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Ahmed SM, Krishnan A, Karim O, Shafique K, Naher N, Srishti SA, Raj A, Ahmed S, Rawal L, Adams A. Delivering non-communicable disease services through primary health care in selected south Asian countries: are health systems prepared? Lancet Glob Health 2024; 12:e1706-e1719. [PMID: 39178879 DOI: 10.1016/s2214-109x(24)00118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 02/06/2024] [Accepted: 03/05/2024] [Indexed: 08/26/2024]
Abstract
In the south Asian region, delivering non-communicable disease (NCD) prevention and control services through existing primary health-care (PHC) facilities is urgently required yet currently challenging. As the first point of contact with the health-care system, PHC offers an ideal window for prevention and continuity of care over the life course, yet the implementation of PHC to address NCDs is insufficient. This review considers evidence from five south Asian countries to derive policy-relevant recommendations for designing integrated PHC systems that include NCD care. Findings reveal high political commitment but poor multisectoral engagement and health systems preparedness for tackling chronic diseases at the PHC level. There is a shortage of skilled human resources, requisite infrastructure, essential NCD medicines and technologies, and dedicated financing. Although innovations supporting integrated interventions exist, such as innovations focusing on community-centric approaches, scaling up remains problematic. To deliver NCD services sustainably, governments must aim for increased financing and a redesign of PHC service.
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Affiliation(s)
- Syed Masud Ahmed
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, India
| | - Obaida Karim
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Kashif Shafique
- School of Public Health, Dow University of Health Sciences, Gulzar-e-Hijri, Karachi, Pakistan
| | - Nahitun Naher
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Aravind Raj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Sana Ahmed
- School of Public Health, Dow University of Health Sciences, Gulzar-e-Hijri, Karachi, Pakistan
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Alayne Adams
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
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Azhar Hilmy SH, Nordin N, Yusof MYPM, Soh TYT, Yusof N. Components in downstream health promotions to reduce sugar intake among adults: a systematic review. Nutr J 2024; 23:11. [PMID: 38233923 PMCID: PMC10792802 DOI: 10.1186/s12937-023-00884-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/19/2023] [Indexed: 01/19/2024] Open
Abstract
Excessive sugar consumption is well documented as a common risk factor for many Non-Communicable Diseases (NCDs). Thus, an adequate intervention description is important to minimise research waste and improve research usability and reproducibility. A systematic review was conducted to identify components in published evidence interventions pertaining to the health promotions on reducing sugar intake among adults. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and used the Mixed Methods Appraisal Tool (MMAT) for quality appraisal. The period for the selected study was from 2000 to 2022, and articles were retrieved from Web of Science (WOS), Medline, Scopus, and PubMed. The target population was adults aged 18 years old and above who underwent intervention to assess the changes in their sugar intake. Data sources and all human epidemiologic studies were included. Out of the 9,333 papers identified, 25 were included. The overall quality of evidence of the studies was considered moderate. Apart from the characteristics of the reviewed studies, components of interventions are including the basis of theoretical or model for the intervention, which majority use Social Cognitive Theory, followed by PRECEDE-PROCEED model, socio-ecological and process-improvement theories and Transtheoretical Model; providers, who are commercial provider, qualified nutritionist, professor of nutrigenomics and nutrigenetics, doctor, dietitian nutritionist, lifestyle coaches, and junior public health nurses; duration of the intervention and follow-up time, varies from as short as one month to as long as 24 months; material provided either softcopy or hardcopy; tailoring approach, based on the individual goals, the process of change, genotype analysis, beliefs, barriers, and sociocultural norms; delivery mechanism either face-to-face or technology-mediated; and tools to measure the sugar consumption outcome mostly used Food Frequency Questionnaire (FFQ), besides 24-h dietary recalls, and food diaries. There are various components in downstream health promotion to reduce sugar intake among adults that can be adapted according to the local health promotion and intervention context. More well-designed interventions using integration components are encouraged in further studies.
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Affiliation(s)
- Syathirah Hanim Azhar Hilmy
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia
- Department of Periodontology & Community Oral Health, Faculty of Dentistry, Universiti Sains Islam Malaysia (USIM), Kuala Lumpur, 57000, Malaysia
| | - Norhasnida Nordin
- Centre of Comprehensive Care, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Selangor, Malaysia
| | - Mohd Yusmiaidil Putera Mohd Yusof
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Selangor, Malaysia
| | - Tuan Yuswana Tuan Soh
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia
| | - Norashikin Yusof
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia.
