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WHO Global report on diabetes: A summary
Gojka Roglic
April-June 2016, 1(1):3-8
The first WHO Global Report on Diabetes was launched on World Health Day 7 th April 2016 which was dedicated to Diabetes (1). Diabetes has been described in ancient scripts and recognized as a serious illness, but it does not appear to have been frequently encountered by physicians or healers. It is in the past few decades that human health and development is increasingly affected by the rising numbers of people with this condition. Diabetes, together with cardiovascular disease, cancer and chronic respiratory disease has been targeted in the Political Declaration on the Prevention and Control of Noncommunicable Diseases (NCDs) at the Un High-level Political Meeting in 2011. In 2013 WHO member states endorsed a global monitoring framework for noncommunicable diseases, with 9 targets to be reached by 2025. Diabetes and its key risk factors are strongly reflected in the targets and indicators - reduction of exposure to unhealthy diet and physical inactivity, zero rise in the prevalence of diabetes, improved access to treatment and reduction of premature mortality. As part of the 2030 Agenda for Sustainable Development, Member States have set an ambitious target to reduce premature mortality from NCDs - including diabetes - by one third; achieve universal health coverage; and provide access to affordable essential medicines - all by 2030( http://www.un.org/sustainabledevelopment/sustainable-development-goals/).
  13,699 199 -
A community-based study on knowledge of diabetes mellitus among adults in a rural population of Kerala
Beteena Kurian, Mariya Amin Qurieshi, Rajini Ganesh, Kamalamma Leelamoni
July-September 2016, 1(2):59-64
Background: Worldwide India leads in diabetes mellitus and within India Kerala tops the list. Keeping in view increasing the burden of diabetes mellitus in Kerala, it is highly important to know about the awareness of the disease among the general population to chalk out culturally appropriate and need oriented educational strategies. Objective: The objective of this study is to assess the knowledge of diabetes mellitus in a rural populace of Kerala. Materials and Methods: A descriptive cross-sectional study was undertaken in a rural Panchayat of District Ernakulam of Kerala wherein 343 adults were randomly interviewed from six randomly selected wards. The interview schedule had 23 items on knowledge which was assessed in four domains including general awareness of diabetes mellitus, its risk factors, complications, and lifestyle modifications. Each item was given a score. Maximum possible score was 23. Knowledge score of <9 was considered as poor, 9-17 as average and above 17 was taken as good. Data were analyzed using SPSS version 11. Descriptive analysis was done for sociodemographic variables, and t-test and ANOVA were used to ascertain the level of significance of predictors of awareness. Results and Conclusion: Mean age of the participants was 47.7 ± 15.74 years with more than half (55.7%) having completed their high school education. Mean knowledge score was 15.6. Being diabetic, having completed high school education and with family history of diabetes had significantly better knowledge score (P < 0.05). Educating the community on risk factors is the key strategy for the prevention of diabetes and delaying the onset of disease among high-risk individuals.
  7,772 332 -
Global research priorities for noncommunicable diseases prevention, management, and control
Atul Sharma
October-December 2017, 2(4):107-112
Noncommunicable diseases (NCDs) are the major cause of global mortality, contributing to more than 63% of all-cause mortality. The burden is expected to escalate further, as the impact of NCDs increases, and as population ages. Limited research is being conducted on NCDs in developing countries because of lack of sufficient resources. This article attempts to identify urgent global research priorities for NCDs prevention, management, and control. A literature review was performed in October 2017 to identify published literature discussing research priorities in NCDs. Findings were supplemented with the key themes emerging from a panel discussion on the topic at 1st World NCD Congress. Results reveal that different researchers and organizations have employed different criteria for setting priorities for investing in NCD-related research and development. Different methodologies for identifications of research priorities have also been adopted, most of which include a mixed method approach, with more reliance on qualitative research methods. For most of the NCDs, country-specific information on extent and patterns of disease and its social impact needs to be identified. Health system-related opportunities related to application of primary and secondary care cost-effective interventions need to be identified and explored. Studies are also required to assess gaps in accessibility and affordability of essential medicines and technologies required for treatment of NCDs. Research to identify effective strategies for improvement of data collection mechanisms for NCD incidence and prevalence is required. The study concludes that multidisciplinary research approaches need to be followed to better elucidate the influence of sociodemographic and economic factors on NCD prevention and control, to enhance availability and accessibility of cost-effective interventions to lower socioeconomic strata, and to increase the uptake of evidence-based research for policy development by policymakers.
