should seek confirmation of dengue infection as early as possible. Diabetes should be considered in the triage of patients for close observation and early intervention, which are challenges, particularly during dengue outbreaks. Timeliness of intervention is the most important factor averting serious complications and death in patients with acute dengue.
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Affiliation(s)
- Nan Shwe Nwe Htun
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Peter Odermatt
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ikenna C. Eze
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Noémie Boillat-Blanco
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Valérie D’Acremont
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Abstract
OBJECTIVE This study aims to forecast lung cancer mortality with respect to recent changes in smoking prevalence and compares the results to estimates from GLOBOCAN and the Global Burden of Disease study. SETTING An established epidemiological model is applied to detailed smoking prevalence data from South Africa to estimate lung cancer mortality from 2010 to 2025. PARTICIPANTS Data from the South Africa Demographic and Health Survey conducted in 2003 was analysed by sex and ethnic group, and combined with longitudinal estimates on smoking prevalence from 1980 to 2010. PRIMARY AND SECONDARY OUTCOME MEASURES Results provide detailed data on tobacco smoking behaviour by age, sex and ethnic group as well as modelled age-adjusted lung cancer mortality and number of yearly lung cancer deaths. RESULTS From 2010 to 2025, a decrease in age-adjusted lung cancer mortality is shown from 17.1 to 14.1 among men; whereas rates were stable around 7.2 among women. As a consequence, the estimated number of yearly lung cancer deaths is expected to increase slightly for men and more for women. With respect to ethnic groups, male mortality is expected to be highest for Asians and lowest for blacks. Female rates were lowest for Asians and highest for whites and for coloured. CONCLUSIONS Mortality estimates of this study are close to the WHO mortality database and to Global Burden of Disease estimates for 2010, but significantly lower compared with GLOBOCAN estimates. In conclusion, our study demonstrates the impact of demographic changes and the positive effects of antismoking policy on lung cancer mortality in South Africa. Results may help decision makers to further improve smoking control.
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Affiliation(s)
- Volker Winkler
- Institut für Public Health, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Nosimanana J Mangolo
- Institut für Public Health, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Heiko Becher
- Institut für Public Health, Universitätsklinikum Heidelberg, Heidelberg, Germany
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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149
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Oggioni C, Cena H, Wells JCK, Lara J, Celis-Morales C, Siervo M. Association between worldwide dietary and lifestyle patterns with total cholesterol concentrations and DALYs for infectious and cardiovascular diseases: an ecological analysis. J Epidemiol Glob Health 2015; 5:315-25. [PMID: 25747186 PMCID: PMC7320501 DOI: 10.1016/j.jegh.2015.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/03/2015] [Accepted: 02/04/2015] [Indexed: 12/03/2022] Open
Abstract
Global dietary and lifestyle trends are primary risk factors for communicable and non-communicable diseases. An ecological analysis was conducted to examine the association of global dietary and lifestyle patterns with total cholesterol concentrations. This study also investigated whether total cholesterol modified the association between dietary and lifestyle habits with disability-adjusted-life-years-lost (DALYs) for infectious and cardiovascular diseases (CVDs). Country-specific mean total cholesterol concentrations and DALYs for infectious and CVDs were obtained. Data were then matched to country-specific food and energy availability for consumption and information on obesity, physical inactivity, urbanization, gross domestic product (GDP), life expectancy and smoking. Stepwise multiple regression models were developed to identify significant predictors of total cholesterol concentrations and DALYs for infectious and CVDs. Life expectancy and egg and meat consumption were significantly associated with cholesterol concentrations. DALYs for infectious diseases were associated with smoking, life expectancy and per capita GDP. Smoking was the only predictor of DALYs for CVDs. The improvement of socio-demographic conditions and economic growth is likely to reduce the burden of communicable diseases in developing countries. A concurring increase in non-communicable diseases is expected, and these results have, yet again, identified smoking as a primary risk factor for CVDs.
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Affiliation(s)
- C Oggioni
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne NE4 5PL, UK; Department of Public Health, Neuroscience, Experimental and Forensic Medicine, Section of Human Nutrition, University of Pavia, via Bassi 21, 27100 Pavia, Italy
| | - H Cena
- Department of Public Health, Neuroscience, Experimental and Forensic Medicine, Section of Human Nutrition, University of Pavia, via Bassi 21, 27100 Pavia, Italy
| | - J C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - J Lara
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne NE4 5PL, UK
| | - C Celis-Morales
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne NE4 5PL, UK
| | - M Siervo
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne NE4 5PL, UK.
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150
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Byrne AL, Marais BJ, Mitnick CD, Lecca L, Marks GB. Tuberculosis and chronic respiratory disease: a systematic review. Int J Infect Dis 2015; 32:138-46. [DOI: 10.1016/j.ijid.2014.12.016] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/05/2014] [Indexed: 11/24/2022] Open
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