An Emerging Epidemic of Noncommunicable Diseases in Developing Populations Due to a Triple Evolutionary Mismatch

Interfaces of 'being healthy and being Ill': how is health being perceived by individuals with non-communicable chronic conditions?

BACKGROUND

Accommodating chronic care into the everyday lives of individuals diagnosed with non-communicable chronic conditions often poses significant challenges. Several studies in public health literature that addressed the question of non-adherence to treatment by turning their gaze towards individual's perception of their own health restricted the use of perception exploration to visceral states and corporeality without adequately acknowledging the mutual permeance of socio-biological worlds. This study explored the socio-economic genealogies of individuals, to understand the role of structural and intermediate factors that determine health perceptions, by attempting to answer the question 'how do individuals with non-communicable chronic conditions perceive their health as healthy or ill'?.

METHODS

This study was conducted in a low-income neighbourhood called Kadugondanahalli in India using qualitative research methods. A total of 20 in-depth interviews were conducted with individuals diagnosed with non-communicable chronic conditions. Individuals were recruited through purposive and snowball sampling.

RESULTS

The participants predominantly perceived their health as being healthy and ill in an episodic manner while adhering to their treatment and medications for chronic conditions. This was strongly determined by the factors such as presence of family support and caregiving, changes in work and occupation, changes in lifestyle, psychological stress from being diagnosed, and care-seeking practices. This episodic perception of illness led to the non-adherence of prescribed chronic care.

CONCLUSIONS

Due to the episodic manner in which the participants experienced their illness, the paper recommends considering health and illness as two different entities while researching chronic conditions. It is important for the health system to understand and fix the healthy and ill episodes, which often lead to switching between controlled and uncontrolled states of diabetes and hypertension. To do so, it is important to consider the social, economic, behavioural and psychological factors in an individual's health outcome. The interplay between these factors has socialized health perception and various related practices from the individual to the community level. Therefore, the health system needs to re-strategize its focus from individual to community level interventions to address the determinants of health and NCD risk factors by strengthening the NCD prevention approach.

Contention and collaboration: the tenuous encounter of modern Ayurveda and Western medicine in the twentieth and twenty-first centuries

Complementary medicine systems are ascending to rapid popularity as the twenty-first century progresses. Often adapted from ancient systems of healing such as Ayurveda, these modern alternative medical movements reappraise millennia-old health traditions that found their inception at the confluence of religious philosophy and herbal healing. Naturally, contemporary global economic forces and a desire to market traditional medicine products in an enticing fashion have characterised how historic traditional medicine systems are presented in the modern context. By establishing a vision of complementary medicine born from ancient traditions, it becomes clear how traditional methods of healing can contend with Western biomedicine-the prevailing standard of care around the globe. The claims made by both sides parry along a line of scientific validity, efficacy and regulatory purview. India, the birthplace of Ayurveda and an epicentre of contemporary medical education, is a prime arena to study the friction between biomedicine and traditional medicine. In this piece, I focus on the modernisation of Ayurveda and how it has found conflict with allopathic medicine. I posit that Ayurveda has re-emerged since the early twentieth century as a key tenet of Indian modernity: and in doing so has found contention with Western medicine. I furthermore argue that despite existing discord, the two medical traditions are not inherently antithetical. They can be synergistic, so long as healthcare delivery and education recognise the limits of each and focus on coaction rather than contradiction.