  5,177 137 -
Effect of nutritional counseling on body mass index of adult hypertensive attending general outpatient clinic, federal medical center, Ido-Ekiti South-Western Nigeria
Taiwo Adebayo Olukokun, Abayomi Olusola Ayodapo, Kehinde Fasasi Monsudi
January-March 2019, 4(1):15-20
Background: Achieving target blood pressure (BP) control has become an important management challenge, as the prevalence of hypertension increases in adult Nigerians. Overweight/obesity and lack of lifestyle behaviors are associated with difficulty in achieving target BP control. This study aim at determine the effect of nutritional counseling on body mass index (BMI) of adult hypertensive attending general outpatient clinic. Materials and Methods: An interventional study was performed on 322 adult patients (161 in the intervention group and 161 in the control group) with hypertension who had been on treatment for at least 3 months. Relevant data were collected using interviewer-administered the semi-structured questionnaire and clinical parameters were measured pre- and post-intervention. The intervention group was given nutritional counseling. Results: The mean BMI in the intervention group decreased to a statistically significant level (P < 0.001), from 25.42 ± 3.99 to 24.89 ± 3.64 compared to an increase in the control group from 25.36 ± 3.73 to 25.39 ± 3.74. The mean change in BMI of the intervention group (−0.53 ± 0.59) was higher than the mean change in BMI of the control group (0.03 ± 0.45), which was statistically significant (P < 0.001). More than two-third of the intervention group 135 (83.9%) had good BP control, compared to 68 (42.2%) of the control group. Conclusion: The nutritional status of the respondents in the intervention group is better than in the control group at the end of the study. Improved nutritional status led to better BMI. Family physicians will do well to counsel hypertensive patients on nutritional and lifestyle behavior with a view to improving BP control in them.
  4,694 21 -
Effectiveness of district health promotion model (Hoshiarpur Ambala model): An implementation experience from two districts from Northern part of India
JS Thakur, Nidhi Jaswal, Ashoo Grover, Rupinder Kaur, Gurismer Jeet, Bhavneet Bharti, Manmeet Kaur
October-December 2016, 1(3):122-130
Introduction: In India, implementation of Health Promotion activities follows a vertical approach at district level. A Health Promotion project was therefore implemented for 3 years in Hoshiarpur and Ambala districts of Northern India, with objectives to develop, implement, and assess the effectiveness of integrated health promotion model. Materials and Methods: Situation analysis in two districts was followed by a state level stakeholders workshop in which detailed layout of model and a health promotion manual (Hindi, English, and Punjabi) was developed for capacity building of workforce. The effectiveness of model was assessed using mix of quantitative as well as qualitative methods. Results: The key features of model included integration and convergence within National Health Programs, multitasking, multisectoral involvement, and community empowerment, using digital media and advocacy tools. The facility assessment survey revealed improvements in implementation of activities as per annual activity calendar of IEC/BCC activities, better display of IEC material, with improved reporting, monitoring, and supervision. At community level, the awareness levels of the community members regarding communicable/noncommunicable diseases and key Reproductive and Child Health issues improved significantly (P < 0.05). Similarly, the client exit survey showed that dissemination of health information by MO/ANM increased in 3 years from 8% to 80% and 7.3% to 75% in districts Hoshiarpur and Ambala, respectively (P < 0.05). In-depth interview with key stakeholders and focused group discussion with Village Health and Sanitation Committee/Village Level Core Committee has shown their active involvement and improvements in their functioning. Based on indicative costing, per capita costs of National Health Mission for IEC/BCC/Health promotion activities need to be increased from INR 0.7 (USD 0.01) to INR 4 (USD 0.06), which requires increase in budget allocation from 1% to minimum of 4%. Conclusion: Model was found to be effective and feasible on pilot implementation. District level human and financial resources, however, must be augmented to implement health promotion activities effectively.
