Epidemiological Transition Research Articles

Towards the sustainable elimination of gambiense human African trypanosomiasis in Côte d'Ivoire using an integrated approach.

Human African trypanosomiasis is a parasitic disease caused by trypanosomes among which Trypanosoma brucei gambiense is responsible for a chronic form (gHAT) in West and Central Africa. Its elimination as a public health problem (EPHP) was targeted for 2020. Côte d'Ivoire was one of the first countries to be validated by WHO in 2020 and this was particularly challenging as the country still reported around a hundred cases a year in the early 2000s. This article describes the strategies implemented including a mathematical model to evaluate the reporting results and infer progress towards sustainable elimination. The control methods used combined both exhaustive and targeted medical screening strategies including the follow-up of seropositive subjects- considered as potential asymptomatic carriers to diagnose and treat cases- as well as vector control to reduce the risk of transmission in the most at-risk areas. A mechanistic model was used to estimate the number of underlying infections and the probability of elimination of transmission (EoT) was met between 2000-2021 in two endemic and two hypo-endemic health districts. Between 2015 and 2019, nine gHAT cases were detected in the two endemic health districts of Bouaflé and Sinfra in which the number of cases/10,000 inhabitants was far below 1, a necessary condition for validating EPHP. Modelling estimated a slow but steady decline in transmission across the health districts, bolstered in the two endemic health districts by the introduction of vector control. The decrease in underlying transmission in all health districts corresponds to a high probability that EoT has already occurred in Côte d'Ivoire. This success was achieved through a multi-stakeholder and multidisciplinary one health approach where research has played a major role in adapting tools and strategies to this large epidemiological transition to a very low prevalence. This integrated approach will need to continue to reach the verification of EoT in Côte d'Ivoire targeted by 2025.

A CASE STUDY ON MADHUMEHA W.S.R TO TYPE 2 DIABETES MELLITUS TREATED WITH CHANDRA KALA GUDIKA

The rising burden of Type 2 Diabetes which has occurred with modernization can be understood in the context of epidemiological transition. Irregular food habits, lack off exercise, stress and strains are some causative factors. Madhumeha leads to be a cause for blindness, renal failure etc., if it is not controlled. Rapid socio economic development and coca colonization have resulted in a life style transition from traditional to modern. As Madhumeha in modern science is compared with diabetes mellitus. Aims of Study-The present study was carried out with an objective to compare the efficacy of Chandra kala gudika in the management of Madhumeha w.s.r. to type 2 Diabetes Mellitus. Materials and Methods- The present study was Open Randomised clinical study, on 30 patients of either sex having symptoms of Madhumeha. These patients were subjective with Chandra kala gudika 500mg Bd. Result- Overall response was excellent improvement in 30%, marked improvement in 60% and mild improvement in 10% of patients. Conclusion- The Chandra kala gudika has a significant effect on both subjective and objective parameters. No adverse drugs effects were observed at the end of study.

Drug utilization evaluation of medications used in the management of neurological disorders

Background and objectThe burden of neurological disorders in India is expected to increase due to the rapid demographic and epidemiological transition, with irrational drug use, which is also a global concern. Thus, drug utilization evaluation is designed to ensure appropriate medicine use within the healthcare settings. The aim of the study was to assess the rate and pattern of drug utilization in the management of neurological disorders. Materials and methodsA hospital-based cross-sectional drug utilization evaluation study on neurological drugs was carried out at the Department of Neurology over a span of six months. All legible prescriptions consisting neurological medications irrespective of patient's gender, aged ≥ 18 years were included for the study. The World Health Organization (WHO) core drug use indicators were used to assess the drug prescribing and utilization patterns. ResultsA total of 310 prescriptions were reviewed, where male predominance was found to be 56.45%. Out of 310 prescriptions, drugs belonging to 26 neurological classes were prescribed for the management of various neurological disorders. The majority of patients were diagnosed with epilepsy and the most prescribed drugs per patient were phenytoin (14.8%) and valproic acid (6.45%). By following the WHO core drug prescribing indicators, 65.47% of drugs prescribed from the India National List of Essential Medicines, 2022, followed by 29.83% of drugs prescribed in generic name and 10.86% of prescriptions including injections. ConclusionThe study findings showed that the prescribing pattern in the Department of Neurology was in accordance with the WHO core prescribing indicators. But, the extent of polypharmacy prescriptions was very high. Therefore, interventions are very necessary to promote rational drug prescribing patterns and thus clinical pharmacists can contribute to assess and review the drug utilization pattern to optimize the drug therapy and improvement in patient safety.

