Epidemiological Transition Research Articles

Type 2 Diabetes Mellitus and Cardiometabolic Prospects: A Rapid Narrative Review.

Cardiometabolic syndrome (CMS), type 2 diabetes mellitus (T2DM), and cardiovascular diseases are among the major altruists to the international liability of disease. The lifestyle and dietary changes attributable to economic growth have resulted in an epidemiological transition towards non-communicable diseases (NCDs) as the leading causes of death. Low- and middle-income countries (LMICs) bear a more substantial disease burden due to limited healthcare sector capacities to address the rapidly growing number of chronic disease patients. The purpose of this narrative review paper was to explore the interrelationships between CMS, T2DM, and cardiovascular impairments in the context of NCDs, as well as major preventative and control interventions. The role of insulin resistance, hyperglycemia, and dyslipidemia in the pathogenesis of T2DM and the development of severe cardiovascular impairments was highlighted. This paper elaborated on the pivotal role of lifestyle modifications, such as healthy diets and physical activity, as cornerstones of addressing the epidemics of metabolic diseases. Foods high in calories, refined sugar, red meat, and processed and ready-to-eat meals were associated with an amplified risk of CMS and T2DM. In contrast, diets based on fruits, legumes, vegetables, and whole grain, home-cooked foods demonstrated protective effects against metabolic diseases. Additionally, the role of a psychological and behavioral approach in addressing metabolic diseases was highlighted, especially regarding its impact on patient empowerment and the patient-centered approach to preventative and therapeutic interventions.

Empowering patients: Harnessing mnemonics for non-communicable disease management.

The epidemiological transition caused a significant non-communicable disease burden in all countries, including India. It can be tackled appropriately by integrating pharmacological and non-pharmacological interventions. The outcome of the disease or control status related to the disease condition depends significantly on patient education. Mnemonics is already an accepted way of improving cognition. The newer learning theories talk about different types of mnemonics and their role in imparting knowledge. We developed three mnemonics regarding essential information related to hypertension, diabetes mellitus, and obesity. It will help achieve better control status in those diseases by improving cognition.

Regional Differences in Life Expectancy in Russia Through the Lens of Epidemiological Transition

An immense territory of Russia with several climatic zones and, accordingly, a fundamentally different styles of life, inevitably results in pronounced varieties in the levels and structure of mortality across the regions of the country. Since the scale and sustainability of differences in mortality in Russia can be considered an entire epidemiological epoch, the evaluation of them through the lens of epidemiological transition seems methodologically appropriate. Regional differences are regarded as a kind of projection of evolution in time, though taking into account modern realities. The analysis of regional differences in mortality is based on such indicators as life expectancy, structure of mortality, i.e., predominantly endogenous to exogenous causes of death ratio, as well as the average age of death from predominantly endogenous causes calculated on the basis of life tables by cause of death. The study showed that according to the periodization of epidemiological transition only Moscow and St. Petersburg are at the final phase of the 3rd stage and are moving to the 4th stage of epidemiological development. Meanwhile, the burden of exogenous and preventable pathologies precludes the completion of the 3rd stage in the regions with high life expectancy according to Russian criteria. The stadial nature of epidemiologic development of Russian regions is currently conditioned by socio-economic and medical determinants, with more pressing medical determinants in regions with high and medium levels of life expectancy and socio-economic factors prevailing in regions with low life expectancy.

Multimorbidity, health Literacy, and quality of life among older adults in an urban slum in India: a community-based cross-sectional study