  3,373 75 -
Contributors to academic failure in postsecondary education: A review and a Canadian context
Tricia L da Silva, Arun V Ravindran
April-June 2016, 1(1):9-17
Postsecondary enrollment has been rising globally over the past years, but poor performance and drop-out have also been increasing and have become an academic concern. Most drop-outs tend not to return, which significantly affects their future prospects. Postsecondary student populations are a diverse mix of local, immigrant, and international students but it is unclear if reasons for academic failure differ between groups. The aim of this review was to examine the published literature for contributors to postsecondary academic failure, including drop-out, among local, immigrant, and international students. A search of the literature was conducted using PubMed, ProQuest, EBSCOHOST, and PsycINFO on the topic for all articles published in English up to March 2016. The results showed that almost all data come from the Western countries. Several personal, sociocultural, and academic factors appear to be associated with postsecondary failure among all students. These include gender, low academic engagement, stress, psychological difficulties, low social support, and poor coping abilities. Immigrant and international students face additional challenges, such as loss of social networks, discrimination, acculturation, and language challenges. Limitations of the data include the relatively small body of literature (particularly from low- and middle-income countries), and lack of subgroup comparisons, such as of local, immigrant and international students. Clarification of the relative contribution of these factors to academic failure will facilitate the development of effective retention strategies, particularly those that focus on addressing psychological distress and building resilience.
  3,251 33 -
Knowledge of diabetes among diabetic patients in government hospitals of Delhi
Saurav Basu, Megha Khobragade, DK Raut, Suneela Garg
January-March 2017, 2(1):8-10
Background: Poor patient knowledge of recommended diabetic self-care practices is a major barrier toward attainment of good glycemic control and prevention of diabetic complications. Materials and Methods: We assessed the knowledge of diabetes self-care practices through a short 7-item pretested questionnaire among diabetes mellitus patients attending special clinics in three government hospitals. Results: The average diabetes knowledge score attained by the patients was 3.79 ± 1.77 (maximum score = 7). Lifetime treatment requirement for diabetes mellitus, plasma glucose levels for good glycemic control, and symptoms of hypoglycemia were correctly reported by 89%, 74%, and 38.5% of the patients, respectively. Low educational status and female gender were significantly associated with poor knowledge of diabetes (P < 0.05). Low level of knowledge of diabetes was a predictor of poor glycemic control but not medication adherence. Conclusion: Knowledge of diabetes in patients attending government hospitals in India is low. Future studies should explore low-cost health education interventions feasible in the Indian health-care context for improving patient knowledge of diabetes.
  3,040 85 1
Effectiveness of visual inspection with acetic acid as a test for cervical cancer screening
Mohammad Harun Ur Rashid, MSA Mansur Ahmed, Shahanaz Chowdhury, Sabrina Ahmed
January-March 2017, 2(1):3-7
Objective: To assess the effectiveness of visual inspection of cervix with acetic acid (VIA test) as an accepted method for screening of cervical Cancer. Materials and Methods: Two hundred women attending the Cervical and Breast Cancer Screening Program and outpatient department (OPD) of Department of Obstetrics and Gynecology at our center were examined by both Pap smear and VIA tests. Results: Patients were aged between 21 and 70 years (mean 35.8 years). Nearly 45% got married between 16 and 20 years and 44% before 15 years of age. Oral contraceptives users were 23%. Nearly 14% of the women tested positive by VIA. Pap smear showed atypical squamous cells of undetermined significance in 9.5%, low-grade lesion in 6%, and high-grade lesions in 1.5%. Colposcopy showed cervical intraepithelial neoplasia (CIN-I) in 9%, 2% had CIN-II/III, invasive cancer in 1%, and 7% had unsatisfactory colposcopy findings. Thirty-six women required biopsy for histopathological confirmation. Among them, 7.5% had chronic cervicitis/koilocytic changes, 4.5% had CIN-I, 2% had CIN-II, 1.5% had CIN-III, 0.5% had invasive cancer, and 2% had normal result. Sensitivity of VIA was 76.5% and specificity was 91.8%. Sensitivity of Pap smear was 64.7% and specificity was 87.4%. Conclusion: Sensitivity and specificity of VIA was higher than that of Pap smear test. VIA can be used as an effective screening test to detect the precancerous and cancerous lesions of the cervix in Bangladesh.
