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Rao KD, Mehta A, Kautsar H, Kak M, Karem G, Misra M, Joshi H, Herbst CH, Perry HB. Improving quality of non-communicable disease services at primary care facilities in middle-income countries: A scoping review. Soc Sci Med 2023; 320:115679. [PMID: 36731302 DOI: 10.1016/j.socscimed.2023.115679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/02/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
Health systems in middle-income countries face important challenges in managing the high burden of Non-Communicable Diseases (NCD). Primary health care is widely recognized as key to managing NCDs in communities. However, the effectiveness of this approach is limited by poor quality of care (QoC), among others. This scoping review identifies the types of interventions that have been used in middle-income countries to improve the quality of NCD services at primary care facilities. Further, it identifies the range of outcomes these quality interventions have influenced. This scoping review covered both the grey and peer-reviewed literature. The 149 articles reviewed were classified into four domains - governance, service-delivery systems, health workforce, and patients and communities. There was a remarkable unevenness in the geographic distribution of studies - lower middle-income countries and some regions (Middle East, North Africa, and South East Asia) had a scarcity of published studies. NCDs such as stroke and cardiovascular disease, mental health, cancer, and respiratory disorders received less attention. The thrust of quality interventions was directed at the practice of NCD care by clinicians, facilities, or patients. Few studies provided evidence from interventions at the organizations or policy levels. Overall, effectiveness of quality interventions was mixed across domains. In general, positive or mixed effects on provider clinical skills and behavior, as well as, improvements in patient outcomes were found across interventions. Access to care and coverage of screening services were positively influenced by the interventions reviewed. This review shows that quality improvement interventions tried in middle-income countries mostly focused at the provider and facility level, with few focusing on the organizational and policy level. There is a need to further study the effectiveness of organizational and policy level interventions on the practice and outcomes of NCD care.
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Affiliation(s)
- Krishna D Rao
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Akriti Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Hunied Kautsar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | - Madhavi Misra
- Johns Hopkins India Private Limited, New Delhi, India
| | - Harsha Joshi
- Johns Hopkins India Private Limited, New Delhi, India
| | | | - Henry B Perry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Ngaruiya C, Bernstein R, Leff R, Wallace L, Agrawal P, Selvam A, Hersey D, Hayward A. Systematic review on chronic non-communicable disease in disaster settings. BMC Public Health 2022; 22:1234. [PMID: 35729507 PMCID: PMC9210736 DOI: 10.1186/s12889-022-13399-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) constitute the leading cause of mortality globally. Low and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by NCDs, yet primary focus on the topic is lagging. We conducted a systematic review on the effect of humanitarian disasters on NCDs in LMICs assessing epidemiology, interventions, and treatment. METHODS A systematic search in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017 was conducted, and publications reporting on NCDs and humanitarian emergencies in LMICs were included. We extracted and synthesized results using a thematic analysis approach and present the results by disease type. The study is registered at PROSPERO (CRD42018088769). RESULTS Of the 85 included publications, most reported on observational research studies and almost half (48.9%) reported on studies in the Eastern Mediterranean Region (EMRO), with scant studies reporting on the African and Americas regions. NCDs represented a significant burden for populations affected by humanitarian crises in our findings, despite a dearth of data from particular regions and disease categories. The majority of studies included in our review presented epidemiologic evidence for the burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited barriers to healthcare access in all phases of disaster and major disease diagnoses studied included: low levels of education, financial difficulties, displacement, illiteracy, lack of access to medications, affordability of treatment and monitoring devices, and centralized healthcare infrastructure for NCDs. Screening and prevention for NCDs in disaster-prone settings was supported. Refugee status was independently identified both as a risk factor for diagnosis with an NCD and conferring worse morbidity. CONCLUSIONS An increased focus on the effects of, and mitigating factors for, NCDs occurring in disaster-afflicted LMICs is needed. While the majority of studies included in our review presented epidemiologic evidence for the burden of disease, research is needed to address contributing factors, interventions, and means of managing disease during humanitarian emergencies in LMICs.
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Affiliation(s)
- Christine Ngaruiya
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA.
| | - Robyn Bernstein
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Rebecca Leff
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lydia Wallace
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Anand Selvam
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Denise Hersey
- Director, Dana Medical Library, University of Vermont, Burlington, VT, USA
| | - Alison Hayward
- Division of Global Emergency Medicine, Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
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Cuschieri S, Grech S. Insight into the Occurrence of Common Non-communicable Diseases at a Population Level and the Potential Impact During the Coronavirus Pandemic - a Need for a Syndemic Healthcare Approach? SN Compr Clin Med 2021; 3:2393-2400. [PMID: 34568765 PMCID: PMC8455231 DOI: 10.1007/s42399-021-01064-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 12/27/2022]
Abstract
People suffering from non-communicable diseases (NCDs) are at an increased risk for severe Covid-19. The aim was to determine the burden of common NCDs at a population level, assess Covid-19 impact while exploring whether a syndemic approach is merited to deal with NCDs and Covid-19. Baseline data from a Malta national representative survey. Individuals with type 2 diabetes (T2DM), hypertension, cardiovascular disease, dyslipidaemia and overweight-obese status were considered. Prevalence for single disease and multimorbidity were used to estimate population burden. Covid-19 impact at a population level was estimated through local Covid-19 infectivity rates. Years of life lost (YLL) and mortality rate were calculated using Covid-19 data and compared to corresponding NCDs data reported by global burden of disease (GBD) study. Half the study population (n = 3947) had a single NCD while a third had multimorbidity. Of these, 6.55% were estimated to be at risk of Covid-19 and require admission. Covid-19 YLL over 12 months was 5228.54 years, which is higher than the estimated YLL for hypertension and T2DM by GBD study for Malta. Health systems and policies should be re-focused to accommodate both Covid-19 and NCDs simultaneously through a targeted syndemic approach with primary healthcare playing a central role. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s42399-021-01064-2.