A retrospective study of environmental predictors of dengue in Delhi from 2015 to 2018 using the generalized linear model

Dengue fever is a mosquito-borne infection with a rising trend, expected to increase further with the rise in global temperature. The study aimed to use the environmental and dengue data 2015–2018 to examine the seasonal variation and establish a probabilistic model of environmental predictors of dengue using the generalized linear model (GLM). In Delhi, dengue cases started emerging in the monsoon season, peaked in the post-monsoon, and thereafter, declined in early winter. The annual trend of dengue cases declined, but the seasonal pattern remained alike (2015–18). The Spearman correlation coefficient of dengue was significantly high with the maximum and minimum temperature at 2 months lag, but it was negatively correlated with the difference of average minimum and maximum temperature at lag 1 and 2. The GLM estimated β coefficients of environmental predictors such as temperature difference, cumulative rainfall, relative humidity and maximum temperature were significant (p < 0.01) at different lag (0 to 2), and maximum temperature at lag 2 was having the highest effect (IRR 1.198). The increasing temperature of two previous months and cumulative rainfall are the best predictors of dengue incidence. The vector control should be implemented at least 2 months ahead of disease transmission (August–November).

Nutrition Transition and Health Outcomes Among Indigenous Populations of Chile

BACKGROUND

Over the past several decades, rural and indigenous populations in Latin America have experienced abrupt and profound transformations in their lifestyles and economies, many having remarkable health consequences. Yet, these changes have had heterogeneous effects on the population's biology in different local contexts.

OBJECTIVES

The primary goal was to characterize the nutrition transition and biomarkers of noncommunicable diseases (NCD) risk in 2 Chilean indigenous populations that have had divergent histories of subsistence strategies (agropastoralism compared with hunter-gathering) in the last few millennia and live in contrasting environments, and to identify context-specific factors driving the nutrition and epidemiological transitions.

METHODS

One-hundred-and-ninety (90 Pehuenche and 100 Atacameño) participants aged 18-87 y completed demographic, food-frequency, and physical activity questionnaires as well as measurements of some NCD risk biomarkers: blood pressure, weight, height, body fat percentage, waist circumference, blood total cholesterol, HDL cholesterol, triglycerides, and glucose. Framingham risk scores (FRSs) were calculated based on age, sex, total cholesterol, HDL cholesterol, systolic blood pressure, smoking, diabetes status, and hypertension medication.

RESULTS

Few differences in dietary composition and physical activity patterns were observed between the 2 populations. Multivariate analyses showed no differences between the 2 populations in any of the individual NCD risk biomarkers or FRSs after adjusting for age, sex, time since last meal, food insecurity in childhood, ultraprocessed food consumption, and physical activity.

CONCLUSIONS

Despite contrasting ecological and historical contexts, the 2 groups are converging into similar processes of market and wage-labor integration and transitioning to a Western diet high in processed and nonlocal foods, although some aspects of their "traditional" foodways are still in practice. The frequency of individuals exhibiting NCD biomarkers "at-risk" is relatively high and corresponds to other populations that have gone through nutrition transition. Furthermore, none of these biomarkers or FRSs differed between the 2 populations, suggesting a homogenization in the NCD risk factors.

Comorbidity of HIV, hypertension, and diabetes and associated factors among people receiving antiretroviral therapy in Bahir Dar city, Ethiopia

Background:

People living with human immunodeficiency virus (HIV) are facing an increased burden of noncommunicable diseases (NCDs) comorbidity. There is, however, paucity of information on the magnitude of HIV-NCDs comorbidity, its associated factors, and how the health system is responding to the double burden in Ethiopia.

Objective:

To determine the magnitude of comorbidity between HIV and hypertension or diabetes and associated factors among HIV-positive adults receiving antiretroviral therapy (ART) in Bahir Dar city, Ethiopia.

Methods:

A facility-based cross-sectional study was conducted among 560 randomly selected HIV-positive adults taking ART. Data were collected using a structured questionnaire and analyzed using SPSS version 23. Descriptive statistics were used to describe the data. A logistic regression model was fit to identify associated factors with comorbidity of HIV and NCDs.

Results:

The magnitude of comorbidity was 19.6% (95% confidence interval (CI): 16.0–23.0). Being older (55 and above years) adjusted odds ratio (AOR: 8.5; 95% CI: 3.2–15.1), taking second-line ART regimen containing tenofovir (AOR: 2.7; 95% CI: 1.3–5.6), and increased body mass index (BMI) ≥25 (AOR: 2.7; 95% CI: 1.2–6.5) were the factors associated with comorbidity. Participants reported that they were not managed in an integrated and coordinated manner.