New-onset Geriatric Epilepsy in a Latin American Country: A Multi-centric Study from Mexico.

Background: In Latin America, epilepsy in the elderly is a neglected issue that has never been studied. The epidemiological transition has significantly altered the demographics of epilepsy, and therefore, we would like to draw attention to this topic. Objective: We require local real-world evidence, as the literature often depicts a different scenario, including pharmacological management. Methods: From 2007 to 2018, we recruited all patients with new-onset geriatric epilepsy (first seizure after the age of 60) tracked from ten Mexican hospitals, adding them to patients with similar characteristics from a previously published study. The diagnosis was confirmed in all patients by a certified neurologist, and they were also studied using a conventional electroencephalogram and imaging workup. Results: A diagnosis of new-onset geriatric epilepsy (Elderly patients was established in 100 cases. No specific cause was found in 26% of patients, while 42% had a stroke and 10% had neurocysticercosis (NCC). Monotherapy was the choice in 83 patients, and phenytoin was the most used drug (50%), followed by carbamazepine (25%). Conclusion: NCC remains a frequent cause of new-onset geriatric epilepsy. This distribution is not seen in the literature, mainly representing patients from wealthy economies. In our setting, financial constraints influence the choice of the drug, and newer antiepileptic drugs should be made more affordable to this population with economic and physical frailty.

Prevalence of the metabolic syndrome in African populations: A systematic review and meta-analysis.

The metabolic syndrome (MS) is a leading cause of death worldwide. Several studies have found MS to be prevalent in various African regions. However, no specific estimates of MS prevalence in African populations exist. The aim of this study was to estimate the overall prevalence of MS in the African populations. A systematic review was conducted in PubMed, Web of Science, Africa Index Medicus, and African Journal Online Scopus to find studies published up to the 15th of August 2022. Pooled prevalence was calculated based on six diagnostic methods. The pooled prevalence of MS was estimated using a random-effects model. Our risk of bias analysis was based on the Hoy et al. tool. A Heterogeneity (I2) assessment was performed, as well as an Egger test for publication bias. PROSPERO number CRD42021275176 was assigned to this study. In total, 297 studies corresponding to 345 prevalence data from 29 African countries and involving 156 464 participants were included. The overall prevalence of MS in Africa was 32.4% (95% CI: 30.2-34.7) with significant heterogeneity (I2 = 98.9%; P<0.001). We obtained prevalence rates of 44.8% (95% CI: 24.8-65.7), 39.7% (95% CI: 31.7-48.1), 33.1% (95% CI: 28.5-37.8), 31.6% (95% CI: 27.8-35.6) and 29.3% (95% CI: 25.7-33) using the WHO, revised NCEP-ATP III, JIS, NCEP/ATP III and IDF definition criteria, respectively. The prevalence of MS was significantly higher in adults >18 years with 33.1% (95%CI: 30.8-35.5) compared to children <18 years with 13.3% (95%CI: 7.3-20.6) (P<0.001). MS prevalence was significantly higher in females with 36.9% (95%CI: 33.2-40.7) compared to males with 26.7% (95%CI: 23.1-30.5) (P<0.001). The prevalence of MS was highest among Type 2 diabetes patients with 66.9% (95%CI: 60.3-73.1), followed by patients with coronary artery disease with 55.2% (95%CI: 50.8-59.6) and cardiovascular diseases with 48.3% (95%CI: 33.5-63.3) (P<0.001). With 33.6% (95% CI: 28.3-39.1), the southern African region was the most affected, followed by upper-middle income economies with 35% (95% CI: 29.5-40.6). This study, regardless of the definition used, reveals a high prevalence of MS in Africa, confirming the ongoing epidemiological transition in African countries. Early prevention and treatment strategies are urgently needed to reverse this trend.

Diabetes Health Literacy, Drug Adherence and Factors Associated with Them among Urban Patients in Kerala, India.

