Common Chronic Non-communicable Diseases Research Articles

Tanshinone IIA exerts therapeutic effects by acting on endogenous stem cells in rats with liver cirrhosis

Background and ObjectiveLiver cirrhosis (LC), the major pathway for the progression and development of chronic liver disease, is an advanced stage of liver disease. It is the third most common chronic noncommunicable disease after cardiovascular diseases and malignant tumors. Tanshinone IIA (Tan), an extract of Salvia miltiorrhiza (S. miltiorrhiza), has been proven to promote the proliferation and differentiation of stem cells. Moreover, its protective effect in liver injury has received widespread attention. The present study investigated whether Tan plays a therapeutic role in LC by promoting endogenous stem cell proliferation and differentiation. Materials and MethodsLC models were established by intraperitoneal injection of an olive oil solution containing 50 % carbon tetrachloride (CCL4) combined with 10 % alcohol in the drinking water. After successful model establishment, the animals were randomly divided into four groups and injected with physiological saline or low-, medium-, or high-dose (10, 20, or 40 mg/kg) Tan for seven consecutive days. The protective effect of Tan on LC was observed by western blotting, serological examination and histopathological staining. Furthermore, immunofluorescence double-labeling of 5-bromo-2-deoxyuridine (BrdU) and the liver cell markers albumin and CK-18 or the liver stem cell markers EPCAM and OV-6 was used to evaluate the proliferation and differentiation of endogenous liver stem cells. ResultsWe confirmed successful establishment of the LC model by observing transaminase levels and hematoxylin-eosin (HE) and Masson staining of liver sections in CCL4-treated and healthy rats. After Tan treatment, HE and Masson staining of paraffin sections of liver tissue showed that Tan treatment significantly improved histological injury to the liver. Serological tests showed that albumin-bilirubin (ALBI) scores and models for end-stage liver disease (MELD) were lower. Immunofluorescence and immunohistochemical staining showed that the newly proliferated cells were colocalized with ALB, OV-6, EPCAM, and CK-18, indicating that new expression of these markers occurred after Tan injection. All results were most significant in the medium-dose treatment group. ConclusionTan can alleviate liver injury induced by CCL4 combined with alcohol in rats and plays a therapeutic role in LC by promoting the proliferation and differentiation of endogenous liver stem cells.

Prevalence and predictors of medication non-adherence in some common non-communicable chronic diseases and cancers: a comparative study

Background: Adherence is a key factor in the success of all pharmacological therapies. Medication non-adherence is an extremely common barrier to achieve positive health outcomes. The present study aims to compare medication non-adherence in some common chronic diseases and cancers and also to assess various factors influencing it.Methods: Pre-validated questionnaires based on general medication adherence scale (GMAS) were equally distributed among 300 patients suffering from chronic illnesses and cancers. 270 patients returned completely filled questionnaires.Results: The study population consists of 53.33% men and 46.66% women.55.55% patients were literate. 70.37% of patients were from rural areas. 61.48% were taking 2-4 drugs. As compared to 14.81% males 18.51% of females had poor or low adherence. Only 0.74% of young patients (<30 years) had poor/low adherence as compared to 16.29% each in other age groups. Rural patients had poor adherence as compared to patients from urban areas. As compared to 31.85% illiterate patients, only 16.29% of literate patients had poor or low adherence. Adherence was better in patients taking more than one drug. Statistically, a significant correlation was found between gender, age, level of education, and area of residence. Duration of treatment, the number of drugs, and the frequency of dosage were not found significantly correlated with adherence. Patients suffering from malignancies had higher medication adherence as compared to chronic illnesses.Conclusions: Medication non-adherence is common in patients with chronic diseases and cancers that are treated with unsupervised oral antineoplastic drugs. The complex problem of non-adherence calls for interventions at various levels.