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Affiliation(s)
- Sarah Cuschieri
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Dukunde A, Marie Ntaganda J, Kasozi J, Nzabanita J. Prediction of prevalence of type 2 diabetes in Rwanda using the metropolis-hasting sampling. Afr Health Sci 2021; 21:702-709. [PMID: 34795726 PMCID: PMC8568256 DOI: 10.4314/ahs.v21i2.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this work, we predict the prevalence of type 2 diabetes among adult Rwandan people. We used the Metropolis-Hasting method that involved calculating the metropolis ratio. The data are those reported by World Health Organiation in 2015. Considering Suffering from diabetes, Overweight, Obesity, Dead and other subject as states of mathematical model, the transition matrix whose elements are probabilities is generated using Metropolis-Hasting sampling. The numerical results show that the prevalence of type 2 diabetes increases from 2.8% in 2015 to reach 12.65% in 2020 and to 22.59% in 2025. Therefore, this indicates the urgent need of prevention by Rwandan health decision makers who have to play their crucial role in encouraging for example physical activity, regular checkups and sensitization of the masses.
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Verma VR, Kumar P, Dash U. Assessing the household economic burden of non-communicable diseases in India: evidence from repeated cross-sectional surveys. BMC Public Health 2021; 21:881. [PMID: 33962625 PMCID: PMC8106177 DOI: 10.1186/s12889-021-10828-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/09/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Financing for NCDs is encumbered by out-of-pocket expenditure (OOPE) assuming catastrophic proportions. Therefore, it is imperative to investigate the extent of catastrophic health expenditure (CHE) on NCDs, which are burgeoning in India. Thus, our paper aims to examine the extent of CHE and impoverishment in India, in conjunction with socio-economic determinants impacting the CHE. METHODS We used cross-sectional data from nationwide healthcare surveys conducted in 2014 and 2017-18. OOPE on both outpatient and inpatient treatment was coalesced to estimate CHE on NCDs. Incidence of CHE was defined as proportion of households with OOPE exceeding 10% of household expenditure. Intensity of catastrophe was ascertained by the measure of Overshoot and Mean Positive Overshoot Indices. Further, impoverishing effects of OOPE were assessed by computing Poverty Headcount Ratio and Poverty Gap Index using India's official poverty line. Concomitantly, we estimated the inequality in incidence and intensity of catastrophic payments using Concentration Indices. Additionally, we delineated the factors associated with catastrophic expenditure using Multinomial Logistic Regression. RESULTS Results indicated enormous incidence of CHE with around two-third households with NCDs facing CHE. Incidence of CHE was concentrated amongst poor that further extended from 2014(CI = - 0.027) to 2017-18(CI = - 0.065). Intensity of CHE was colossal as households spent 42.8 and 34.9% beyond threshold in 2014 and 2017-18 respectively with poor enduring greater overshoot vis-à-vis rich (CI = - 0.18 in 2014 and CI = - 0.23 in 2017-18). Significant immiserating impact of NCDs was unraveled as one-twelfth in 2014 and one-eighth households in 2017-18 with NCD burden were pushed to poverty with poverty deepening effect to the magnitude of 27.7 and 30.1% among those already below poverty on account of NCDs in 2014 and 2017-18 respectively. Further, large inter-state heterogeneities in extent of CHE and impoverishment were found and multivariate analysis indicated absence of insurance cover, visiting private providers, residing in rural areas and belonging to poorest expenditure quintile were associated with increased likelihood of incurring CHE. CONCLUSION Substantial proportion of households face CHE and subsequent impoverishment due to NCD related expenses. Concerted efforts are required to augment the financial risk protection to the households, especially in regions with higher burden of NCDs.
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Affiliation(s)
- Veenapani Rajeev Verma
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, India
| | - Piyush Kumar
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, India
| | - Umakant Dash
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, India
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Kelishadi R. Life-Cycle Approach for Prevention of Non Communicable Disease. Adv Exp Med Biol 2019; 1121:1-6. [PMID: 31392647 DOI: 10.1007/978-3-030-10616-4_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Non communicable diseases (NCDs) become symptomatic in adulthood, but they mainly origin from early life. As NCDs are the major cause of mortality both in developed and developing countries, global actions are necessary for their life course prevention and control. The main preventable risk factors of NCDs include tobacco use, unhealthy diet, and physical inactivity. These risk factors track from childhood to adulthood; it is well documented that healthy lifestyles play an important role for primordial and primary prevention of NCDs. Sedentary lifestyle, especially prolonged screen time, is a main underlying factor for NCDs. Regarding dietary intake, lower consumption of fruits, vegetables and fibers, as well as higher consumption of fatty and salty foods (fast foods, junk food), and carbonated soft drinks are of most usual habits correlated with increased risk of NCDs.Strategic action areas for the prevention and control of NCDs are health promotion, risk reduction, health systems strengthening for early detection and management of NCD risk factors. Low-cost solutions for reduction the common modifiable risk factors including unhealthy life-cycle are important for guiding policy and priorities of governments and for decreasing the prevalence of NCDs.