BackgroundIndia is experiencing a rising burden of chronic disease multimorbidity due to an aging population and epidemiological transition. Older adults residing in urban slums are especially vulnerable due to challenges in managing multimorbidity amid deprived living conditions. This study aimed to assess the prevalence of multimorbidity, associated health literacy, and quality of life impact in this population.MethodsA community-based cross-sectional study was conducted among 800 adults aged ≥ 65 years in an urban slum in Gujarat, India. Data on sociodemographics, physical and mental health conditions, health literacy (HLS-SF-47), quality of life (Short Form-12 scale), and social determinants of health were collected. Multimorbidity is ≥ 2 physical or mental health conditions in one person.ResultsThe prevalence of multimorbidity was 62.5% (500/800). Multimorbidity was significantly associated with lower physical component summary (PCS) and mental component summary (MCS) scores on the SF-12 (p < 0.001). After adjusting for sociodemographic variables, the odds ratio of 0.81 indicates that for every 1 unit increase in the health literacy score, the odds of having multimorbidity decrease by 19%. Older age within the older adult cohort (per year increase) was associated with greater odds of multimorbidity (AOR 1.05, 95% CI 1.02–1.09). Physical inactivity (AOR 1.68, 95% CI 1.027–2.77) and lack of social support (AOR 1.57, 95% CI 1.01–2.45) also increased the likelihood of multimorbidity.ConclusionThere is a substantial burden of multimorbidity among urban slum dwellers aged ≥ 65 years in India, strongly linked to modifiable risk factors like poor health literacy and social determinants of health. Targeted interventions are essential to alleviate this disproportionate burden among urban slum older adults.

Did the 1917–21 economic depression accelerate the epidemiological transition? Milk prices, summer peak of mortality, and food-and-water causes of death in Madrid, Spain

This article aims to answer a provocative question: would higher prices, particularly that of milk, be beneficial for the survival of children under 2 years old? Using a database of more than 230,000 births, matched to deaths, we test this hypothesis in the context of a large Mediterranean city, Madrid, in the years 1915–1926. During this period an inflationary crisis spread from 1917 to 1921. We compare child survival, the impact of milk price fluctuations, and the summer mortality peak, controlling for socio-spatial segregation and considering all-cause mortality and mortality due to food- and water-borne illnesses, before, during and after the economic depression. A positive association between increases in the milk price and better chances of survival is statistically robust, but only observed during depression. Several explanations are discussed.

Smoking and the Risk of Type 2 Diabetes: A Cross-sectional Analytical Study.

India is undergoing epidemiological transitions with the increase in noncommunicable disease (NCD) burden. Targeting the modifiable risk factors through lifestyle changes in the early years of life remains the most effective strategy for decreasing the prevalence of type 2 diabetes mellitus (T2DM). To determine the association between cigarette smoking and T2DM. An analytical cross-sectional study was conducted among the patients attending the outpatient department of a tertiary care teaching hospital in Kolkata, West Bengal, India. Patients aged more than 35 years were enrolled, and details regarding sociodemography, clinical status, and NCD risk factors were collected using pretested semistructured questionnaires after obtaining IEC approval. Data collected were entered in MS Excel and analyzed using SPSS software. Simple logistic regression and multivariable logistic regression analysis were used to calculate the crude and adjusted odds ratio with 95% confidence interval. Out of 434 participants, 37.3% had diabetes mellitus, 51.6% were males, and 28.6% had alcohol consumption. Univariate logistic regression analysis revealed age, BMI, systolic BP, diastolic BP, and cigarette smoking were significantly associated with increased risk of T2DM. Multivariable logistic regression analysis revealed cigarette smoking, systolic BP, age, and female gender were significant risk factors for T2DM. Our study reported cigarette smoking and systolic BP are modifiable risk factors associated with T2DM. Early identification of smoking through screening and appropriate control of hypertension in T2DM patients will decrease the morbidities and mortalities in T2DM cases.