  2,859 45 -
Overview of national strategies on noncommunicable disease and adolescent health in South-East Asia Region countries
JS Thakur, Neena Raina, Priya Karna, Preeti Singh, Gursimer Jeet, Nidhi Jaswal
July-September 2016, 1(2):76-86
Research shows that risk factors for noncommunicable diseases (NCDs) are associated with behaviors that either begin or are reinforced during adolescence. Yet, focus on this age group in national NCDs policies globally or regionally in South-East Asia Region (SEAR) has not been adequately addressed. This overview of strategies to prevent NCDs among adolescents in SEAR countries provides a benchmark against which policy response can be assessed and strengthened. We reviewed all publically available documented strategies issued by governments in the 11 SEAR member countries of the World Health Organization on NCDs, published between January 1, 2002, and December 31, 2015. NCDs are currently a policy priority in many of the countries with school-based campaigns on healthy lifestyles; alcohol and tobacco-free environment and public ban on advertisements glamorizing unhealthy food among others. However, major challenges such as lack of specific focus on adolescents, lack of recognition of all major risk factors in national policies/programs, weak surveillance, unavailability of age disintegrated data, inefficient program management, low community awareness, and absence of multistakeholder policies persist. Of the countries reviewed, only 54.5% (6/11) proposed a policy that addressed all four of the main NCD risk factors - alcohol and tobacco use, physical inactivity, and obesity. This review demonstrates the disconnection between NCDs, adolescent health, and national policies.
  2,800 97 -
Determining the prevalence of and risk factors for depressive symptoms among adults in Nepal: Findings from the Dhulikhel Heart Study
Michelle S Lam, Annette L Fitzpatrick, Archana Shrestha, Biraj M Karmacharya, Rajendra P Koju, Deepa Rao
January-March 2017, 2(1):18-26
Context: Nepal is currently experiencing a rapid growth in noncommunicable diseases (NCDs). Depression has previously been associated with NCDs in South Asia; however, data regarding its prevalence and risk factors are lacking in Nepal. Aims: This study aims to describe the prevalence of and risk factors for depressive symptoms in a suburban population of adults within Nepal. Setting and Design: We conducted a cross-sectional analysis of baseline data collected from participants enrolled in the Dhulikhel Heart Study, a population-based, longitudinal cohort study investigating cardiovascular risk factors in Dhulikhel, a suburban town outside Kathmandu. Subjects and Methods: Baseline questionnaire data from 1073 adults age 18 years and older included the Center for Epidemiologic Studies Depression Scale (CES-D). A score of 16 or greater on the CES-D has been shown to indicate major depressive symptomatology. Statistical Analysis: Using STATA 13, we conducted Pearson's Chi-square tests and multiple logistic regressions to examine associations between the binary CES-D score and gender, age, education, marital status, body mass index, physical activity, and hypertensive status. Results: The mean CES-D score in the sample was 11.7 (standard deviation: 5.3), with 21.3% scoring 16 or greater. Age over 60 and lack of formal education were associated with increased risk of depressive symptoms. Being physically active was associated with decreased risk of depressive symptoms. Conclusions: The estimated prevalence of depression among adults in Dhulikhel was 21.3%. Significant risk factors for increased depressive symptoms included lack of formal education, age over 60, and physical inactivity.
  2,770 43 2
Assessment and barriers to medication adherence for secondary prevention of cardiovascular disease among patients with coronary artery disease in Chandigarh, India
Jarnail S Thakur, Rajesh Vijayvergiya, Nidhi Jaswal, Amy Ginsburg
April-June 2016, 1(1):37-41
Context: Medication adherence is critical for the secondary prevention of cardiovascular disease (CVD). Nonadherence to prescribed treatment is associated with adverse health outcomes and higher costs of care. Aims: The present study aimed to assess medication adherence among patients diagnosed with coronary artery disease (CAD) in Chandigarh, India. Settings and Design: This cross-sectional study was conducted in five different hospitals or health centers of Chandigarh. Materials and Methods: The standardized Morisky Medication Adherence Scale-8 item was used to assess medication adherence among adult patients with CAD seen during a visit to major tertiary hospitals, secondary and primary health-care center in Union Territory, Chandigarh. In a separate qualitative study, barriers and facilitators to adherence were assessed through twenty in-depth interviews (ten males and ten females) and one focus group discussion. Statistical analysis was completed using SPSS 16.0 software and simple frequencies and proportions were computed. Results: A total of 260 patients were included in the cross-sectional survey, of which 70.4% were males with a mean age of 58.61 years. More than half (52.7%) of the respondents were from the age group of 41 to 60 years. Low to medium adherence to treatment was observed in about half (47.3%) of the respondents with low adherence among females. Adherence was better in a tertiary hospital as compared to the primary or secondary facility. Provider barriers and access to drugs due to cost barriers were found to be major barriers to treatment adherence in the in-depth interviews. Conclusions: Medication adherence to the secondary prevention of CVD among the CAD patients surveyed in Chandigarh, India, is poor and increased access to essential drugs and improved provider-patient communication is required.