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Affiliation(s)
- Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, USERN Office, Isfahan University of Medical Sciences, Isfahan, Iran
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Udedi M, Muula AS, Stewart RC, Pence BW. The validity of the patient health Questionnaire-9 to screen for depression in patients with type-2 diabetes mellitus in non-communicable diseases clinics in Malawi. BMC Psychiatry 2019; 19:81. [PMID: 30813922 PMCID: PMC6391834 DOI: 10.1186/s12888-019-2062-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression is a global problem, affecting populations worldwide, but is too often under-diagnosed. The identification of depression among patients with diabetes is important because depression is prevalent in this group and can complicate diabetes management. OBJECTIVES The aim of the study was to determine the sensitivity and specificity of the PHQ-9 in the detection of depression among patients with type-2 diabetes mellitus attending non-communicable diseases (NCD) clinics in Malawi. METHODS We conducted a validation study of the Patient Health Questionnaire (PHQ-9) among 323 patients with type-2 diabetes mellitus who attended two NCD clinics in one of the 28 districts of Malawi. The participants were screened consecutively using the nine-item PHQ-9 in Chichewa by a research assistant and completed a diagnostic interview using the Structured Clinical Interview for DSM-IV (SCID) for depression with a mental health clinician. We evaluated both content validity based on expert judgement and criterion validity of the Patient Health Questionnaire (PHQ-9) based on performance against the SCID. The PHQ-9 cutpoint that maximized sensitivity plus specificity was selected to report test characteristics. RESULTS Using the SCID for depression, the prevalence of minor or major depression was 41% (133/323). The internal consistency estimate for the PHQ-9 was 0.83, with an area under the receiver operator curve (AUC) of 0.93 (95% CI, [0.91-0.96]). Using the optimal cut-point of ≥9, the PHQ-9 had a sensitivity of 64% and a specificity of 94% in detecting both minor and major depression, with likelihood ratio-positive = 10.1 and likelihood ratio negative =0.4 as well as overall correct classification (OCC) rate of 81%. CONCLUSIONS This is the first validation study of the PHQ-9 in NCD clinics in Malawi. Depression was highly prevalent in this sample. The PHQ-9 demonstrated reasonable accuracy in identifying cases of depression and is a useful screening tool in this setting. Health care workers in NCD clinics can use the PHQ-9 to identify depression among their patients with those having a positive screen followed up by additional diagnostic assessment to confirm diagnosis. TRIAL REGISTRATION PACTR201807135104799 . Retrospectively registered on 12 July 2018.
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Affiliation(s)
- Michael Udedi
- Department of Mental Health, University of Malawi, College of Medicine, P/Bag 360, Chichiri, Blantyre, 3, Malawi. .,Department of Clinical Services, Ministry of Health, P. O. Box 30377, Capital City, Lilongwe, 3, Malawi. .,Department of Public Health, University of Malawi, College of Medicine, P/Bag 360, Chichiri, Blantyre, 3, Malawi.
| | - Adamson S. Muula
- 0000 0001 2113 2211grid.10595.38Department of Public Health, University of Malawi, College of Medicine, P/Bag 360, Chichiri, Blantyre, 3 Malawi ,0000 0001 2113 2211grid.10595.38Africa Center of Excellence in Public Health and Herbal Medicine, University of Malawi, College of Medicine, P/Bag 360, Chichiri, Blantyre, 3 Malawi
| | - Robert C. Stewart
- 0000 0001 2113 2211grid.10595.38Department of Mental Health, University of Malawi, College of Medicine, P/Bag 360, Chichiri, Blantyre, 3 Malawi
| | - Brian W. Pence
- 0000000122483208grid.10698.36Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC 27599 USA
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Campostrini S, Dal Grande E, Taylor AW. Increasing gaps in health inequalities related to non-communicable diseases in South Australia; implications towards behavioural risk factor surveillance systems to provide evidence for action. BMC Public Health 2019; 19:37. [PMID: 30621648 PMCID: PMC6325833 DOI: 10.1186/s12889-018-6323-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/14/2018] [Indexed: 11/14/2022] Open
Abstract
Background Although Australia is a country cited as having generally low health inequalities among different socioeconomic groups, inequalities have persisted. The aim of this analysis was to highlight how inequalities have evolved over a 13 years period in South Australia (SA). Methods Since 2002, over 600 interviews per month have been undertaken with SA residents through a computer assisted telephone survey method (total 77,000+). Major risk factors and chronic diseases have been analyzed providing trends by two socio-economic variables: education and a proxy of income (ability to save). Results While income and educational gaps are reducing over time in SA, those that remain in the lower socio-economic groups have a generally higher prevalence of risk factors and chronic diseases. The health disparity gap is still relevant, although at a different extent, for all the variables considered in our study, with most appearing to be stable if not increasing over time. Conclusions Surveillance can be a good source of information both to show the evolution of problems and to evaluate possible future interventions. Extensive effort is still required to “close the gap” of health inequalities in SA. More precisely targeted and properly implemented interventions are needed. Electronic supplementary material The online version of this article (10.1186/s12889-018-6323-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefano Campostrini
- Department of Economics, Ca' Foscari University of Venice, San Giobbe 873, 30121, Venice, Italy. .,School of Medicine, The University of Adelaide, Adelaide, South Australia.
| | - Eleonora Dal Grande
- Population Research & Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia
| | - Anne W Taylor
- Population Research & Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia
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Bekele BB. The prevalence of macro and microvascular complications of DM among patients in Ethiopia 1990-2017: Systematic review. Diabetes Metab Syndr 2019; 13:672-677. [PMID: 30641787 DOI: 10.1016/j.dsx.2018.11.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/13/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND The prevalence of diabetes mellitus (DM) has been growing rapidly in the world. It is smashing particularly the lower and middle income countries (LMICs) severely. Due to its acute and chronic complications many lives have fallen under its bad shadow. Therefore, we aimed to review the existing evidence on major types and specific complications of DM among diabetic patients in Ethiopia. METHODS Both relevant quantitative and qualitative studies, conducted after 1990s, investigated and reported DM and complications from MEDLINE/PubMed, CINAHL, SCOPUS, DAOJ and Cochrane library databases were explored. In addition, System for Information for grey literature in Europe (SINGLE) database was investigated for the existence of unpublished grey literature. Total of 161 titles were identified and 17 studies met the inclusion criteria. Findings were narrated descriptively. RESULTS In this review 17 studies were included, and both macro and micro complications were summarized. Among the diabetic complications retinopathy, nephropathy, metabolic syndrome, impotence and depression were the main findings among diabetic patients in Ethiopia. CONCLUSION The burden of DM and its microvascular and macrovascular complications have been increasing among diabetic patients in Ethiopia. The increased duration of the diseases, lower socio economic level, existence of other complications, old age attributed the diabetic complications. Therefore, close monitoring and follow up of diabetic patients is necessary to reduce the incidence and prevalence of diabetic complications among the patients.
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Affiliation(s)
- Bayu Begashaw Bekele
- Department of Public Health, College of Health Sciences, Mizan Tepi University, Mizan Aman Street, 260, Ethiopia.