Qualitative evaluation of the general practitioner chronic non-communicable diseases training programme

BackgroundIn China, general practitioners have limited ability to provide care for common chronic non-communicable diseases because they lack postgraduate training. In an attempt to improve general practitioners’ skills in this regard, the present authors previously launched the Chronic Non-Communicable Diseases Training Programme. The present study aims to evaluate the effectiveness of this programme.MethodsThirty-nine trainee general practitioners who participated in the programme underwent semi-structured interviews, which explored how they performed the training, what they achieved from the programme, and their suggestions for future programmes. The interview data were analysed using a thematic analysis approach.ResultsUnder the guidance of supervisors, the thirty-nine trainee general practitioners completed the structured but individualised training plan, which comprised a four-day basic theory class, 3 months practising in a ward, and 6 months assisting in an outpatient clinic. They reported an improvement in their ability to provide care for chronic non-communicable diseases and perform two-way referral, as well as their communication with patients. They also reported that, since returning to their communities, they had become more confident, were building better relationships with their patients, and had changed their clinic behaviours from copying prescriptions to making medical decisions independently. Their principal suggestion for the training programme was to alter the order of the training, as they preferred to practice in the ward before assisting in the outpatient clinic.ConclusionThe course comprised a learner-centred, practice- and apprenticeship-based, general-practitioner training programme. Given the participants’ progress and the beneficial effects of the programme reported in the interview data, it appears to be worthwhile to extend the General Practitioner Chronic Non-Communicable Diseases Training Programme.

Treatment with azelastine hydrochloride and fluticasone propionate in a single delivery device of young children and adolescents with allergic rhinitis.

Background: Allergic rhinitis (AR) is the most common chronic noncommunicable disease worldwide that affects any age during the human life span but raises particular concerns among the parents and caregivers of the children who are affected. H1-receptor antagonists and corticosteroids provide the most effective way of bringing the condition under control. Intranasal application of these medications has the advantage of a faster onset of action and avoids systemic unwanted adverse effects. The only combination treatment, which comprises azelastine hydrochloride and fluticasone propionate, so far in a single advanced delivery system has proven its efficacy and safety in clinical trials of adult patients with AR. Objective: To critically review and identify gaps in the existing data for children in all different strata of pediatric ages. Methods: We searched the specialized medical literature for publications on the efficacy and safety of the combined formulation of azelastine and fluticasone in a single delivery device in adolescents (ages < 18 years) and children (ages < 12 years). Results: Altogether, 12 peer-reviewed articles have been published about trials that also involved subjects in different strata of the pediatric ages, seven of the articles pooled adolescents and adults. Three articles presented the results of studies in children ages 4 to 11 years specifically designed to overcome the difficulties that children experience in expressing themselves verbally. Conclusion: All the trials with the novel combination product that involved young children and adolescents documented its efficacy, effectiveness, and safety. However, the numbers of the youngest children (ages 4 and 5 years) were low, which suggested that further data about safety and efficacy in this age group are needed.

Prevalence and Associated Risk Factors of Chronic Kidney Disease in an Elderly Population from Eastern China.

Chronic kidney disease (CKD) is a global major public health problem. Almost all of previous studies evaluating the prevalence of CKD focused on adults, while studies among the elderly were relatively rare, especially in China. The aim of this study was to investigate the prevalence and associated risk factors of CKD among the elderly in Qingdao, China. This was a cross-sectional study with 38,038 inhabitants (aged 60–109) randomly recruited in Qingdao, China. All participants were required to complete a questionnaire for their demographic characteristics. Blood and urine samples of participants were collected, and the albumin and creatinine levels were measured for albuminuria and estimated glomerular filtration rate (eGFR) assessment. The associations between risk factors and indicators of kidney damage were analyzed by logistic regression. A total of 34,588 inhabitants completed the survey. The overall prevalence of CKD was 11.41% (95% confidence interval (CI): 11.07–11.74%) in the elders from Qingdao in 2016. The prevalence of albuminuria and low eGFR (<60 mL/min per 1·73 m²) were 8.47% (95% CI: 8.17–8.76%) and 3.98% (95% CI: 3.78–4.19%), respectively. Older age, hypertension, diabetes, anemia, hyperuricemia, hyperhomocysteinemia, hypertriglyceridemia, obesity, and LDL-C ≥ 4.1 mmol/L were independently associated with the presence of CKD. In conclusion, common chronic non-communicable diseases, including hypertension, diabetes, obesity, hyperhomocysteinemia, hyperuricemia, and hypertriglyceridemia, were associated with greater prevalence of CKD.