  2,549 90 -
Young people and noncommunicable diseases – vulnerable to disease, vital for change
Marie Hauerslev, Luke Allen
April-June 2018, 3(2):45-48
Youth have a right to health, but that is not adequately reflected in our societies and health systems. In fact, for cancer, diabetes, chronic lung disease, and cardiovascular diseases - so-called noncommunicable diseases (NCDs) - more than two-thirds of preventable adult deaths are associated with behavior that started in adolescence. Many young people are well aware of how drastically NCDs will affect their generation in the current system and have taken the challenge to change the discourse for a healthier global population. Yet, youth voices are often dismissed or tokenized in political conversations. This is despite the many examples of youth making positive change at all levels of society. This paper provides an overview of the challenges and emerging youth-driven actions to address NCDs at local, national, and global levels.
  2,518 67 -
Rising popularity of “tobacco-free” hookah among youth: A burgeoning public health challenge for India!
Pavan Pandey
April-June 2017, 2(2):30-35
The world is experiencing a second tobacco consumption pandemic in the form of increasing hookah use among youths. Post-1990s, there has been an unprecedented increase in the number of hookah smokers across the world. Despite having a well-formulated tobacco control policy, India has one of the highest numbers of tobacco users in the world. The increase in the proportion of hookah smokers to the levels currently seen in Middle Eastern countries would prove disastrous for India's demographic dividend. However, compared to rest of the world, India is witnessing a slightly different problem in the form of an increase in the number of “tobacco-free” hookah users. This article reviews global hookah smoking trend and how India is ill prepared to counter the increasing hookah use among youths and suggests what government needs to do to prevent global hookah smoking pandemic to spread in India.
  2,503 58 -
Noncommunicable disease research
Luke Allen
October-December 2016, 1(3):131-133
Research is an essential component of the fight against noncommunicable disease (NCD) as it provides the evidence for effective prevention and control interventions. While the biological causes and manifestations of NCDs have been studied in depth, we are still trying to understand the best ways of implementing effective control policies. Exploring which interventions work in different settings is fundamental to the attainment of international targets set out in the Global Action Plan and the Sustainable Development Goals. The vast majority of NCD research comes from high-income countries and interventions that work in these settings are not necessarily effective in the Global South. Translational research is needed alongside wider engagement with social scientists: the most significant drivers of NCD epidemics are political, social, economic, and behavioral. Collaborative research spanning these domains is required for the development of effective, evidence-based NCD prevention, and control policies. This short article provides an overview of the role research has to play in the global NCD response and highlights areas in need of investment.
  2,464 82 1
Assessing health workers' capacity for the prevention and control of noncommunicable diseases in Haroli health block of district Una in Himachal Pradesh, India: A mixed methods approach
Gopal Chauhan, JS Thakur
April-June 2016, 1(1):26-29
Background: Noncommunicable diseases (NCDs) account for 60% of the total deaths in India. The National Program for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is operational in selected districts of India since 2009-2010. Health workers (HWs) are the key stakeholders in the implementation of NPCDCS at community level. Keeping in view the dismal progress of the program implementation in existing districts, it is evident to assess the capacities of the HWs before rolling out the program in new districts. Methodology: This cross-sectional study was conducted in 2015 on all the existing 69 HWs of Haroli Health Block of district Una in Himachal Pradesh. The district is still not covered under NPCDCS. The study tools consisted of self-administered questionnaire, observational findings, and focused group discussions. Results: The HWs capacities for the prevention and control of NCDs are about 26% less than the baseline required as per their perception (mean 3.69, standard deviation [SD] ±0.26). Supportive supervision, trainings, workload, and management information system are the key factors affecting the capacity. Observational finding shows a gap of 39% in their skills (mean 1.83 SD ± 0.06). The health promotional skills and follow-up practices are improving with the working experience of HWs. Conclusions: The capacity of HWs for the prevention and control of NCDs in the selected health block in a district is poor and must be assessed before rolling out NPCDCS in a new district. Special focus shall be given to supportive supervision, training, and management information system.
