Main Non-communicable Diseases Research Articles

The economic cost of physical inactivity in China

ObjectiveTo estimate the total economic burden of physical inactivity in China. MethodThe costs of physical inactivity combine the medical and non-medical costs of five major Non Communicable Diseases (NCDs) associated with inactivity. The national data from the Chinese Behavioral Risk Factors Surveillance Surveys (2007) and the National Health Service Survey (2003) are used to compute population attributable risks (PARs) of inactivity for each major NCD. Costs specific to inactivity are obtained by multiplying each disease costs by the PAR for each NCD, by incorporating the inactivity effects through overweight and obesity. ResultsPhysical inactivity contributes between 12% and 19% to the risks associated with the five major NCDs in China, namely coronary heart disease, stroke, hypertension, cancer, and type 2 diabetes. Physical inactivity is imposing a substantial economic burden on the country, as it is responsible alone for more than 15% of the medical and non-medical yearly costs of the main NCDs in the country. ConclusionsThe high economic burden of physical inactivity implies the need to develop more programs and interventions that address this modifiable behavioral risk, in order to curb the rising NCDs epidemic in China.

Bidirectional Relationship between Chronic Kidney Disease & Periodontal Disease: A Review

Non communicable diseases (NCDs) affect the life of an individual in terms of mortality, morbidity and financial crises. Main NCDs are diabetes mellitus (DM), cardiovascular diseases (CVD), pulmonary diseases, osteoporosis and chronic kidney diseases (CKD). About 40% of the total deaths can be controlled by eliminating the risk factors for NCDs. Periodontitis have recently been labeled as an important potential risk factor for NCDs. CKD affect the oral health status of patients by inducing gingival hyperplasia, xerostomia, calcification of root canals and delayed eruption of teeth. Periodontitis increases systemic inflammatory burden leading to worsening of CKD which in turn has been has been found to negatively affect CKD of patients on hemodialysis therapy by altering their serum albumin and C-reactive protein levels. As hypoalbuminemia leads to increased mortality in CKD patients, it needs to be avoided by reducing systemic inflammatory burden in patients receiving HD therapy. Treating periodontal disease could be one factor that might decrease the systemic inflammatory burden and thereby improve quality of life of these patients. Sources of Data: Data from descriptive, cross sectional and longitudinal studies published between 2000 and 2012 were included. Data searches based on human studies only. Data Extraction: The key words, periodontitis, chronic kidney disease and hemodialysis, on MEDLINE, approximately 120 studies were identified. 35 of them were relevant to all three keywords. Most of them were cross sectional studies and total 7 clinical trials were identified regarding checking of serum levels after periodontal therapy with variable results. Conclusion: Patients with CKD have higher prevalence of periodontal disease while non-surgical periodontal therapy has been indicated to decrease the systemic inflammatory burden in patients with CKD specially those undergoing HD therapy.

Measuring progress on NCDs: one goal and five targets

Heads of states and governments made commitments to the prevention and control of non-communicable diseases (NCDs) in the Political Declaration from the UN High-level Meeting on NCDs in September, 2011.1 A key commitment in the Political Declaration calls upon WHO to develop a comprehensive global monitoring framework to assess progress in the implementation of national strategies and plans for the four main NCDs: cardiovascular diseases (CVD), diabetes, cancer, and chronic respiratory diseases.

Assessing research activity on priority interventions for non-communicable disease prevention in low- and middle-income countries: a bibliometric analysis

Introduction: Action is urgently needed to curb the rising rates of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) and reduce the resulting social and economic burdens. There is global evidence about the most cost-effective interventions for addressing the main NCD risk factors such as tobacco use, unhealthy diets, physical inactivity, and alcohol misuse. However, it is unknown how much research is focused on informing the local adoption and implementation of these interventions.Objective: To assess the degree of research activity on NCD priority interventions in LMICs by using bibliometric analysis to quantify the number of relevant peer-reviewed scientific publications.Methods: A multidisciplinary, multi-lingual journal database was searched for articles on NCD priority interventions. The interventions examined emphasise population-wide, policy, regulation, and legislation approaches. The publication timeframe searched was the year 2000–2011. Of the 11,211 articles yielded, 525 met the inclusion criteria.Results: Over the 12-year period, the number of articles published increased overall but differed substantially between regions: Latin America & Caribbean had the highest (127) and Middle East & North Africa had the lowest (11). Of the risk factor groups, ‘tobacco control’ led in publications, with ‘healthy diets and physical activity’ and ‘reducing harmful alcohol use’ in second and third place. Though half the publications had a first author from a high-income country institutional affiliation, developing country authorship had increased in recent years.Conclusions: While rising global attention to NCDs has likely produced an increase in peer-reviewed publications on NCDs in LMICs, publication rates directly related to cost-effective interventions are still very low, suggesting either limited local research activity or limited opportunities for LMIC researchers to publish on these issues. More research is needed on high-priority interventions and research funders should re-examine if intervention research is enough of a funding priority.