Активное долголетие: дефиниция понятия, основные детерминанты и противоречия

Introduction. With the increasing share of elderly people in the population, shifting the focus of attention towards solving the problems of healthy longevity is one of the conditions for ensuring social, economic and geopolitical sustainability of modern society. However, despite the relevance of the issue, we can talk about the existence of a number of problems that reduce the effectiveness of the implementation of the active longevity policy and dictate the need for further theoretical and empirical research.The purpose of the article is to elaborate the definition of active longevity, analyze and systematize the main determinants affecting the increase in life expectancy and quality of life, and identify the key contradictions demonstrating the vulnerable nature of the concept of active longevity as a political, economic and social construct.Methodology. The methodology of the study is based on the concepts of active longevity, demographic, epidemiological and reverse epidemiological transitions, approaches considering active longevity specifics in male and female populations, the theory of demographic security and demographic well-being. To confirm the theoretical conclusions, a secondary analysis of the results of sociological research on this issue was used. The information base of the article was compiled by the official statistics of the United Nations and the Federal State Statistics Service.Results. To study the phenomenon of active longevity, the scientific literature uses concepts that affect various aspects of the well-being of elderly people and best meet the needs and/or challenges of a modern “aging" society.The whole set of factors of active longevity can be conditionally combined into three groups: macro-, meso- and micro-level factors. In the case of a society in a state of permanent transformation, socio-economic, political, cultural and historical factors, the state of ecology, the specifics of social structure and stratification, working and living conditions, and the development of social networks are decisive.An analysis of strategic regulatory documents at the international and Russian levels, adopted as part of the implementation of the active longevity strategy has demonstrated a shift in emphasis to considering the problems of population aging not as a demographic threat, but as a global process that provides new opportunities for realizing the potential of the population of older age groups and society as a whole.Conclusions. A conceptual understanding of the phenomenon of population aging in scientific and political discourse, including a shift in focus towards active longevity, opens up great prospects both for the elderly themselves and for the state interested in realizing the potential of older people, including for ensuring socio-economic, political and demographic security and sustainability.The classification of determinants of active longevity proposed in this article covers the entire set of macro-, meso- and micro-level factors and can be used to adjust active longevity strategies at the federal and regional levels.It is also important to take into account and resolve the contradictions that demonstrate the vulnerability of the concept of active longevity and require close attention from authorities, public structures and the scientific community.

Disease Prevention in a Communist State and the Second Epidemiological Transition: The Case of Post-war Poland

Abstract This article examines the issue of disease prevention in Poland under communist rule. The analysis is primarily focused on the second epidemiological transition – the process of displacing infectious diseases as the main cause of morbidity and mortality by chronic and degenerative conditions. The epidemiological transition coincided with the establishment of the new authorities and the stabilization of the socio-political order that the communists had introduced. This text will explore the interdependence of the political system and prophylaxis. Two interrelated problems are identified: the first is the role of the state in curbing infectious diseases; and the second is the ability of state institutions to identify and respond to new threats. The latter issue is considered in relation to the sharp rise in the incidence of cancer. This article demonstrates that the relationship between state and individual inherent in the authoritarian communist state was reflected in the ways in which prevention policies operated.

Rising Incidence of Inflammatory Bowel Disease in the Asian Subcontinent—An Exploration of Causative Factors

Inflammatory bowel disease (IBD), comprising ulcerative colitis (UC) and Crohn’s disease (CD), is a global health problem with a worldwide increase in incidence. While previously it was more prevalent in Western countries, especially in North America and Europe, there has been a recent sizeable increase in the incidence of IBD in Asia. This article is a brief overview of the causative factors that contribute to this rise in IBD cases in Asian countries. There is a notable disparity between the Asian IBD population and the Western one in terms of age distribution and gender predilection, and genetic studies reveal both shared and unique susceptibility loci. Changes in environmental factors, including alterations in diet, hygiene, and lifestyle, are thought to play a key role in the epidemiological transition observed in Asia. It is crucial to comprehend how genetic predisposition interacts with environmental factors in order to understand the causes of IBD in the Asian population and develop precise interventions to alleviate its impact.