Dynamics of the occupational respiratory diseases in Bulgaria in the period 2009-2016

Abstract Background The number of occupational respiratory diseases has declined in recent years in Bulgaria. This is the result of technological advance, mechanization and automation of the processes generating high levels of dust in the work environment; adequate ventilation; personal protective equipment and, last but not least, the training of workers on preventive approaches. Methods The aim of the study is to find out the trends of registered occupational respiratory diseases in Bulgaria in 2009-2016, according to official statistics. Analytical and statistical methods were used. Results In 2016, the number of occupational diseases (n = 33), registered in Bulgaria decreased by 71.55% compared to 2009 (n = 116). In 2009, the relative share of silicosis from respiratory occupational diseases was 47.54% (n = 29), while in 2016 it grew to 64.29% (n = 9). Its share is also increasing as part of all occupational diseases in Bulgaria from 25% in 2009 to 27,27% in 2016. The registered cases of chronic rhinitis, nasopharyngitis and pharyngitis for the whole period are only 2, of professional asthma - 3; of chronic bronchitis - 5, less than cases of asbestosis - 9. In 2009, there were five reported cases of talcosis and the total number of cases of siderosis was 23 for the period of eight years. There are 4 cases of other pneumoconiosis and 2 of pneumoconiosis associated with tuberculosis, as well as 10 cases of toxic pulmonary fibrosis during the whole period. Conclusions It is worth noting the small number of occupational respiratory diseases that could be caused by other factors not necessarily related to the work environment, such as chronic bronchitis and asthma, although they are significantly more frequent than those mandatory caused by occupational hazards such as silicosis, asbestosis and toxic pulmonary fibrosis. This means that a significant proportion of these cases are counted as common chronic non-communicable diseases with significant negative social consequences. Key messages The registered occupational respiratory diseases decrease, but the relative share of those with strictly professional etiology, such as silicosis, is growing. A significant proportion of occupational respiratory diseases are reported as chronic non-communicable diseases.

A systematic review of the clinical effectiveness of monitoring patients with diabetes mellitus using individual blood glucose meters with function of transmitting measurements via gsm channel or via the internet

BACKGROUND: In recent years, there has been an active introduction of telecommunication technologies in various spheres of scientific and practical knowledge, including medicine. Diabetes mellitus (DM) is one of the most common chronic non-communicable diseases requiring constant monitoring of the patients condition. For telemedicine monitoring of patients with DM, glucose self-monitoring devices with the option of transmitting patients measurements via GSM channel or via the Internet have been developed.&#x0D; AIM: To evaluate the clinical effectiveness of telemedicine observation of patients with DM using individual glucose self-monitoring devices with option of transmitting patients measurements via a GSM channel or via the Internet.&#x0D; MATERIALS AND METHODS: Publications about clinical trials were searched in PubMed. The search, selection and evaluation of the methodological quality of clinical trials were carried out by two independent researchers. Clinical trials were included in the review if the clinical efficacy of remote monitoring of patients with DM using individual glucose self-monitoring devices with the option of transmitting the results of measurements taken by the patient via a GSM channel or via the Internet was evaluated in comparison with traditional observation methods.&#x0D; RESULTS: As a result of the systematic search, 10 original randomized controlled trials (RCTs) with different methodological quality were selected. It was found that the use of remote technologies for 12 months does not affect the level of glycated hemoglobin, however, it allows to increase the frequency of achieving individual therapeutic goals in patients with type 2 DM. In addition, it was found that the use of remote technologies allows to reduce the frequency of outpatient visits of patients with type 2 DM, but does not reduce the length of hospitalization and the frequency of an emergency calls of these patients.&#x0D; CONCLUSION: Thus, evidence was obtained of the potential therapeutic benefits of remote observation of patients with diabetes based on data from foreign clinical studies. Based on the results obtained, a Russian clinical trial of this medical technology can be recommended.