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Zarean M, Poursafa P. The Role of Environmental Disruptor Chemicals in the Development of Non Communicable Disease. Adv Exp Med Biol 2019; 1121:21-31. [PMID: 31392649 DOI: 10.1007/978-3-030-10616-4_3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The increasing prevalence of non communicable diseases (NCDs) poses main challenges to global public health. Various environmental exposures to different chemicals and pollutants might interact with genetic and epigenetic mechanisms resulting in the development of NCDs. Among these environmental exposures, endocrine disrupting chemicals (EDCs) consist of a group of compounds with potential adverse health effects and the interference with the endocrine system. They are mostly used in food constituents, packaging industries and pesticides. Growing number of in vitro, in vivo, and epidemiological studies documented the link of EDC exposure with obesity, diabetes, and metabolic syndrome, which are the underlying factors for development of NCDs. Prevention of exposure to EDCs and reduction of their production should be underscored in strategies for primordial prevention of NCDs.
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Leone M, Corsi FM, Ferrari F, Thole D, Didato G, Marazzi MC, Germano P, Bartolo M. Teleneurology in sub-Saharan Africa: Experience from a long lasting HIV/AIDS health program (DREAM). J Neurol Sci 2018; 391:109-111. [PMID: 30103956 DOI: 10.1016/j.jns.2018.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Massimo Leone
- Department of Neurology, The Foundation of the Carlo Besta Neurological Institute, IRCCS, via Celoria 11, 20133 Milan, Italy; DREAM Program, Community of Sant'Egidio, Via San Gallicano 25, 00153 Roma, Italy.
| | - Fabio Massimo Corsi
- Neurology and Neurophysiology Department, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense 87, 00152 Rome, Italy
| | - Fabio Ferrari
- Department of Radiological Oncological and Pathological Sciences, University La Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | | | - Giuseppe Didato
- Department of Clinical Epileptology and Experimental Neurophysiology, The Foundation of the Carlo Besta Neurological Institute, IRCCS, via Celoria 11, 20133 Milan, Italy
| | | | - Paola Germano
- DREAM Program, Community of Sant'Egidio, Via San Gallicano 25, 00153 Roma, Italy
| | - Michelangelo Bartolo
- DREAM Program, Community of Sant'Egidio, Via San Gallicano 25, 00153 Roma, Italy; Telemedicine Department, San Giovanni Addolorata Hospital, Via dell'Amba Aradam, 9, 00184 Rome, Italy
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Morris-Paxton AA, Rheeder P, Ewing RMG, Woods D. Detection, referral and control of diabetes and hypertension in the rural Eastern Cape Province of South Africa by community health outreach workers in the rural primary healthcare project: Health in Every Hut. Afr J Prim Health Care Fam Med 2018; 10:e1-e8. [PMID: 29781685 PMCID: PMC5913786 DOI: 10.4102/phcfm.v10i1.1610] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/03/2017] [Accepted: 11/09/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-communicable diseases, mainly cardiovascular diseases, diabetes, cancer and chronic respiratory diseases, are responsible for approximately 63% of all deaths occurring worldwide in any given year. The majority of these deaths have occurred in low- and middle-income countries (LMICs). The latest World Health Organization (WHO) report shows that the increase in diabetes is also most pronounced in the LMICs. The South African Labour and Development Research Unit estimated a 9% prevalence within the adult population in 2016. In the Eastern Cape Province, hypertensive heart disease has become the second most common cause of death, followed by diabetes, the third most common cause of death.Aim and setting: The aim of this study was to report on the follow-up of patients in the community with known hypertension or diabetes or who were deemed at-risk (as identified during a prior community-wide survey). METHODS Data were collected via a household primary health screening, monitoring and follow-up process, which included taking anthropometric measurements, blood pressure (BP) and blood glucose and referring to clinics for further testing and treatment where necessary. RESULTS Of the 1885 participants followed up by the community health outreach workers, 1702 were known to be hypertensive and 183 were deemed at-risk [of these, only 24 (13.2%) had normal or high normal systolic BP readings]. There were 341 participants with diabetes and 34 at-risk of diabetes [of these, 28 (82%) had levels of 11 mmol/l or higher at follow-up]. There was a significant improvement in BP and glucose control over repeated visits. CONCLUSION In this rural area of the Eastern Cape, South Africa, the follow-up of patients with hypertension or diabetes as well as those individuals at-risk adds value to hypertension and glucose control.
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Newtonraj A, Murugan N, Singh Z, Chauhan RC, Velavan A, Mani M. Factors Associated with Physical Inactivity among Adult Urban Population of Puducherry, India: A Population Based Cross-sectional Study. J Clin Diagn Res 2017; 11:LC15-LC17. [PMID: 28658812 DOI: 10.7860/jcdr/2017/24028.9853] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 02/01/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Physical inactivity is the fourth leading cause of death worldwide. Increase in physical activity decreases the incidence of cardiovascular diseases, Type 2 diabetes, stroke, and improves psychological wellbeing. AIM To study the level of physical inactivity among the adult population in an urban area of Puducherry in India and its associated risk factors. MATERIALS AND METHODS This cross-sectional study was conducted among 569 adult participants from an urban area of Pondicherry. The level of physical inactivity was measured by using WHO standard Global Physical Activity Questionnaire (GPAQ). RESULTS Overall prevalence of physical inactivity in our study was 49.7% (CI: 45.6-53.8). Among the physically active people, contribution of physical activity by work was 77.4%, leisure time activities were 11.6% and transport time was 11%. Both men and women were equally inactive {Physically inactive among women was 50% (CI:44.1-55.9)} and {Physically inactive among men was 49.5% (CI:43.8-55.2)}. Prevalence of physical inactivity was increasing with increasing age. Non tobacco users were two times more active than tobacco users {Adjusted Odds Ratio: 2.183 (1.175- 4.057)}. Employed were more active as compared to retired {Adjusted Odds Ratio: 0.412 (0.171-0.991)}, students {Adjusted Odds Ratio: 0.456 (0.196-1.060)}, house wives {Adjusted Odds Ratio: 0.757 (0.509-1.127)} and unemployed {Adjusted Odds Ratio: 0.538 (0.271-1.068)}. Non alcoholics were only 0.34 times as active as alcoholics. CONCLUSION Level of physical activity was found to be insufficient among adult urban population of Puducherry. Working adult population found to be active, that too due to their work pattern. There is a need to promote leisure time and travelling time physical activity.