Double malnutrition and associated factors in a middle-aged and older, rural South African population

IntroductionDouble malnutrition (co-existing overnutrition and undernutrition) is increasingly prevalent in sub-Saharan Africa due to rapid epidemiological and nutritional transitions. In this region, studies of double malnutrition have largely been conducted at country and household level, with individual-level studies primarily limited to children and women of reproductive age. We investigated the prevalence and determinants of individual-level double malnutrition in middle-aged and older adults who constitute an increasing proportion of the sub-Saharan African population.Methods250 individuals aged 40–70 years (50% women) and resident in the Agincourt Health and socio-Demographic Surveillance System in rural Mpumalanga province, South Africa, were randomly selected. Double malnutrition was defined as overweight/obesity and anaemia only, overweight/obesity and iodine insufficiency, or overweight/obesity and any micronutrient deficiency (anaemia and/or iodine insufficiency). The Chi-squared goodness of fit test was used to compare the expected and observed numbers of individuals with the type of double malnutrition. Logistic regression was used to investigate determinants of each type of double malnutrition.ResultsDouble malnutrition was present in 22–36% of participants, depending on the definition used. All types of double malnutrition were more common in women than in men (overweight/obesity and anaemia: 34% vs. 10.2%, p < 0.01; overweight/obesity and iodine insufficiency: 32% vs. 12.2%, p < 0.01 and overweight/obesity and any micronutrient deficiency: 50.5% vs. 20.4%, p < 0.01). There were no differences between the overall expected and observed numbers of individuals with combinations of overweight and micronutrient deficiencies [overweight/obesity and anaemia (p = 0.28), overweight/obesity and iodine insufficiency (p = 0.27) or overweight/obesity and any micronutrient deficiency (p = 0.99)]. In models adjusted for socio-demographic factors, HIV and antiretroviral drug status, and food security or dietary diversity, men were 84–85% less likely than women to have overweight/obesity and anaemia, 65% less likely to have overweight/obesity and iodine insufficiency and 74% less likely to have overweight/obesity and any micronutrient deficiency.ConclusionsIndividual-level double malnutrition is prevalent in middle-aged and older adults in a rural sub-Saharan African community. Interventions to improve nutrition in similar settings should target individuals throughout the life course and a focus on women may be warranted.

Caregiving for China’s one-child generation: a simulation study of caregiving responsibility and impact on women’s time use

IntroductionThe introduction, strict enforcement and recent exit of China’s one-child policy (OCP) resulted in China’s demographical changes, and, alongside its epidemiological transition, disproportionately impacted caregiving needs and demands on women....

Evaluation of trend and mortality pattern of communicable diseases in a teaching institution in Kerala.

Even in this era of epidemiologic transition communicable disease is still a major public health problem. Surveillance and timely prevention and control activities are the key to the reduction of morbidity and mortality of communicable diseases. Identifying the trend in communicable diseases and pattern of mortality for a period of ten years will be an insight into the ongoing surveillance. In this study we have analysed data from 2013 to 2022 to evaluate the trend and mortality pattern of communicable diseases in a teaching institution in Kerala. A retrospective record-based cross-sectional study conducted at the Department of Community Medicine, Government Medical College, Kottayam. All confirmed communicable disease cases reported from 2013 to 2022 were included in this study except COVID-19-positive cases. The communicable diseases were grouped as: airborne, waterborne, vector-borne, zoonosis, bloodborne diseases and others. SPSS version 20.0 software, Microsoft Word, and Excel were used in data handling and analysis. Total cases reported were 48124. The majority of the morbidity was due to airborne diseases (17585,37%) followed by waterborne diseases (6381, 13%). The total number of deaths reported was 1842. Airborne and zoonotic diseases together accounted for more than 50% of the mortality. Case fatality rate of zoonosis (20.2%) was the highest followed by bloodborne diseases (10.2%). Communicable diseases still continue as a public health problem contributing to morbidity and mortality. Airborne diseases and zoonotic diseases constitute the maximum mortality.