  2,357 163 -
Sugar and fat taxes as means to halt obesity and prevent lifestyle diseases: Opportunities and challenges in the Indian context
Saurav Basu, Neha Dahiya, Damodar Bachani
April-June 2017, 2(2):56-59
Obesity in both children and adults is a major public health problem globally and is also increasing in the developing world which contributes to the epidemic of early onset of non-communicable diseases and associated premature mortality. Dietary consumption of unhealthy foods rich in sugar, salt and saturated fats is a significant risk factor for obesity. There is growing evidence that taxation on sugar sweetened beverages (SSBs) and fat rich foods along with restricting access to such unhealthy foods in school premises can shift dietary consumption patterns of school students towards healthier foods and reduce their risk of developing obesity and lifestyle diseases. However, despite some limited initiatives, the application of taxes on SSBs as a public health intervention have yet to be unequivocally applied in Indian settings due to inadequate advocacy from public health groups and political reluctance due to the industry being a major source of tax revenue. Efforts in combating obesity through tax on unhealthy foods like SSBs and fats is overdue in India but the barriers and challenges against their successful implementation cannot be overlooked. These include the necessity of application of a sufficiently high tax which would compel manufacturers of unhealthy foods like SSBs to pass the burden of the tax upon consumers by significantly increase retail prices. Furthermore, India's vast informal food sector producing local counterparts of branded SSB and fat foods should not be spared and kept out of the taxation net out of any political considerations. Similarly, the restriction on sale of unhealthy foods in school premises should also include implementation in areas and markets in the vicinity to which students have easy access.
  2,327 56 -
Determinants of hypertension among adults in Tigray, Northern Ethiopia: A matched case–control study
Alemayehu Bekele Mengesha, Susan Benedict, Eva Kantelhardt
April-June 2017, 2(2):36-44
Background: Hypertension has become an epidemic and a global public health challenge resulting in considerable morbidity, mortality, and disability in human beings. There are reports indicating increasing magnitude of hypertension in Ethiopia. Despite this fact, less is known as for the determinants of hypertension. Objective: To assess the determinants of hypertension among adults in Tigray, Northern Ethiopia. Methods: A matched case–control study design was employed to identify the determinants of hypertension. A total of 117 cases and 235 controls were included in the study. Conditional logistic regression analysis was conducted to identify the determinants of hypertension. Results: Low-income status, moderate work-related physical activity, shorter duration of alcohol use, and normal waist circumference were found to reduce the odds of hypertension. Poor perception on body size and mental stress was found to increase the odds of hypertension. Conclusions: Multifaceted interventions including raising awareness and attitudinal changes on lifestyle modifications have to be intervened to prevent the risky behaviors by different actors.
  2,279 47 -
Economic burden of coronary heart disease in North India
Akashdeep Singh Chauhan, Kanchan Mukherjee
April-June 2016, 1(1):18-25
Background: The treatment of chronic diseases like coronary heart disease (CHD) is expensive and can consume a significant portion of household's income, leading to catastrophic effects on families, particularly those of low socioeconomic status. Methodology: This was a cross-sectional study carried out in a private super specialty hospital and a government tertiary care hospital. Nonprobability purposive sampling method was used to collect primary data from a sample of 102 households; having a member suffering from CHD. Economic burden was assessed regarding average out of pocket (OOP) expenditure and prevalence of distress financing (DF) (borrowings or selling of assets) among the households. Results: Average OOP expenditure among those having an episode of hospitalization and those who got treated in outpatient department sessions only was INR 243,606 and INR 48,578, respectively. This expenditure was statistically higher (P < 0.5) for richest than the poorest households. However this expenditure as a proportion of annual household consumption expenditure was highest for the poorer than the richest (P < 0.5). Expenses were reported higher for those who got treatment in private hospital as compared to government hospital by 26%. The prevalence of DF came out to be 38.2% with poorest reporting higher percentage of 67% as compared to 4% in richest households. Conclusion: There is a need to consider the rising OOP expenditure for the treatment of chronic conditions like CHD. There is a need to develop health financing systems that improve the financial risk protection for those requiring treatment.