Conclusions:

The magnitude of comorbidity among adults was high in the study area. Being older, second-line ART regimen and high BMI ≥25 increased the odds of having NCDs among HIV-positive adults. Targeted screening for the incidences of NCDs, addressing modifiable risk factors, and providing integrated care would help to improve the quality of life comorbid patients.

Precision Medicine in Non-Communicable Diseases

The increase in life expectancy during the 20th century ranks as one of society's greatest achievements, with massive growth in the numbers and proportion of the elderly, virtually occurring in every country of the world. The burden of chronic diseases is one of the main consequences of this phenomenon, severely hampering the quality of life of elderly people and challenging the efficiency and sustainability of healthcare systems. Non-communicable diseases (NCDs) are considered a global emergency responsible for over 70% of deaths worldwide. NCDs are also the basis for complex and multifactorial diseases such as hypertension, diabetes, and obesity. The epidemics of NCDs are a consequence of a complex interaction between health, economic growth, and development. This interaction includes the individual genome, the microbiome, the metabolome, the immune status, and environmental factors such as nutritional and chemical exposure. To counteract NCDs, it is therefore essential to develop an innovative, personalized, preventative, early care model through the integration of different molecular profiles of individuals to identify both the critical biomarkers of NCD susceptibility and to discover novel therapeutic targets.

Why monkeys do not get multiple sclerosis (spontaneously): An evolutionary approach

The goal of this review is to apply an evolutionary lens to understanding the origins of multiple sclerosis (MS), integrating three broad observations. First, only humans are known to develop MS spontaneously. Second, humans have evolved large brains, with characteristically large amounts of metabolically costly myelin. This myelin is generated over long periods of neurologic development—and peak MS onset coincides with the end of myelination. Third, over the past century there has been a disproportionate increase in the rate of MS in young women of childbearing age, paralleling increasing westernization and urbanization, indicating sexually specific susceptibility in response to changing exposures. From these three observations about MS, a life history approach leads us to hypothesize that MS arises in humans from disruption of the normal homeostatic mechanisms of myelin production and maintenance, during our uniquely long myelination period. This review will highlight under-explored areas of homeostasis in brain development, that are likely to shed new light on the origins of MS and to raise further questions about the interactions between our ancestral genes and modern environments.

Defining a Research Agenda to Address the Converging Epidemics of Tuberculosis and Diabetes: Part 1: Epidemiology and Clinical Management

There is growing interest in the interaction between type 2 diabetes mellitus (DM) and TB, but many research questions remain unanswered. Epidemiologists, basic scientists, and clinical experts recently convened and identified priorities. This is the first of two reviews on this topic, summarizing priority areas of research regarding epidemiology, clinical management, and public health. First, from an epidemiologic point of view, more study is needed to determine the importance of transient hyperglycemia in patients with TB and on the importance of DM for the global epidemic of multidrug resistant (MDR)-TB. Second, regarding the screening and clinical management of combined TB and DM (TB-DM), clinical trials and large cohort studies should examine the benefits of improved DM care as well as prolonged or intensified TB treatment on the outcome of TB-DM and investigate the cost-effectiveness of screening methods for DM among patients newly diagnosed with TB. Third, from a public health and health systems point of view, the population health impact and cost-effectiveness of different interventions to prevent or treat DM and TB in high-burden populations should be examined, and health-system interventions should be developed for routine TB-DM screening, management of DM after completion of TB treatment, and better access to DM services worldwide. Studies are needed across different ethnicities and settings given the heterogeneity of metabolic perturbations, inflammatory responses, medications, and access to health care. Finally, studies should address interactions between TB, DM, and HIV because of the convergence of epidemics in sub-Saharan Africa and some other parts of the world.

The global diabetes epidemic: what does it mean for infectious diseases in tropical countries?

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.