Coagulopathy in Type 2 Diabetes Mellitus: Pathological Mechanisms and the Role of Factor XIII-A Single Nucleotide Polymorphisms.

The prevalence of type 2 diabetes mellitus (T2DM) has quadrupled within three decades since 1980, affecting 422 million adults in 2016. It remains one of the most common noncommunicable chronic diseases and the underlying risk factor for cardiovascular diseases worldwide. There are different underlying mechanisms that play a role in the development of pathologies associated with the disease such as hyperglycaemia, oxidative stress, obesity, inflammation and hypercoagulation; each of which are interlinked. Hyperglycaemia, oxidative stress and obesity play a huge role in the activation of inflammation and coagulation. Activation of inflammatory pathways increases the production of thrombin which predisposes the development of thrombotic related diseases. One of the factors that contribute to the increase of thrombin is the impairment of the fibrinolysis process due to decreased expression of tissue-plasminogen activator (tPA) by increased levels of plasminogen activator inhibitor-1 (PAI-1). Coagulation factor XIII (FXIII), a transglutaminase that is composed of subunits A and B (FXIII-A2B2), is essential for the last step of fibrin clot formation in the coagulation pathway. Genetic variation of FXIII-A in the form of single nucleotide polymorphisms (SNPs) alters the activity of FXIII, altering clot properties which influence disease outcomes. This review discusses the link between underlying mechanisms of T2DM, well known FXIII-A variants and coagulation.

Large Scale Mobile Medical Service Programme: Data Insights for strengthening local surveillance

ObjectiveWe report the findings of Andhra Pradesh state’s mobile medical service programme and how It is currently used to strengthen the disease surveillance mechanisms at the village level.IntroductionIndia has an Integrated Disease Surveillance project that reports key communicable and infectious diseases at the district and sub-district level. However, recent reviews suggest structural and functional deficiencies resulting in poor data quality (1). Hence evidence-based actions are often delayed. Piramal Swasthya in collaboration with Government of Andhra Pradesh launched a mobile medical unit (MMU) programme in 2016. This Mobile medical service delivers primary care services to rural population besides reporting and alerting unusual health events to district and state health authorities for timely and appropriate action.The MMU service in the Indian state of Andhra Pradesh is one of the oldest and largest public-private initiatives in India. Two hundred and ninety-two MMUs provide fixed-day services to nearly 20,000 patients a day across 14,000 villages in rural Andhra Pradesh. Every day an MMU equipped with medical ( a doctor) and non-medical (1 nurse, 1 registration officer, 1 driver, 1 pharmacist, 1 lab technician, 1 driver) staff visit 2 service points (villages) as per prefixed route map. Each MMU also has its own mobile tablet operated by registration officer for capturing patient details. The core services delivered through MMUs are the diagnosis, treatment, counseling, and free drug distribution to the beneficiaries suffering from common ailments ranging from seasonal diseases to acute communicable and common chronic non-communicable diseases. The routinely collected patient data is daily synchronized on a centrally managed data servers.MethodsFor this analysis, we used aggregated and pooled data that were routinely collected from August 2016-March 2018. Patient details such as socio-demographic variables (age, sex etc.) medical history and key vitals (random blood sugar, blood pressure, pulse rate etc.) and disease diagnosis variables were analyzed. Besides, communication and action taken reports shared with Government of Andhra Pradesh were also analyzed. We report the findings of the programme with reference to strengthing the village level communicable disease surveillance. Unusual health events were defined as more than 3 patients reporting the epidemiologically linked and similar conditions clustered in the same village.ResultsWe observed 4,352,859 unique beneficiaries registrations and 9,122,349 patient visits. Of all unique beneficiaries, 79.3% had complete diagnosis details (53% non-communicable disease, 39% communicable and 8% others conditions). A total of 7 unusual health events related to specific and suspected conditions (3 vector-borne diseases related, 4 diarrhea-related) were reported to district health authorities, of which 3 were confirmed outbreaks (1 dengue, 1 malaria, and 1 typhoid) as investigated by local health authorities.ConclusionsMobile medical services are useful to detect unusual health events in areas with limited resources. It increases accountability and response from the Government authorities if the timely information is shared with competent health authorities. Careful evaluation of the mobile health interventions is needed before scaling-up such services in other remote rural areas.