The study aimed to assess diabetes health literacy, adherence to diabetes medication, and its associated factors in Kerala, India, the most advanced Indian state in epidemiological transition with the highest literacy level in India. We conducted a community-based cross-sectional study among 280 diabetes patients (mean age 62 years, male 42%) selected by multistage cluster sampling. Information on sociodemographic variables was collected using a pretested structured interview schedule. Diabetes health literacy was assessed using the revised Michigan Diabetes Knowledge test. Adherence to diabetes medication was assessed using the Hill-Bone subscale. Binary logistic regression analysis was done to find out the factors associated with diabetes health literacy and medication adherence. Good diabetes health literacy was reported by 35.7% [95% confidence interval (CI): 30.1-41.6] of the patients. Perfect adherence to diabetes medication was reported by 33.2% of patients (CI: 27.7-39.1). Patients who reported regular newspaper reading [adjusted odds ratio (AOR) 3.16; CI: 1.57-6.30], using the internet (AOR 2.23; CI: 1.11-4.50) and insulin use (AOR 2.60; CI: 1.35-5.00) were more likely to report good diabetes health literacy compared to their counterparts. Patients who reported reading health magazines (AOR 2.75; CI: 1.01-7.60) were more likely to report perfect medication adherence compared to those who did not. Why diabetes health literacy and medication adherence were low among diabetes patients in the most literate state needs further investigation. Interventions to enhance diabetes health literacy and medication adherence may be undertaken among diabetes patients encouraging them to read newspapers and health magazines regularly and use the internet.

Epidemiologic transition of lung cancer mortality in Italy by sex, province of residence and birth cohort (1920-1929 to 1960-1969).

Space-time analysis of mortality risk is useful to evaluate the epidemiologic transitions at the subnational level. In our study, we analysed the death certificate records for lung cancer in Italy in 1995-2016, obtained from the Italian National Institute of Statistics. Our objective was to investigate the spatial-temporal evolution of lung cancer mortality by sex and province of residence (n = 107) using the birth cohort as relevant time axis. We built Bayesian space-time models with space-time interactions. Among males (n = 554 829), mortality peaked in the 1920-1929 cohort, followed by a generalised decline. Among females (n = 158 619), we found novel original evidence for a peak in the 1955-1964 cohort, equivalent to a 35-year delay, with a downward trend being observed thereafter. Over time, the documented north-south decreasing mortality gradient has been replaced by a west-east decreasing gradient. Naples has become the province at highest risk in Italy, both among males and females. This pattern is consistent with an epidemiologic transition of risk factors for lung cancer to the south-west of the country and raises concern, because 5-year age-standardised net survival from the disease in this geographic area is lower than in northern and central Italy. The variability of mortality rates among provinces has changed over time, with an increasing homogeneity for males and an opposite trend for females in the more recent birth cohorts. These unprecedented observations provide evidence for a profound spatio-temporal transition of lung cancer mortality in Italy.

What diseases affect elderly Mexican population? Clinical and socialdemographic characteristics of patients of the psychogeriatric clinic of the National Institute of Psychiatry

Introduction. The demographic and epidemiological transition, as well as the aging population has changed how older adults are treated in our healthcare system. Objective. To establish the sociodemographic and clinical characteristics of the patients from the Psychogeriatric Clinic (PC) of the Ramón de la Fuente Muñiz National Institute of Psychiatry (INPRFM) seen between January 1, 2011, and December 31, 2020. Method. Descriptive, observational, cross-sectional, retrospective study. A database was created with the information from digital clinical records. No additional scales were used. Statistical analysis performed in SPSS 20.0. Results. 2056 records were found, 1247 met the inclusion criteria. The mean age was 74.28 years, women 73.46% (n = 916), primary school 46.62% (n = 427), married 35.70% (n = 327), urban area 93.99% (n = 1172), home-based 78.28% (n = 717), low socioeconomic level 59.99% (n = 522). The most common psychiatric pathology was depressive disorders 62.07% (n = 774) and neurocognitive disorders 37.52% (n = 468) due to Alzheimer’s disease 17.08% (n = 213), with Mini-Mental State Examination of 18.88 points (± 6.68). They had comorbidities such as arterial hypertension 52.85% (n = 659), diabetes mellitus 23.34% (n = 291) and had a geriatric syndrome in 64.42% (n = 218). Discussion and conclusion. Aging in Mexico affects the female population the most. The analysis report from the prevalence for psychogeriatric pathologies of the PC it’s for of its kind. The main goal is promoting research on dementias and highlighting the magnitude of the problem for Latin American governments. The results are not intended to be extrapolated to the general population.

Physiological aging in India: The role of the epidemiological transition.