Genomic epidemiology of CVA10 in Guangdong, China, 2013–2021

Hand, Foot and Mouth Disease (HFMD) is a highly contagious viral illness primarily affecting children globally. A significant epidemiological transition has been noted in mainland China, characterized by a substantial increase in HFMD cases caused by non-Enterovirus A71 (EV-A71) and non-Coxsackievirus A16 (CVA16) enteroviruses (EVs). Our study conducts a retrospective examination of 36,461 EV-positive specimens collected from Guangdong, China, from 2013 to 2021. Epidemiological trends suggest that, following 2013, Coxsackievirus A6 (CVA6) and Coxsackievirus A10 (CVA10) have emerged as the primary etiological agents for HFMD. In stark contrast, the incidence of EV-A71 has sharply declined, nearing extinction after 2018. Notably, cases of CVA10 infection were considerably younger, with a median age of 1.8 years, compared to 2.3 years for those with EV-A71 infections, possibly indicating accumulated EV-A71-specific herd immunity among young children. Through extensive genomic sequencing and analysis, we identified the N136D mutation in the 2 A protein, contributing to a predominant subcluster within genogroup C of CVA10 circulating in Guangdong since 2017. Additionally, a high frequency of recombination events was observed in genogroup F of CVA10, suggesting that the prevalence of this lineage might be underrecognized. The dynamic landscape of EV genotypes, along with their potential to cause outbreaks, underscores the need to broaden surveillance efforts to include a more diverse spectrum of EV genotypes. Moreover, given the shifting dominance of EV genotypes, it may be prudent to re-evaluate and optimize existing vaccination strategies, which are currently focused primarily target EV-A71.

Assessing the Impact of Education on Life Expectancy in Rwanda

Purpose: Education's impact on life expectancy is a crucial area of study, particularly in nations undergoing rapid demographic and epidemiological transitions like Rwanda. This research examines the intricate relationship between education and life expectancy in Rwanda, considering the nation's advancements in education and healthcare. Despite progress, challenges persist in ensuring equitable access to quality education. Methodology: The study utilizes quantitative research methods, employing descriptive, correlation, and causal-comparative approaches, alongside econometric analyses like co-integration tests and vector error correction models. Data covering the period from 1965 to 2020 were collected from the World Bank Database. Findings: Findings indicate a significant effect of education on fertility rates, with higher education levels associated with lower fertility. Additionally, forecasts project an increase in life expectancy across educational groups, albeit less pronounced for the less educated. Gender disparities persist, with the rate of decrease in life expectancy differences between males and females slower than in previous decades. Increasing prediction intervals highlight growing uncertainty over time. Unique Contribution to Theory, Practice and Policy: The research contributes to understanding the complex interplay between education and life expectancy in Rwanda, offering insights for policy interventions to enhance population health outcomes and promote sustainable development. This study underscores the imperative for targeted strategies to mitigate educational barriers and advance inclusive development, addressing existing gaps in empirical evidence within the Rwandan context.

Holistic Approach in Strengthening of Primary Health Care Service

Holistic Approach in Strengthening of Primary Health Care Service

Proposed System of Integrated Geriatric and Disability Care Services in Sri Lanka (A Concept Note)

The global landscape is witnessing a significant transformation marked by a rapid increase in the aging population, driven by epidemiological and demographic transitions. Sri Lanka, like many other countries, is experiencing a significant demographic shift with an increase of older population. Notably, Sri Lanka stands out in South Asia, with 12.3% of its population aged 60 or older, the highest proportion in the region. Similar to other countries Sri Lanka also experiencing the increasing of elderly population. Sri Lanka is not geared to cater the elderly population and their needs as well as related health conditions, hence; it is the need in the current context. Objective of this paper is to propose a service delivery framework for elderly and related health care to the Sri Lankan health system based on the current findings. Methodology used are a desk reviews and key informant interviews to gather current data on elderly care and develop the model based on these findings. The development of geriatric health services in Sri Lanka is crucial to ensure that the growing elderly population receives the care and support they need to age healthily and maintain their quality of life. By addressing the unique healthcare challenges faced by the elderly, we can enhance the overall health and well-being of the elderly population in the nation.

ИЗМЕНЕНИЕ СТРУКТУРЫ И ФОРМ УЧЕТА ФАКТОВ ДЕТСКОЙ И МЛАДЕНЧЕСКОЙ СМЕРТНОСТИ В ЕЖЕГОДНОЙ ДЕМОГРАФИЧЕСКОЙ ОТЧЕТНОСТИ КРАСНОЯРСКОГО КРАЯ В 1959–1985 гг.