Use of inhaler devices in the asthma clinic of Alexandria University Children’s Hospital

Background Asthma is the most common chronic noncommunicable disease among children. High rates of incorrect inhaler use among children with asthma have been reported and are associated with worse outcomes. Aim This study was designed to state the types of inhaler devices and to evaluate inhalation techniques and their relation to control of asthma Patients and methods The study was conducted on 130 asthmatic children on inhaled corticosteroids at the age between 1 and 14 years attending the asthma clinic of Alexandria University Children’s Hospital, Egypt. The cases were subjected to detailed history. A preprepared questionnaire about the type of inhaler device and their correct use by the caregivers or older children was conducted. Correlation between inhaler techniques and asthma control according to Global Initiative for Asthma guidelines was done. Results The number of patients who used meter dose inhaler (MDI)-spacer, turbuhaler, and aerolizer was 115, 8, and 7, respectively. The percentage of children having wrong inhalational techniques was 21.74, 25, and 14.28% for MDI-spacer, turbuhaler, and aerolizer, respectively.Wrong technique has a significant relation with asthma control in the three devices (P Conclusion Poor inhalational technique is associated with poor asthma control and regular assessment of inhalational technique in asthmatic children is recommended.

The Relation between Ambient Temperature and Asthma Exacerbation in Children: A Systematic Review

Background: Asthma is one of the most common chronic non-communicable diseases which is seen more in the developed than developing countries of the world. Recurrence and exacerbations of the disease are common among patients and often lead to hospitalization and therapeutic interventions. Ambient air temperature might be related to the relapse of asthma. This review was conducted to investigate the relation between ambient temperature and exacerbations of asthma in children. Methods: Related articles were searched in PubMed, Web of Science, Science Direct, and Scopus databases with appropriate keywords and no specific limitation on October 1, 2018. Initially, the relevance of the articles was examined using the title and abstract. Out of 2633 articles, 23 articles were eligible according to the inclusion and exclusion criteria. Results: Fourteen studies had reported inverse relations; and showed as the temperature dropped, the number of asthma attacks increased in children. Nine papers observed a relation between hot weather and asthma attacks, 3 studies reported a relation between temperature differences and asthma attacks, and two studies did not show any relation. Some studies suggested the increased incidence of asthma in the 5-14 year old age group was associated with the start of the school year and probably due to the spread of viral diseases, not temperature changes. Conclusion: Extreme temperatures are likely to cause exacerbation of childhood asthma.