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Gowdru Srinivasa M, B C R, Prabhu A, Rani V, Ghate SD, Kumar B R P. Development of novel thiazolidine-2,4-dione derivatives as PPAR-γ agonists through design, synthesis, computational docking, MD simulation, and comprehensive in vitro and in vivo evaluation. RSC Med Chem 2023; 14:2401-2416. [PMID: 37974963 PMCID: PMC10650958 DOI: 10.1039/d3md00273j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/06/2023] [Indexed: 11/19/2023] Open
Abstract
The present study was conducted to develop new novel 2,4-thiazolidinedione derivatives (3h-3j) as peroxisome proliferator-activated receptor-γ (PPAR-γ) modulators for antidiabetic activity. The objective was to overcome the adverse effects of existing thiazolidinediones while maintaining their pharmacological benefits. The synthesized compounds were elucidated based on FT-IR, 1H-NMR, 13C-NMR, and MS techniques. Molecular docking was utilized to investigate the interaction binding modes, binding free energy, and amino acids engaged in the compounds' interactions with the target protein. Subsequently, molecular dynamics modelling was used to assess the stability of the top-docked complexes and an assay was utilized to assess the cytotoxicity of the compounds to C2C12 myoblasts. Compounds 3h-3j exhibited PPAR-γ modulatory activity and demonstrated significant hypoglycaemic effects when compared to the reference drug pioglitazone. The new compounds were evaluated for their in vivo blood glucose-lowering potential by using a dexamethasone-induced diabetic rat model. All the compounds showed a hypoglycaemic effect of 108.04 ± 4.39, 112.55 ± 6.10, and 117.48 ± 43.93, respectively, along with pioglitazone (153.93 ± 4.61) compared to the diabetic control. Additionally, all the compounds significantly reduced AST and ALT levels and did not cause liver damage.
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Affiliation(s)
- Mahendra Gowdru Srinivasa
- Department of Pharmaceutical Chemistry, Nitte (Deemed to be University), NGSM Institute of Pharmaceutical Sciences (NGSMIPS) Mangalore India
| | - Revanasiddappa B C
- Department of Pharmaceutical Chemistry, Nitte (Deemed to be University), NGSM Institute of Pharmaceutical Sciences (NGSMIPS) Mangalore India
| | - Ashwini Prabhu
- Yenepoya Research Centre, Yenepoya (Deemed to be University) Deralakatte Mangalore 575 018 Karnataka India
| | - Vinitha Rani
- Yenepoya Research Centre, Yenepoya (Deemed to be University) Deralakatte Mangalore 575 018 Karnataka India
| | - Sudeep D Ghate
- Center for Bioinformatics, Nitte (Deemed to be University) Deralakatte Mangalore Karnataka - 575 018 India
| | - Prashantha Kumar B R
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, JSS Academy of Higher Education and Research Mysuru-570015 Karnataka India
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Luo J, Tao Y, Xu Y, Yang L, Zhang H, Chen Y, Liu X, Zhang Y, Lan R, Chen Y, Liu B, Deng T. Global comparison of the effect of non-pharmacological interventions on glycemic control in patients with type 2 diabetes: A network meta-analysis from 107 randomized controlled trials. J Diabetes Complications 2023; 37:108518. [PMID: 37267719 DOI: 10.1016/j.jdiacomp.2023.108518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/24/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the effectiveness of non-pharmacological interventions (NPIs) on glycemic control in patients with type 2 diabetes (T2D) and to provide guidance for clinical healthcare-giver. DESIGN Network meta-analysis (NMA). SETTING AND PARTICIPANTS Randomized controlled trials comparing the effect of NPIs with usual care, waitlist, or other NPIs on glycemic control in patients with T2D. METHODS This NMA was guided by frequentist framework. PubMed, Embase, the Cochrane Library Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature, and Web of Science were searched from their inception until January 2023. The primary outcome was HbA1c and secondary outcomes were cardiovascular risk scores and related psychosocial scores. Mean differences and standardized mean differences were pooled using NMA. Study quality was assessed with the Confidence in Network Meta-analysis. RESULTS A total of 107 studies (10,496 participants) were included. The median sample size of the included studies was 64 (range, 10-563) and the median duration was 3 months (range, 1-24). Compared to usual care, all NPIs except acupuncture (MD: -0.28; 95 % CI: -1.02, 0.26) and psychological therapy (MD: -0.29; 95 % CI: -0.66, 0.08) showed significantly differences in improving glycemic control in patients with T2D. And according to the results of surface under the cumulative ranking analysis and Cluster ranking, meditation therapy was considered to the best choice when balancing the efficacy of glycemic control with self-efficacy and diabetes related problems, while nutrition therapy was considered to the best choice when balancing quality of life with risk of cardiovascular complications. CONCLUSIONS These findings validate the efficacy of NPIs for glycemic control in patients with T2D and suggest that healthcare-giver should consider both the efficacy of interventions and the psychosocial needs of patients when developing NPIs programs.
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Affiliation(s)
- Jingsong Luo
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Yanmin Tao
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yaxin Xu
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; School of Nursing, Tongji University, Shanghai 200000, China
| | - Liping Yang
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Han Zhang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Yufei Chen
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Xingting Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yunwu Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Ruixi Lan
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yuxin Chen
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Beijia Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Tingting Deng
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
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