We construct a cohort-based frailty index from age-related health deficits to investigate physiological aging in India over the period 1990-2019. During this period, the Indian states underwent at different speeds the epidemiological transition and experienced unprecedented economic growth. We show that the rate of physiological aging remained remarkably stable to the changing environment. Age-related health deficits increased by about 3 percent per year of age with little variation across states, ages, cohorts, and over time. We find that, with advancing epidemiological transition, health deficits for given age declined at the individual level (within states and within cohorts). Across cohorts born between 1900 and 1995, we show that, for given age, health deficits are higher for later-born cohorts until birth years around 1940 and remained trendless afterwards. We propose a selection-based theory of aging during the epidemiological transition that explains these facts.

PREVALENCE AND RISK FACTORS ASSOCIATED WITH TUBERCULOSIS OCCURRENCE AMONG PATIENTS ATTENDING MUHIMA DISTRICT HOSPITAL, NYARUGENGE DISTRICT, RWANDA

Tuberculosis (TB) is one the serious public health problems globally and locally and killed at least eight million in 2018 (WHO, 2019). TB is a curable disease if well treated and followed. One of the most key considerations for tracking and evaluating TB prevention and control programs is the prevalence and related risk factors. The study adopted a quantitative approach and a cross-sectional retrospective design to collect data from the respondents. A systematic sampling technique was used and secondary data recorded in the laboratory were collected. Specific objectives were: to determine the prevalence of tuberculosis among patients attending Muhima District Hospital in Nyarugenge District, and to identify behavioral factors associated with TB occurrence among patients attending Muhima District Hospital in Nyarugenge District. Descriptive and analytical statistics were used to analyze the data. The total number of respondents was 2161 patients. The majority, were male 1524(70.5%) and female were 637(29.5%). For the age, those less than 9 years were 19(.9%), between 10-17 years 76(3.5%), between 18-35 years 1185(54.8%), between 36-59 years 843(39.0%), and above 60 years 38(1.8%). Those who were married were 1014(47%), singles were 977(45.2%), and widower were 57(2.6%). For employment, 883(40.9%) were unemployed, 845(39.1%) were employed, 206(9.5%) were students, and 227(10.4%) were prisoners. Based on location, 1181(54.7%) were from urban areas, and 980(45.3%) were from rural areas. The prevalence of TB was 7.2%, out of which the females were 53(34.0%) and males were 103(66.0%). The prevalence of TB among HIV patients was 32.6%. For behavior practices, drinking alcohol was found among 908(42.0%) and smokers were 186(8.6%). For all the predictors of TB occurrence, none of them was statistically associated with TB occurrence. These include demographic characteristics, behavioral factors including use of alcohol, smoking and use of tobacco products, and serology. The prevalence of TB among patients attending Muhima District was higher than the National TB prevalence estimates reported by the World Health Organization (WHO, 2019), respectively 7.2% versus 5.2%. All predictors of TB occurrence including demographic characteristics and behavioral factors none of them was associated with TB occurrence. It is worth recommending a further study to understand in-depth risk factors for TB occurrence in the era of epidemiological transition.&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/soc/0045/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Heart failure in Nigeria: protocol for a systematic review and meta-analysis.

Heart failure is now a significant contributor to the burden of non-communicable diseases in developing countries like Nigeria which is experiencing epidemiologic and demographic transition. The epidemiology of heart failure in this country is poorly characterized. The aim of the review is to determine the prevalence of heart failure, the associated risk factors, the aetiology, management, and outcomes of the condition in the country. Relevant databases such as PubMed /Medline, EMBASE, Web of Science, Google Scholar, African Index Medicus, and African journal online would be searched for articles published in English from January 2000 to December 2021. The analysis will include observational studies conducted among Nigerian adults aged 12 years and above. Article selection shall be conducted by pairs of independent reviewers. Data extraction shall be done by 2 independent reviewers. The primary outcome would be the pooled prevalence of heart failure while the secondary outcomes would be to identify the risk factors and management of heart failure in Nigeria. This will be the first systematic review and meta-analysis of heart failure epidemiology in Nigeria which will hopefully identify gaps for future research and guidance for policy interventions.

Prevalence of Cardiovascular Risk Factors among Young Adults (18-25 Years) in Mozambique.