Prevalence of Hypertension and diabetes mellitus in rural hilly regions of Uttarakhand state

Introduction: Among the most common chronic non-communicable diseases worldwide, hypertension (HT) and Type 2 Diabetes mellitus (DM) are increasingly becoming a matter of public health importance. Limited studies on the prevalence of HT and DM have been performed in rural hilly regions of Uttarakhand state.Objectives: To estimate the prevalence of HT and DM and their association with some selected risk factors among adults in rural hilly areas of Uttarakhand. Methods: This cross-sectional study was carried out from August 2015 to October 2016 with a randomly selected sample of 401 adults in hilly region of Tehri Gharwal and Uttarkashi Districts of Uttarakhand. Demographic, anthropometric measures and lifestyle factors were obtained for all participants with the help of predesigned and pretested interview schedule. A subject with recorded systolic blood pressure of ≥ 140 mmHg or diastolic blood pressure of ≥ 90mmHg was considered hypertensive. Screening for DM was based on the following World Health Organization (WHO) criteria. Bivariate analysis was used to identify the association.Results: The mean age of the study population was 46.6 years ± 16.1 years. Mean BMI of the participants was 22.7 ± 4.8. It was found that 27.7 per cent of the subjects were current tobacco users while 24.7 per cent were current alcoholic. The overall prevalence of HT and DM were 31.4% and 4.7% respectively. About 2.5% of the study subjects were suffering from both HT and DM. The risk factors for HT in this study included age, BMI, vegetarian diet and increase salt intake. Age was found to be a significant risk factor for DM in the present study.Conclusions: A high prevalence of HT and DM in rural hilly areas of Uttarakhand need community outreach campaigns regularly for their early detection &amp; proper health education.Jour of Diab and Endo Assoc of Nepal 2018; 2 (1): 29-30

Precipitation and Termination of Asthmatic Attack by Intense Anxiety

Asthma is one of the most common chronic non-communicable diseases, and characterized by airflow obstruction with variable respiratory symptoms and variable airflow limitation. Several risk factors that predispose to asthma and several triggers which are environmental factors that worsen asthma in a patient with established disease have been identified. Psychological factors can induce bronchoconstriction, and many asthmatics report worsening symptoms with stress and anxiety. We describe a patient with bronchial asthma who developed a severe asthmatic attack in response to intense anxiety. As the asthmatic attack became more severe, also the anxiety became more intense and progressed to a hysterical attack with “loss of consciousness”. This was followed, almost immediately, by termination of her asthmatic attack. To the best of our knowledge, no similar case has been previously reported. J Med Cases. 2018;9(7):226-228 doi: https://doi.org/10.14740/jmc3092w

Progress in research of family-based cohort study on common chronic non-communicable diseases in rural population in northern China

Family-based cohort study is a special type of study design, in which biological samples and environmental exposure information of the member in a family are collected and related follow up is conducted. Family-based cohort study can be applied to explore the effect of genetic factors, environmental factors, gene-gene interaction, and gene-environment interaction in the etiology of complex diseases. This paper summarizes the objectives, methods and results, as well as the opportunities and challenges of the family-based cohort study on common chronic non-communicable diseases in rural population in northern China.

Precipitation and Termination of Asthmatic Attack by Intense Anxiety

Asthma is one of the most common chronic non-communicable diseases, and characterized by airflow obstruction with variable respiratory symptoms and variable airflow limitation. Several risk factors that predispose to asthma and several triggers which are environmental factors that worsen asthma in a patient with established disease have been identified. Psychological factors can induce bronchoconstriction, and many asthmatics report worsening symptoms with stress and anxiety. We describe a patient with bronchial asthma who developed a severe asthmatic attack in response to intense anxiety. As the asthmatic attack became more severe, also the anxiety became more intense and progressed to a hysterical attack with “loss of consciousness”. This was followed, almost immediately, by termination of her asthmatic attack. To the best of our knowledge, no similar case has been previously reported. J Med Cases. 2018;9(7):226-228 doi: https://doi.org/10.14740/jmc3092w

Health systems facilitators and barriers to the integration of HIV and chronic disease services: a systematic review.