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Affiliation(s)
- Ariarathinam Newtonraj
- Assistant Professor, Department of Community Medicine, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Puducherry, India
| | - Natesan Murugan
- Associate Professor, Department of Community Medicine, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Puducherry, India
| | - Zile Singh
- Assistant Professor, Department of Community Medicine, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Puducherry, India
| | - Ramesh Chand Chauhan
- Assistant Professor, Department of Community Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Anandan Velavan
- Assistant Professor, Department of Community Medicine, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Puducherry, India
| | - Manikandan Mani
- Assistant Professor, Department of Community Medicine, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Puducherry, India
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Sippli K, Rieger MA, Huettig F. GPs' and dentists' experiences and expectations of interprofessional collaboration: findings from a qualitative study in Germany. BMC Health Serv Res 2017; 17:179. [PMID: 28270205 PMCID: PMC5341464 DOI: 10.1186/s12913-017-2116-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/24/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Against the background of well-described associations between oral and general health, collaboration between dentists and general practitioners (GP) is crucial to provide therapeutic and preventive patient care. However, in the German health system, GPs and dentists are organizationally separated, implying that interprofessional collaboration can only occur informally and on a voluntary basis. Given the scarce evidence of interprofessional collaboration between dentists and GPs, an explorative study was conducted. This paper outlines the findings of this study with regard to GPs' and dentists' experiences and expectations of interprofessional collaboration. METHODS Semi-structured interviews were conducted with GPs (n = 15) and dentists (n = 13) from three structurally different regions in Baden-Wurttemberg, Germany. The interview guide included questions on occasions, expectations and experiences of interprofessional collaboration. The interviews were transcribed verbatim and analysed using qualitative content analysis according to Mayring. RESULTS Both GPs and dentists reported perceived knowledge deficits of the other profession with regard to medication, particularly anticoagulants and bisphosphonates, as well as systemic and general respectively dental diseases. Expectations regarding the scope of collaboration diverge: whereas dentists were interested in extending collaboration, most GPs saw no need for collaboration. CONCLUSIONS The perceived medical knowledge deficits of the other profession as well as divergent expectations concerning the scope of collaboration hinder profound and regular interprofessional collaboration between GPs and dentists. These perceived knowledge deficits may be rooted in the separate education of dentists and GPs in Germany. Fostering interprofessional education is a promising way to improve cooperation between GPs and dentists in the long term.
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Affiliation(s)
- Khira Sippli
- Department of Prosthodontics, Centre for Dentistry, Oral Medicine, and Maxillofacial Surgery at the University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Osianderstr. 2-8, D-72076 Tübingen, Germany
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tuebingen, Wilhelmstr. 27, D-72074 Tübingen, Germany
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tuebingen, Wilhelmstr. 27, D-72074 Tübingen, Germany
- CoreFacility/Coordinating Center Health Services Research, Faculty of Medicine, Eberhard Karls University Tuebingen, Wilhelmstr. 27, D-72074 Tübingen, Germany
| | - Fabian Huettig
- Department of Prosthodontics, Centre for Dentistry, Oral Medicine, and Maxillofacial Surgery at the University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Osianderstr. 2-8, D-72076 Tübingen, Germany
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Gwatidzo SD, Stewart Williams J. Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE). BMC Geriatr 2017; 17:14. [PMID: 28077072 PMCID: PMC5225610 DOI: 10.1186/s12877-016-0408-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/27/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Expenditure on medications for highly prevalent chronic conditions such as diabetes mellitus (DM) can result in financial impoverishment. People in developing countries and in low socioeconomic status groups are particularly vulnerable. China and India currently hold the world's two largest DM populations. Both countries are ageing and undergoing rapid economic development, urbanisation and social change. This paper assesses the determinants of DM medication use and catastrophic expenditure on medications in older adults with DM in China and India. METHODS Using national standardised data collected from adults aged 50 years and above with DM (self-reported) in China (N = 773) and India (N = 463), multivariable logistic regression describes: 1) association between respondents' socio-demographic and health behavioural characteristics and the dependent variable, DM medication use, and 2) association between DM medication use (independent variable) and household catastrophic expenditure on medications (dependent variable) (China: N = 630; India: N = 439). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010). RESULTS Prevalence of DM medication use was 87% in China and 71% in India. Multivariable analysis indicates that people reporting lifestyle modification were more likely to use DM medications in China (OR = 6.22) and India (OR = 8.45). Women were more likely to use DM medications in China (OR = 1.56). Respondents in poorer wealth quintiles in China were more likely to use DM medications whereas the reverse was true in India. Almost 17% of people with DM in China experienced catastrophic healthcare expenditure on medications compared with 7% in India. Diabetes medication use was not a statistically significant predictor of catastrophic healthcare expenditure on medications in either country, although the odds were 33% higher among DM medications users in China (OR = 1.33). CONCLUSIONS The country comparison reflects major public policy differences underpinned by divergent political and ideological frameworks. The DM epidemic poses huge public health challenges for China and India. Ensuring equitable and affordable access to medications for DM is fundamental for healthy ageing cohorts, and is consistent with the global agenda for universal healthcare coverage.