  2,240 85 -
Evolution of noncommunicable diseases: Past, present, and future
Arun Chockalingam, Jarnail S Thakur, Subhash Varma
January-March 2017, 2(1):1-2
  2,195 78 -
Integration of yoga with modern medicine for promotion of cardiovascular health
Jaya Prasad Tripathy, Jarnail Singh Thakur
July-September 2017, 2(3):64-68
Yoga and modern medicine are not exclusive, but complementary systems. Their combination can provide us with a holistic health care. While modern medicine has a lot to offer mankind in its treatment and management of acute illnesses and emergency conditions, yoga offers services in terms of preventive, promotive, and rehabilitative methods in addition to many management methods to tackle modern illnesses. Several published studies have demonstrated the health benefits of yoga. Regular practice of yoga has shown significant improvement in cardiovascular risk factors such as hypertension, diabetes, hyperlipidemia, obesity, metabolic syndrome, and psychological stress. However, there are many limitations with respect to the reported studies. Therefore, large multicentric trials using uniform methodologies and long-term outcomes are needed to confirm the findings. In view of the existing knowledge, yoga is a cost-effective and beneficial supportive/adjunct treatment without side effects. There is a favorable atmosphere for integration of alternate medical systems in resource-strained public health systems.
  2,157 80 -
Co-occurring mental health and addiction disorders: The elusive path to integrated care
Avra Selick, Mary Wiktorowicz
October-December 2016, 1(3):97-104
Background: Co-occurrence of mental health and addictions disorders occurs at a high rate, posing significant costs to affected individuals and society if left untreated. Although decades of research and policy reports have argued the necessity of integrated mental health and addiction services to effectively treat this population, it appears as though relatively little integration has been achieved. Methods: This exploratory study used key informant interviews to investigate the current state of integrated treatment in Ontario, Canada, potential models for integrated treatment and barriers to their implementation. Interview transcripts were analyzed inductively, and thematic analysis used to identify emerging themes. Results: Five domains were identified: organizational barriers, system barriers, historical barriers, barriers related to stigma and discrimination, and knowledge barriers. A key challenge is the absence of provincial direction and limited evidence on the relative effectiveness of the different integrated treatment models. Discussion and Conclusion: Insights from interviews with research, policy and provider experts clarify the relevant factors affecting the implementation of integrated treatment in Ontario. In identifying potential models of integration and the barriers to their implementation, further research is required to assess the relative effectiveness of the different integration models and to identify the critical organizational and system factors needed for successful implementation of integrated care. Avenues that merit further exploration are the fields of implementation science and complex adaptive systems.
  2,165 31 1
Prevalence, awareness, treatment, and control of hypertension in patients with type 2 diabetes: A cross-sectional survey among middle-aged people in China
Zengwu Wang, Xin Wang, Zuo Chen, Linfeng Zhang, Manlu Zhu
April-June 2016, 1(1):30-36
Objective: To assess the prevalence, awareness, treatment, and control of hypertension and their associated factors in patients with type 2 diabetes. Methods: A cross-sectional survey across China, including 12,000 participants aged 35-64 years, was conducted in 2009-2010. Data were collected by using questionnaires, blood pressure (BP) measurement, and laboratory test. About 11,623 participants fitted the inclusion. Diabetes was defined as fasting glucose at least 7.0 mmol/L, and/or use of insulin, and/or oral antidiabetic drug. For diabetic participants, hypertension was considered to be controlled if the average BP was <130/80 mmHg. Results: Overall, there were 1063 patients with diabetes (9.2%). The prevalence of hypertension among the patients with diabetes was 59.6%. Among the hypertensive patients (n = 633), 57.5% were aware of their condition, 41.7% received treatment, and only 3.8% had their BP adequately controlled. Age, region, body mass index (BMI), and family hypertension history were correlated with the prevalence, awareness, treatment, and control of hypertension among patients with diabetes. Conclusion: The prevalence of hypertension among patients with diabetes was higher whereas the control was lower. Age, BMI, and family hypertension history were significantly associated with hypertension.