The paper examines the change in the forms and structure of recording infant and child mortality in the Krasnoyarsk Region in the period 1959–1985 based on annual reports on vital statistics in the context of changes in the demographic policy of the USSR. The hypothesis is that the problem of child and infant mortality was quite acute for the Soviet state, and in certain periods unsatisfactory indicators were perceived painfully, as a result of which the question of the accuracy and depth of accounting for demographic processes developing in the age group of children under one year old will be reflected in the forms and the structure of annual demographic reporting. A retrospective analysis of accounting forms clearly shows that over time, the development of medicine, methods and systems for recording demographic facts, statistical accounting of various aspects relating to the facts of child and infant mortality becomes more and more detailed and deep. Separate forms appear, devoted only to the issue of the circumstances of death of children under the age of one year or under the age of one month, and their share in the total volume of annual demographic reporting only grows over the years, which indicates the correctness of the initial hypothesis. It was also discovered that statistical authorities focused their attention on the demographic processes that took place among the indigenous peoples of the Far North, Siberia and the Far East, especially in the short period of 1963–1964. The author of the article presents his own conclusions based on what is presented in the main part of the material in relation to the theory of epidemiological transition.

The pioneers of Vietnam’s epidemiological transition: an ethnographic study of pregnant women’s experiences of gestational diabetes

ABSTRACT Background Gestational diabetes mellitus (GDM) is an abnormal glucose metabolism diagnosed during pregnancy that can have serious adverse consequences for mother and child. GDM is an exceptional health condition, as its management serves not only as treatment but also as prevention, reducing the risk of future diabetes in mother and child. Objectives This qualitative study aimed to explore how pregnant women experience and respond to GDM, focusing particularly on the role of the family environment in shaping women’s experiences. Methods The research was carried out in Vietnam’s Thái Bình province in April–May 2023. We conducted in-depth ethnographic interviews with 21 women with GDM, visiting them in their homes. Our theoretical starting point was phenomenological anthropology, and the data were analysed using a thematic analysis approach. Results At the centre of women’s experiences was the contrast between GDM as a biomedical and a social condition. Whereas GDM was biomedically diagnosed and managed in the healthcare system, it was often deemed insignificant or non-existent by family members. This made GDM a biomedically present but socially absent health condition. This paradox posed challenges to women’s GDM self-care, placing them in pioneering social positions. Conclusions The biomedical presence yet social absence of GDM turned women into pioneers at biomedical, digital, epidemiological, and family frontiers. This article calls for appreciation of pregnant women’s pioneering roles and for health systems action to involve women and families in the development of GDM policies and programmes at a time of sweeping global health changes.

Healthcare System Sustainability Challenges in Nepal and Opportunities Offered by Alternative Healthcare Delivery Arrangements.

The burden of chronic diseases in Nepal is increasing due to demographic and epidemiological transitions; alongside the persistent impact of communicable, maternal, newborn, and child health diseases, this critical situation acts as the precursor to rising healthcare costs. Nepal struggles to sustain its healthcare system amidst political instability, pandemics, natural disasters, and slow economic growth, particularly when healthcare funding is mainly dependent on out-of-pocket payments. Nepal requires lower-cost alternative healthcare delivery arrangements to provide high-value care while relieving economic sustainability pressures. Alternative healthcare delivery arrangements have a broad potential scope; they can involve strategic changes in how care is delivered and by whom, or they can also involve the application of information and communication technologies, e.g., telemedicine. This paper highlights the specific challenges to healthcare system sustainability in Nepal and the potential for high-value, lower-cost alternative healthcare delivery models to improve system performance in the longer term.

Factors affecting the participation and utilization of breast cancer screening services among health care workers Kolar: a qualitative study

Factors affecting the participation and utilization of breast cancer screening services among health care workers Kolar: a qualitative study