Integration of services for patients with more than one diagnosed condition has intuitive appeal but it has been argued that the empirical evidence to support it is limited. We report the findings of a systematic review that sought to identify health system factors, extrinsic to the integration process, which either facilitated or hindered the integration of services for two common disorders, HIV and chronic non-communicable diseases. Findings were initially extracted and organized around a health system framework, followed by a thematic cross-cutting analysis and validation steps. Of the 150 articles included, 67% (n = 102) were from high-income countries. The articles explored integration with services for one or several chronic disorders, the most studied being alcohol or substance use disorders (47.7%), and mental health issues (29.5%). Four cross-cutting themes related to the health system were identified. The first and most common theme was the requirement for effective collaboration and coordination: formal and informal productive relationships throughout the system between providers and within teams, and between staff and patients. The second was the need for adequate and appropriately skilled and incentivized health workers—with the right expertise, training and operational support for the programme. The third was the need for supportive institutional structures and dedicated resources. The fourth was leadership in terms of political will, effective managerial oversight and organizational culture, indicating that actual implementation is as important as programme design. A fifth theme, outside the health system, but underpinning all aspects of the system operation, was that placing the patient at the centre of service delivery and responding holistically to their diverse needs. This was an important facilitator of integration. These findings confirm that integration processes in service delivery depend substantially for their success on characteristics of the health systems in which they are embedded.

Coexistence of Hypertension and Diabetes Mellitus in Elderly Population of Arar City, Northern Saudi Arabia

Background: Type 2 diabetes (DM) mellitus and Hypertension (HT) are among the most common chronic non-communicable diseases affecting at a higher prevalence in the older age group. The presence of hypertension in diabetic patients substantially increases the risks of coronary heart disease, stroke, nephropathy and retinopathy. The objective of this study is to determine the prevalence rate and risk factor associated with co-existence of hypertension and diabetes mellitus in elderly population in Arar city, Northern Saudi Arabia. Methods: A cross sectional study, included 181 elderly attending seven randomly selected primary healthcare centers in Arar city during the period from 1st January to 30th June 2017. Participants selected using a systemic random sampling procedure as we take every second elderly attending the PHC during the study period. Data collected by means of personal interview using a predesigned questionnaire covering the required items. Results: The prevalence of coexistence of diabetes and hypertension was 16.6% while coexistence of diabetes, hypertension and obesity were found in 9.9%. Two-thirds (66.66%) of cases of coexisting diabetes and hypertension were females (P value>0.05). The relation between coexisting diabetes and hypertension with smoking status was significant (P value 0.05). Conclusion: Coexistence of diabetes and hypertension were found in 16.6% of elderly population of Arar, Northern KSA. This association leads to several cardiovascular complications, so it is mandatory to adopt more strategies for the control of DM and HT in Arar elderly population by appropriate methods.

A cohort study protocol to analyze the predisposing factors to common chronic non-communicable diseases in rural areas: Fasa Cohort Study.

BackgroundNon-communicable diseases (NCDs) have become the main causes of morbidity and mortality even in rural areas of many developing countries, including Iran. In view of this increased risk, Fasa Cohort Study (FACS) has been established to assess the risk factors for NCDs with the ultimate goal of providing optimal risk calculators for Iranian population and finding grounds for interventions at the population level.MethodsIn a population-based cohort, at least 10,000 people within the age range of 35 to 70 years old from Sheshdeh, the suburb of Fasa city and its 24 satellite villages are being recruited. A detailed demographic, socioeconomic, anthropometric, nutrition, and medical history is obtained for each individual besides limited physical examinations and determination of physical activity and sleep patterns supplemented by body composition and electrocardiographic records. Routine laboratory assessments are done and a comprehensive biobank is compiled for future biological investigations. All data are stored online using a dedicated software.DiscussionFACS enrolls the individuals from rural and little township areas to evaluate the health conditions and analyze the risk factors pertinent to major NCDs. This study will provide an evidence-based background for further national and international policies in preventive medicine. Yearly follow ups are designed to assess the health events in the participating population. It is believed that the results would construct a contemporary knowledge of Iranian high risk health characteristics and behaviors as well as the platform for further interventions of risk reduction in a typical Iranian population. Constantly probing for future advances in NCDs prevention and management, the accumulated database and biobank serves as a potential for state of the art research and international collaborations.