The life course development of cardiovascular diseases (CVDs) and the undergoing epidemiological transition in Mozambique highlight the importance of monitoring the cardiovascular risk profile in young adults. Therefore, this study aims to estimate the prevalence of CVD risk factors in a population aged 18-25 years living in Mozambique. A total of 776 young adults from a nationally representative sample were evaluated in 2014/2015 following the World Health Organization's STEPwise approach to chronic disease risk factor surveillance. Current smoking was the most prevalent among rural men (10.8%, 95%CI: 6.3-17.8), and drinking was most prevalent among urban men (38.6%, 95%CI: 29.3-48.8). The proportion of young adults not engaging in at least 75 min of vigorous physical activity per week ranged between 14.5% in rural men and 61.6% in urban women. The prevalence of being overweight/obese and hypertension were highest among urban women (21.6%, 95%CI: 14.7-30.6) and urban men (25.2%, 95%CI: 15.9-37.6), respectively. Education >8 years (vs. none) was independently associated with lower odds of being a current smoker, and increased monthly household income was associated with increased odds of low levels of physical activity. This study shows that important CVD risk factors are already common in the young adult population of Mozambique.

Measures of health and association, and epidemiologic transition—fundamental concepts for veterinary public health specialists

Measures of health and association, and epidemiologic transition—fundamental concepts for veterinary public health specialists

Barriers and facilitators of brown rice consumption among staff at Durban University of Technology, South Africa

South Africa is experiencing an epidemiological and nutrition transition that is characterised by a surge in the prevalence of overweight and obesity, with an increase in the consumption of energy-dense, low nutritive value foods and beverages and a marked decrease in physical activity. Numerous studies have documented the healthful benefits of making the transitional shift from white rice to brown rice. The aim of this study was to explore the barriers and facilitators of brown rice consumption among staff at Durban University of Technology in South Africa. In this exploratory qualitative study, focus group discussions (FGDs) were conducted to gain an understanding of brown rice consumption among staff at the university. The study sample comprised of non-diabetic, permanent and contract staff at the University. Three focus group discussions were conducted until meaning saturation was reached; two were face to face and one online. Data were analysed using the thematic analysis method. Participants perceived healthy foods as safe and nutrient-dense, with consumption leading to positive health outcomes whereas unhealthy foods were perceived as energy-dense, nutrient-poor and hyper-palatable. The main determinants of food choice included peer and family influence, psychological state, education, availability, affordability, state of health and taste. Factors that influenced rice choice included sensory acceptability, availability, affordability, cultural acceptability, and convenience. Major barriers of brown rice consumption included family preferences and influence, sensory acceptability, time-intensive preparation, affordability, knowledge and skills. Two facilitators of brown rice consumption emerged: natural sensory appeal and healthful benefits. The sensory attributes of brown rice have had limited consumer acceptance, compelling the activation of consumer education and visually enticing cues in preparation methods and extended application uses in food products. This study found that the inclusion and acceptance of brown rice into the participants’ diet is limited. A multi-stakeholder approach towards consumer education and practical preparation solutions is likely to positively influence consumer acceptance of brown rice. Innovative and creative food behaviour modifications should be promoted to channel change towards healthier food choices for a positive impact on health and wellness. Key words: Brown rice, focus group discussions, perception, barriers, facilitators, consumption

Penyuluhan “CERDIK” (Cek Kesehatan Secara Rutin) Sebagai Upaya Pengendalian Penyakit Tidak Menular

Non-communicable diseases (PTM) are diseases that kill around 41 million people every year, equivalent to 74% of all deaths globally. Every year around 17 million people die from NCD before the age of 70, of which 86% of these premature deaths occur in low- and middle-income countries (World Health Organization, 2023). PTM risks threaten everyone of all age groups, regions and countries affected by PTM. Indonesia is facing an epidemiological transition in health problems, where communicable diseases cannot be resolved, while non-communicable diseases, including asthma tend to increase. This Community Service aims to provide education to the public through health education needed to overcome the problem of infectious diseases in the community. In conclusion, this community service activity is that the counseling is going well and the advice to the counseling participants is that the community service counseling participants can do CERDIK which is a healthy life behavior that is able to keep people away from various non-communicable diseases (PTM) such as vascular disease, heart disease, and kidney problems . Likewise, the hope is that the community can take part in community activities in the form of Posbindu which are held every month in their respective areas.

Patterns of Non-Communicable Disease, Multimorbidity, and Population Awareness in Bahir Dar, Northwest Ethiopia: A Cross-Sectional Study.