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Affiliation(s)
- Shingai Douglas Gwatidzo
- Umeå International School of Public Health, Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, SE-90185 Umeå, Sweden
| | - Jennifer Stewart Williams
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, SE-90185 Umeå, Sweden
- Research Centre for Gender, Health and Ageing, Faculty of Health, University of Newcastle, New Lambton Heights, Newcastle, NSW 2305 New South Wales Australia
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Amundsen MS, Kirkeby TMG, Giri S, Koju R, Krishna SS, Ystgaard B, Solligård E, Risnes K. Non-communicable diseases at a regional hospital in Nepal: Findings of a high burden of alcohol-related disease. Alcohol 2016; 57:9-14. [PMID: 27916144 DOI: 10.1016/j.alcohol.2016.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/12/2016] [Accepted: 10/17/2016] [Indexed: 11/28/2022]
Abstract
Recent global burden of disease reports find that a major proportion of global deaths and disability worldwide can be attributed to alcohol use. Thus, it may be surprising that very few studies have reported on the burden of alcohol-related disease in low income settings. The evidence of non-communicable disease (NCD) burden in Nepal was recently reviewed and concluded that data is still lacking, particularly to describe the burden of alcohol-related diseases (ARDs). Therefore, here we report on NCD burden and specifically ARDs, in hospitalized patients at a regional hospital in Nepal. We conducted a retrospective chart-review that included detailed information on all discharged patients during a four month period. A local database that included sociodemographic information and diagnoses at discharge was established. All doctor-assigned discharge diagnoses were retrospectively assigned ICD-10 codes. A total of 1,139 hospitalized adult patients were included in the study and one third of these were NCDs (n = 332). The main NCDs were chronic obstructive pulmonary disease (COPD) (n = 148, 45%) and ARDs (n = 57, 17%). Patients with ARD often presented with signs of liver cirrhosis and were typically younger men, with a median age at 43 years, from specific ethnic groups. These data demonstrate that severe alcohol-related organ failure in relatively young men contributed to a high proportion of NCDs in a regional hospital in Nepal. These findings are novel and alarming and warrant further studies that can establish the burden of ARDs and alcohol use in Nepal and other similar low-income countries.
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Affiliation(s)
- M S Amundsen
- Norwegian University of Science and Technology, NTNU, P.O. Box No.: 7491, Trondheim, Norway; St. Olavs Hospital, Children's Clinic, Olav Kyrres Gate 11, P.O. Box 7030, Trondheim, Norway.
| | - T M G Kirkeby
- Norwegian University of Science and Technology, NTNU, P.O. Box No.: 7491, Trondheim, Norway; St. Olavs Hospital, Clinic of Emergency Medicine and Prehospital Care, Prinsesse Kristinas Gate 3, P.O. Box. No: 7030, Trondheim, Norway.
| | - S Giri
- Dhulikel Hospital, Kathmandu, P.O. Box No.: 11008, Nepal; Norwegian University of Science and Technology, NTNU, Institute of Circulation and Medical Imaging, NTNU, P.O. Box No.: 7491, Trondheim, Norway.
| | - R Koju
- Dhulikel Hospital, Kathmandu, P.O. Box No.: 11008, Nepal.
| | - S S Krishna
- Dhulikel Hospital, Kathmandu, P.O. Box No.: 11008, Nepal.
| | - B Ystgaard
- St. Olavs Hospital, P.O. Box 3250, Sluppen, 7006, Trondheim, Norway.
| | - E Solligård
- Norwegian University of Science and Technology, NTNU, Institute of Circulation and Medical Imaging, NTNU, P.O. Box No.: 7491, Trondheim, Norway; St. Olavs Hospital, Clinic of Emergency Medicine and Prehospital Care, Prinsesse Kristinas Gate 3, P.O. Box. No: 7030, Trondheim, Norway.
| | - K Risnes
- Norwegian University of Science and Technology, Institute of Public Health and General Practice, NTNU, P.O. Box No.: 7491, Trondheim, Norway; St. Olavs Hospital, Children's Clinic, Olav Kyrres Gate 11, P.O. Box 7030, Trondheim, Norway.
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Doddoli S, Shete S, Kulkarni D, Bhogal R. Effect of yoga training on lipid metabolism in industrial workers with reference to body constitution ( Prakriti). J Tradit Complement Med 2016; 7:322-326. [PMID: 28725627 PMCID: PMC5506662 DOI: 10.1016/j.jtcme.2016.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/08/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The progressive increase in dyslipidemia and physical inactivity are considered to be major risk factors for the onset of non communicable diseases. Awareness of body constitution plays a vital role to regularise optimum health. The present study was planned to evaluate the effect of yoga practices on lipid metabolism with reference to specific body constitution (Prakriti). METHODS A self-as-control study was conducted on 36 male healthy volunteers between age group of 30-58 years. Their prakriti analysis was done using standardized, validated questionnaire and were divided into Vata-Pitta (n = 16) and Pitta-Kapha (n = 20) groups. The assessment of lipid profile was done in fasting blood samples before and after 12 weeks of yoga training. Data were analyzed using paired t-test and independent t-test. RESULTS After yoga intervention, the result of within group comparison revealed that in Vata-Pitta (V-P) group, significant decrease in the levels of TC, LDL (p < 0.001) and significant increase in HDL (p < 0.01) was observed. While, Pitta-Kapha (P-K) group showed significant decrease in TC (p < 0.001), TG (p < 0.01), LDL (p < 0.001) and VLDL (p < 0.05) levels. Further, the results between groups revealed that P-K group has significantly higher baseline levels of TC, TG and VLDL as compared to V-P group (p < 0.05). CONCLUSION The study concludes that yoga practices can effectively regulate lipid metabolism and total body energy expenditure with reference to specific constitutional type (Prakriti) that may act as a tool to assess magnitude of metabolic functions.