The importance of educating postgraduate pediatric physicians about food allergy.

BackgroundFood allergy is an increasing public health burden, and is considered among the most common chronic noncommunicable diseases in children. Proper diagnosis and management of food allergy by a health care provider is crucial in keeping affected children safe while simultaneously averting unnecessary avoidance.ObjectiveThe rationale of the study was to estimate the knowledge of pediatric residents and academic general pediatric fellows with regard to food allergies in children.MethodsA cross-sectional and prospective study was carried out at Hamad Medical Corporation, the only tertiary care, academic and teaching hospital in the State of Qatar. The study took place between January 1, 2015 and September 30, 2015.ResultsOut of the 68 questionnaires distributed, 68 (100%) were returned by the end of the study. Among the participants, 15 (22%) were in post-graduate year-1 (PGY-1), 16 (23.5%) in PGY-2, 17 (25%) in PGY-3, 12 (16%) in PGY-4, and 8 (12%) were academic general pediatric fellows. Our trainees answered 60.14% of knowledge based questions correctly. In the section of treatment and management of food allergy in childhood, 23 (34%) of respondents’ main concern when taking care of a patient with food allergies was making sure the patient is not exposed to food allergen, while 22 (33%) reported no concerns. In the section of treatment and management of food allergy in childhood, 22 (33%) of participants reported no concerns in taking care of a child with food allergy, while 23 (34%) of respondents’ main concern was making sure the patient is not exposed to food allergen. In the teaching and training section, 56% of participants stated that they have not received formal education on how to recognize and treat food allergies, while 59% claimed not being trained on how to administer injectable epinephrine. Furthermore, approximately 60% of all participants expressed the need of additional information about recognizing and treating food allergies and recommended certification and regulation of food allergy training for all residents.ConclusionThere is an appreciable lack of knowledge in identifying food allergy and managing anaphylaxis reaction in children, among pediatric residents. Robust efforts should be implemented by attending immunologists to improve the lack of knowledge and improve the trainee’s confidence when facing such cases.

Associations of common chronic non-communicable diseases and medical conditions with sleep-related problems in a population-based health examination study

A cross-sectional population-based survey, the National FINRISK 2012 Study, designed to monitor chronic diseases and their risk factors in Finland. A random sample of 10,000 adults aged 25–74 years, and of them, 64% (n=6424) participated the study. Participants subjectively reported the total durations for sleep and naps (n=6238), sleep quality (n=5878), bedtimes and wake-up times separately for working days and weekends yielding the amount of sleep debt (n=5878), and the seasonal variation in sleep duration (n=4852). The participants were asked whether they were diagnosed or treated for common chronic diseases in the past 12 months. Logistic regression models were adopted to analysis and adjusted for a range of covariates as potential confounding factors. Total sleep duration and nap duration prolonged in depression and other mental disorder (p<.001 for all). Seasonal variation in sleep duration was associated with depression (p=.014), hypertension (p=.018) and angina pectoris (p=.024). Participants with gallstones, cardiac insufficiency, depression, or degenerative arthritis had poor sleep quality (odds ratios of 1.6–6.3, p=.001 or less for each). Those with degenerative arthritis had sleep debt less (p<.05) and those with angina pectoris more (p<.05) than individuals without these medical conditions. Depression is significantly associated with sleep problems, albeit no sleep debt. Cardiovascular diseases, degenerative arthritis, and gallstones had significant associations with one or more sleep problems. There is therefore a need for more successful management of sleep problems in chronic diseases to improve the quality of life, to reduce treatment relapses, and to increase health and longevity in a population.