Ethiopia, like other developing countries, is going through an epidemiological transition, and high rates of non-communicable diseases (NCDs) are having a significant impact on the health system; however, there is limited evidence about community level NCD prevalence, multimorbidity, and population awareness that could inform targeted interventions and policy responses. This study aimed to identify factors associated with NCD prevalence, multimorbidity, and population awareness of NCDs in Bahir Dar, Northwest Ethiopia. A community-based cross-sectional survey was conducted with 417 randomly sampled adults. We performed descriptive and logistic regression analyses to evaluate associations between NCD prevalence (cardiovascular diseases, diabetes, cancer, chronic respiratory diseases, chronic kidney disease, and hypertension) multimorbidity (2 or more NCDs) and demographic, socioeconomic, individual risk factors, anthropometrics, knowledge, and attitude. This study reveals that 24% of participating adults have an NCD, and 8% have multimorbidity. One-third (34.5%) have some NCD knowledge, and 75% consider NCDs more dangerous than communicable diseases. We find low NCD prevalence in participants: younger than 40 years of age (AOR 0.17, 95% CI 0.07 to 0.39); with normal body mass index (AOR 0.27, 0.10 to 0.77) and; with a family history of NCD (AOR 7.7, 4.2 to 14.1). Multimorbidity is lower in young adults (AOR 0.08, 0.03 to 0.26). NCD knowledge is higher in men (AOR 1.76, 1.06 to 2.93) and employed adults (AOR 2.91, 1.52 to 5.57), and NCD attitude in normal-weight adults (AOR 3.23, 1.42 to 7.39). This study reveals a high prevalence of NCD and overall low NCD awareness in the population. Age above 40 years, family history of NCD, and weight in the obese category are significant predictors of NCD prevalence. These findings can help health professionals, health offices, and concerned stakeholders to plan targeted health interventions to reduce NCDs in the population.

Literature Review : Penyakit Degeneratif : Penyebab, Akibat, Pencegahan Dan Penanggulangan

Background: Degenerative diseases are generally defined as diseases caused by a process of decreased organ function which generally occurs in old age. This disease has many varieties and symptoms and often attacks the community in general. In Indonesia, the epidemiological transition has led to a shift in disease patterns, in which there has been an increase in degenerative diseases. Degenerative disease is a chronic non-communicable disease due to the decline in the function of the body's organs due to the aging process. Indonesia's health sector is currently bearing a double burden, because on the one hand there has been an increase in degenerative diseases, while on the other hand infectious diseases are still rampant. Purpose: to gain a better understanding of problems related to degenerative diseases: causes, effects, prevention and management. Method: In this study we used a research method in the form of library research, which is a series of studies relating to library data collection methods, or the research was collected through various kinds of library information (scientific journals, books, encyclopedias, magazines, newspapers, and documents). Conclusion: Based on the research results obtained from reviewing journals that match the theme, it can be concluded that the poor and middle class are more at risk of death from degenerative diseases ENMD and DCS than the rich. While the population with the age group of 45–54 years is more at risk of dying from DCS degenerative disease than those aged 33 years.

Estimating mortality and disability in Peru before the COVID-19 pandemic: a systematic analysis from the Global Burden of the Disease Study 2019.

Estimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru's healthcare system performance. Using estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region. The Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8-70.3) to 80.3 (77.2-83.2) years. This increase was driven by the decline in under-5 mortality (-80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5-10.1) and reached 7.5 million (6.1-9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region. In the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.

Advance Care Planning in India: Current status and future directions. A short narrative review

India is undergoing economic, demographic and epidemiologic transitions. The healthcare industry is expanding rapidly as the burden of non-communicable diseases increases. The Indian Supreme Court [1] has recently enabled Advance Medical Directives (AMD). Implementation of Advance Care Planning (ACP) will depend on civil society and the palliative care sector until government support is available.

Relationship Between Nutritional Status And Degenerative Diseases In The Elderly

The increasing number of elderly population has resulted in an epidemiological transition, namely the shift in disease patterns from infectious diseases and nutritional disorders to degenerative diseases. The health of the elderly basically lies in their nutritional status. Nutritional problems in the elderly are mostly a problem of excess nutritional status which triggers the emergence of various degenerative diseases. Some of the diseases that are often experienced by the elderly include hypertension, arthritis, stroke, chronic obstructive pulmonary disease (COPD), and diabetes mellitus. The purpose of this study was to determine the relationship between nutritional status and degenerative diseases experienced by the elderly. This study uses a literature review method with a reference study approach. The keywords used in the journal search were "nutritional status, degenerative diseases, elderly". The number of articles included in the inclusion criteria was nine articles. Based on the results of a literature study, it is stated that the nutritional status of the elderly has an effect on the emergence of degenerative diseases. From the nine articles reviewed, it can be concluded that there is a relationship between nutritional status and degenerative diseases experienced by the elderly.