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Tolley H, Snowdon W, Wate J, Durand AM, Vivili P, McCool J, Novotny R, Dewes O, Hoy D, Bell C, Richards N, Swinburn B. Monitoring and accountability for the Pacific response to the non-communicable diseases crisis. BMC Public Health 2016; 16:958. [PMID: 27613495 PMCID: PMC5018177 DOI: 10.1186/s12889-016-3614-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Non-communicable diseases (NCD) are the leading cause of premature death and disability in the Pacific. In 2011, Pacific Forum Leaders declared “a human, social and economic crisis” due to the significant and growing burden of NCDs in the region. In 2013, Pacific Health Ministers’ commitment to ‘whole of government’ strategy prompted calls for the development of a robust, sustainable, collaborative NCD monitoring and accountability system to track, review and propose remedial action to ensure progress towards the NCD goals and targets. The purpose of this paper is to describe a regional, collaborative framework for coordination, innovation and application of NCD monitoring activities at scale, and to show how they can strengthen accountability for action on NCDs in the Pacific. A key component is the Dashboard for NCD Action which aims to strengthen mutual accountability by demonstrating national and regional progress towards agreed NCD policies and actions. Discussion The framework for the Pacific Monitoring Alliance for NCD Action (MANA) draws together core country-level components of NCD monitoring data (mortality, morbidity, risk factors, health system responses, environments, and policies) and identifies key cross-cutting issues for strengthening national and regional monitoring systems. These include: capacity building; a regional knowledge exchange hub; innovations (monitoring childhood obesity and food environments); and a robust regional accountability system. The MANA framework is governed by the Heads of Health and operationalised by a multi-agency technical Coordination Team. Alliance membership is voluntary and non-conditional, and aims to support the 22 Pacific Island countries and territories to improve the quality of NCD monitoring data across the region. In establishing a common vision for NCD monitoring, the framework combines data collected under the WHO Global Framework for NCDs with a set of action-orientated indicators captured in a NCD Dashboard for Action. Summary Viewing NCD monitoring as a multi-component system and providing a robust, transparent mutual accountability mechanism helps align agendas, roles and responsibilities of countries and support organisations. The dashboard provides a succinct communication tool for reporting progress on implementation of agreed policies and actions and its flexible methodology can be easily expanded, or adapted for other regions.
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Affiliation(s)
- Hilary Tolley
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Wendy Snowdon
- World Health Organisation, Western Pacific Regional Office, Suva, Fiji
| | - Jillian Wate
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases (C-POND), Fiji National University, Suva, Fiji
| | - A Mark Durand
- Pacific Islands Health Officers Association, Honolulu, HI, USA
| | | | - Judith McCool
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | | | - Ofa Dewes
- School of Population Health & Department of Molecular Medicine, University of Auckland, Auckland, New Zealand
| | - Damian Hoy
- Pacific Community, Noumea, New Caledonia
| | - Colin Bell
- School of Medicine, Deakin University, Geelong, Australia
| | - Nicola Richards
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Boyd Swinburn
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
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Charlton KE, Russell J, Gorman E, Hanich Q, Delisle A, Campbell B, Bell J. Fish, food security and health in Pacific Island countries and territories: a systematic literature review. BMC Public Health 2016; 16:285. [PMID: 27009072 PMCID: PMC4806432 DOI: 10.1186/s12889-016-2953-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 03/14/2016] [Indexed: 12/12/2022] Open
Abstract
Background Pacific Island countries and territories (PICTs) face a double burden of disease, with a high prevalence of household food insecurity and childhood micronutrient deficiencies, accompanied by a burgeoning increase in adult obesity, diabetes and heart disease. Methods A systematic literature review was undertaken to assess whether increased availability of, and access to, fish improves a) household food security and b) individual nutritional status. Results A total of 29 studies were reviewed. Fourteen studies identified fish as the primary food source for Pacific Islanders and five studies reported fish/seafood as the primary source of dietary protein. Fish consumption varied by cultural sub-region and Pacific Island countries and territories. Fish consumption and nutritional status was addressed in nine studies, reporting moderate iodine deficiency in Vanuatu where only 30 % of participants consumed mostly fresh fish. Similarly, the degree to which Pacific Islanders depended on fishing for household income and livelihood varied between and within PICTs. For more economically developed countries, household income was derived increasingly from salaried work and dependency on fishing activities has been declining. Conclusions Fishing remains a major contributor to food security in PICTs, through subsistence production and income generation. However, there is a paucity of research aimed at assessing how maintaining and/or improving fish consumption benefits the diets and health of Pacific Islanders as they contend with the ongoing nutrition transition that is characterised by an increasing demand for packaged imported foods, such as canned meats, instant noodles, cereals, rice, and sugar-sweetened beverages, with subsequent decreased consumption of locally-produced plants and animals.
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Affiliation(s)
- Karen E Charlton
- School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Joanna Russell
- School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Emma Gorman
- School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Quentin Hanich
- Australian National Centre for Ocean Resources and Security (ANCORS), University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Aurélie Delisle
- Australian National Centre for Ocean Resources and Security (ANCORS), University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Brooke Campbell
- Australian National Centre for Ocean Resources and Security (ANCORS), University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Johann Bell
- Australian National Centre for Ocean Resources and Security (ANCORS), University of Wollongong, Wollongong, NSW, 2522, Australia.,Betty and Gordon Moore Center for Science and Oceans, Conservation International, Arlington, VA, 22202, USA
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Raimondi de Souza S, Moraes de Oliveira GM, Raggio Luiz R, Rosa G. Effects of oat bran and nutrition counseling on the lipid and glucose profile and anthropometric parameters of hypercholesterolemia patients. NUTR HOSP 2016; 33:123-30. [PMID: 27019267 DOI: 10.20960/nh.40] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND In order to prevent chronic, non communicable disease, it is essential that lifestyle is modified to include a diet high in fiber. AIM To assess the effect oat bran (OB) in conjunction with nutrition counseling (NC) have on lipid and glucose profile, anthropometric parameters,quality of diet, and ingestion of ultraprocessed foods (UPF) and additives in hypercholesterolemia sufferers. METHOD This was a 90-day, double-blind, placebo-controlled, block-randomized trial undertaken on 132 men and women with LDL-c ≥ 130 mg/ dL. The participants were sorted into two groups: OB Group (OBG) and Placebo Group (PLG), and were given NC and 40g of either OB or rice flour, respectively. Lipid and glucose profile were assessed, as were the anthropometric data, quality of diet (Diet Quality Index revised for the Brazilian population - DQI-R) and whether or not UPF or additives were consumed. RESULTS Both groups showed a significant decrease in anthropometric parameters and blood pressure, as well as a significant reduction in total and LDL cholesterol. There was also an improvement in DQI-R in both groups and a decrease in consumption of UPF. Blood sugar, HOMA-IR and QUICKI values were found to be significantly lower only in the OBG. CONCLUSION Our findings in lipid profile and anthropometric parameters signify that NC has a beneficial effect, which is attributable to the improved quality of diet and reduced consumption of UPF. Daily consumption of 40 g of OB was found to be of additional benefit, in decreasing insulin-resistance parameters.