  2,117 61 -
Sustainable development goals and noncommunicable diseases: Roadmap till 2030 – A plenary session of world noncommunicable diseases congress 2017
Soundappan Kathirvel, Jarnail Singh Thakur Rapporteurs
January-March 2018, 3(1):3-8
The global epidemic of noncommunicable diseases (NCDs) was recognized by the United Nations and is addressed by the Sustainable Development Goals (SDGs) to be achieved by 2030. This review article describes the proceedings of the plenary session “SDGs and NCDs: Roadmap till 2030” of the first “World NCD Congress 2017” held at Chandigarh, India. The plenary session emphasized the need for political commitment to take up NCD agenda at the national level to prevent and reduce the premature NCD deaths. Establishing the national action plan and monitoring framework for prevention and control of NCDs are the major initial initiatives to implement the best buy NCD interventions. Primary prevention of four common and shared risk factors and health system strengthening are the important interventions to achieve the SDG goal 3.4. The implementation strategies at subnational level and engagement of sectors other than health on prevention and control of NCDs can be reviewed and further researched for effective implementation of the identified interventions.
  2,102 67 2
Input of stakeholders on reducing depressive symptoms and improving diabetes outcomes in India: Formative work for the INtegrated DEPrEssioN and Diabetes TreatmENT study
Deepa Rao, Lauren Lipira, Shuba Kumar, Rani Mohanraj, Subramani Poongothai, Nikhil Tandon, GR Sridhar, Wayne Katon, KM Venkat Narayan, Lydia Chwastiak, Viswanathan Mohan, Mohammed K Ali
July-September 2016, 1(2):65-75
Context: Depression and diabetes are highly comorbid, adversely affecting treatment adherence, and resulting in poor outcomes. To improve treatment and outcomes for people dually affected by diabetes and depression in India, we aimed to develop and test an integrated care model. Aims: In the formative phase of this INtegrated DEPrEssioN and Diabetes TreatmENT (INDEPENDENT) study, we sought stakeholder perspectives to inform culturally-sensitive adaptations of the intervention. Settings and Design: At our Delhi, Chennai, and Visakhapatnam sites, we conducted focus groups for patients with diabetes and depression and interviewed health-care workers, family members, and patients. Subjects and Methods: Key informants were asked about experiences with diabetes and depression and for feedback on intervention materials. Analysis: Qualitative data were analyzed using a grounded theory approach. Results: Three major themes emerged that have bearing on adaptation of the proposed intervention: importance of family assistance, concerns regarding patient/family understanding of diabetes, and feedback regarding the proposed intervention (e.g., adequate time needed for implementation; training program, and intervention should address stigma). Conclusions: Based on our findings, the following components would add value when incorporated into the intervention: (1) engaging families in the treatment process, (2) clear/simple written information, (3) clear nonjargon verbal explanations, and (4) coaching to help patients cope with stigma.
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Partnerships in noncommunicable disease prevention and control
Jaya Prasad Tripathy
October-December 2017, 2(4):102-106
The World Health Organization (WHO) Noncommunicable Disease (NCD) Global Action Plan 2013–2020 and the WHO Action Plan for NCD in South-East Asia, 2013–2020, have identified advocacy, partnerships, and leaderships as a key strategic action area. The paper describes the proceedings of the plenary session titled “Partnerships in NCD Prevention and Control” which was held at the World NCD Congress at Chandigarh, India, in November 2017. Besides, a review of various data sources and literature was also carried to search for case studies related to successful partnership models in NCD prevention and control. This review describes the role of multiple partners such as the civil society, research organizations, private sector which includes the private health-care sector, pharmaceutical and the food industry, and other national and international experiences in multistakeholder partnerships to combat NCDs. Civil societies play a range of roles from generating evidence to advocating policies, providing technical support, partnering in implementation to monitoring commitments' direct provision of services, and ensuring accountability. Research organizations provide the much-needed evidence for informed policy-making. The key challenges in building a partnership are lack of clarity in roles and responsibilities of each partner in the alliance, resource constraints, imbalance of benefits and power between the partners, organizational difficulties, and differences in philosophies. A clear understanding of roles, responsibilities, interests and incentives of each of the partners, regular communication, and give-and-take philosophy are required to create effective partnerships. A mechanism of feedback channel is essential to monitor the progress and relevance. Communities should remain the central stakeholder in any partnership.
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