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Montesi L, Caletti MT, Marchesini G. Diabetes in migrants and ethnic minorities in a changing World. World J Diabetes 2016; 7:34-44. [PMID: 26862371 PMCID: PMC4733447 DOI: 10.4239/wjd.v7.i3.34] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/19/2015] [Accepted: 01/04/2016] [Indexed: 02/05/2023] Open
Abstract
On a worldwide scale, the total number of migrants exceeds 200 million and is not expected to reduce, fuelled by the economic crisis, terrorism and wars, generating increasing clinical and administrative problems to National Health Systems. Chronic non-communicable diseases (NCD), and specifically diabetes, are on the front-line, due to the high number of cases at risk, duration and cost of diseases, and availability of effective measures of prevention and treatment. We reviewed the documents of International Agencies on migration and performed a PubMed search of existing literature, focusing on the differences in the prevalence of diabetes between migrants and native people, the prevalence of NCD in migrants vs rates in the countries of origin, diabetes convergence, risk of diabetes progression and standard of care in migrants. Even in universalistic healthcare systems, differences in socioeconomic status and barriers generated by the present culture of biomedicine make high-risk ethnic minorities under-treated and not protected against inequalities. Underutilization of drugs and primary care services in specific ethnic groups are far from being money-saving, and might produce higher hospitalization rates due to disease progression and complications. Efforts should be made to favor screening and treatment programs, to adapt education programs to specific cultures, and to develop community partnerships.
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Zahra A, Lee EW, Sun LY, Park JH. Cardiovascular disease and diabetes mortality, and their relation to socio-economical, environmental, and health behavioural factors in worldwide view. Public Health 2015; 129:385-95. [PMID: 25724438 DOI: 10.1016/j.puhe.2015.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 01/07/2015] [Accepted: 01/17/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Today, non-communicable diseases, mainly cardiovascular diseases and diabetes, represent a leading threat to human health and development. This study observed mortality trends in all income group countries in relation to a wide variety of related factors like economical and environmental factors, health behaviour and health risk factors. STUDY DESIGN Ecological study. METHOD Data were analysed for 72 countries using the ecological study method. Data were collected from various sources including WHO, World Bank and previous studies. Cardiovascular disease and diabetes mortality rates for males and females were used as the dependent variables. GDP, GINI, literacy rate, urbanization, health expenditure, the number of physicians and the number of beds, BMI, western diet, blood glucose, blood pressure, serum cholesterol, physical inactivity, alcohol, and smoking were used as the independent variables initially. The final model was decided on the basis of availability of complete data and result of co-linearity test. Correlation test and linear regression were employed to identify the affecting factors for the dependent variables. RESULT Analysis showed that cardiovascular disease and diabetes mortality was more concentrated in middle- and low-income countries and was negatively associated with GDP, GINI, and western diet. Countries with high average blood pressure had higher mortality rates showing a positive relationship. CONCLUSION Non-communicable disease mortality rate is strongly associated with many economical, social, environmental, and behavioural factors. More comprehensive preventive and diagnostic strategies are needed to decrease mortality especially in low- and middle-income countries.
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Affiliation(s)
- A Zahra
- Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Republic of Korea
| | - E-W Lee
- Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Republic of Korea
| | - L-Y Sun
- Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Republic of Korea
| | - J-H Park
- Department of Social and Preventive Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Republic of Korea.
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Buso DL, Longo-Mbenza B, Bovet P, van den Borne B, Okwe AN, Mzingelwa M. Deaths rates in public hospitals of eastern cape province of South Africa. Iran J Public Health 2012; 41:19-25. [PMID: 23641386 PMCID: PMC3640777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 11/18/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND South Africa (SA) is experiencing a rapid epidemiologic transition as a consequence of political, economic and social changes. In this study we described, based on hospital data, the mortality patterns of Non communicable Diseases (NCD), Communicable Diseases (CD), the NCD/CD ratios, and the trends of deaths. METHODS We conducted a cross-sectional survey of all deaths occurring in several public hospitals in the Eastern Cape Province of SA between 2002 and 2006. Causes of deaths were coded according to the ICD 10 Edition. RESULTS A total of 107380 admissions responded to the inclusion criteria between 2002 and 2006. The crude death rate was 4.3% (n=4566) with a mean age of 46±21 years and a sex ratio of 3.1 men (n=3453): 1 woman (n=1113). Out of all deaths, there were 62.9% NCD (n=2872) vs. 37.1% CD (n=1694) with NCD/CD ratio of 1.7. The ratio NCD/CD deaths in men was 1.3 (n=1951/1502) vs. NCD/CD deaths in women of 1.9 (n=735/378). The peak of deaths was observed in winter season. The majority of NCD deaths were at age of 30-64 years, whereas the highest rate of CD deaths was at age< 30 years. The trend of deaths including the majority of NCD, increased from 2002 to 2006. There was a tendency of increase in tuberculosis deaths, but a tendency of decrease in HIV/AIDS deaths was from 2002 to 2006. CONCLUSION Non-communicable diseases are the leading causes of deaths in rural Eastern Cape province of SA facing Post-epidemiologic transition stages. We recommend overarching priority actions for the response to the Non-communicable Diseases: policy change, prevention, treatment, international cooperation, research, monitoring, accountability, and re-orientation of health systems.
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Affiliation(s)
- DL Buso
- Walter Sisulu University, Faculty of Health Sciences, Mthatha, Eastern Cap, South Africa
| | - B Longo-Mbenza
- Walter Sisulu University, Faculty of Health Sciences, Mthatha, Eastern Cap, South Africa,Corresponding Author: Tel: +27732822843
| | - P Bovet
- Institute of Social and Preventive Medicine, University of Lausanne, Switzerland
| | - B van den Borne
- Dept. of Health Promotion, Faculty of Medicine, Maastricht University, The Nederland
| | - A Nge Okwe
- Biostatistics Unit, LOMO MEDICAL Center and Heart of Africa Center of Cardiology DRC, South Africa
| | - M Mzingelwa
- Walter Sisulu University, Faculty of Health Sciences, Mthatha, Eastern Cap, South Africa
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