Cardiovascular Disease and the Changing Face of Global Public Health: A Focus on Low and Middle Income Countries

Eighty percent of the global 17 million deaths due to cardiovascular disease (CVD) occur in low and middle income countries (LMICs). The burden of CVD and other noncommunicable diseases (NCDs) is expected to markedly increase because of the global aging of the population and increasing exposure to detrimental lifestyle-related risk in LMICs. Interventions to reduce four main risks related to modifiable behaviors (tobacco use, unhealthy diet, low physical activity and excess alcohol consumption) are key elements for effective primary prevention of the four main NCDs (CVD, cancer, diabetes and chronic pulmonary disease). These behaviors are best improved through structural interventions (e.g., clean air policy, taxes on cigarettes, new recipes for processed foods with reduced salt and fat, urban shaping to improve mobility, etc.). In addition, health systems in LMICs should be reoriented to deliver integrated cost-effective treatment to persons at high risk at the primary health care level. The full implementation of a small number of highly cost effective, affordable and scalable interventions (“best buys”) is likely to be the necessary and sufficient ingredient for curbing NCDs in LMICs. NCDs are both a cause and a consequence of poverty. It is therefore important to frame NCD prevention and control within the broader context of social determinants and development agenda. The recent emphasis on NCDs at a number of health and economic forums (including the September 2011 High Level Meeting on NCDs at the United Nations) provides a new opportunity to move the NCD agenda forward in LMICs.

Commentary: Non-communicable diseases in sub-Saharan Africa: a new global health priority and opportunity

As part of the updated assessment of the Global Burden of Disease (GBD) study, the World Health Organization (WHO) has provided an overview of the global and regional levels and patterns of causes of death. Based on this assessment, it is estimated that nearly 59 million people died in the world during 2004. Of these deaths, 60% were due to noncommunicable diseases (NCDs) (i.e. Group II conditions), such as cardiovascular disease, diabetes, cancer and metabolic disorders. With only about one-third of the deaths due to communicable diseases, maternal and prenatal conditions and nutritional deficiencies (Group I conditions), there is increasing recognition of the importance of NCDs as a growing contributor of the GBD. Within sub-Saharan Africa, Group I conditions remain an important cause of deaths, although the contribution of NCDs is also increasing. In 2004, Group I conditions accounted for 62% of all deaths among adults aged 15–59 years in this region, whereas cardiovascular diseases, cancer and other Group II conditions contributed for about one-third of the deaths in this age group among both males and females. Within Group I conditions, HIV/AIDS was the main contributor of mortality, accounting for 35% of the overall adult deaths. Thus, if we exclude HIV/ AIDS, the contribution of remaining Group I conditions to the burden of diseases in sub-Saharan Africa is comparable with that of NCDs, which are becoming a significant public health problem in the region. Similar trends have been observed in other lowas well as middle-income countries which, when taken together, are projected to account for 80% of all global deaths due to NCDs by the year 2030. The increasing burden of NCDs in lowand middle-income countries previously dominated by infectious and other Group I conditions suggests that a major epidemiological transition is taking place in these settings. However, the precise burden of NCDs and other chronic conditions, as well as the rate of occurrence of associated morbidity and mortality in most countries remains unknown. This is particularly true in sub-Saharan Africa where health facilities are under-resourced and accurate information about chronic diseases is lacking. In addition, only few patients with NCDs seek medical services, and limited research has been conducted to determine the burden of NCDs and the distribution of potential risk factors in various geographical locations. To help fill this gap in our knowledge, Dalal et al. report in this issue of the IJE a comprehensive review of literature on the burden of NCDs as contributors of morbidity and mortality, as well as the prevalence of associated risk factors. As part of this publication, they searched the PubMed database and included community-based studies conducted in any subSaharan African country, published in English, and reported on the burden or risk factors for four main NCDs: heart diseases, stroke, diabetes mellitus type 2 and cancer. They also analysed publicly available data sets on estimated and projected causes of death from the WHO GBD and the International Agency for Research on Cancer (IARC). The findings of this report provide important insights on the epidemiology of NCDs in Africa and associated risk factors. Overall, NCDs were relatively common in the studies reported, indicating that they are a major public health priority in sub-Saharan Africa. These results confirm that Africa is facing an emerging epidemic of NCDs, which is overlapping with the ongoing burden of infectious diseases. The prevalence of specific conditions and associated risk factors varied from one country to another and also within the same country, indicating that the burden Published by Oxford University Press on behalf of the International Epidemiological Association

Creating a 21st Century Global Health Agenda

On May 13, 2010, the General Assembly of the United Nations (UN) voted unanimously for UN Resolution 64/265 to hold a High Level Meeting on Non-Communicable Diseases in September 2011. This UN High Level Meeting, to be held in New York, is an unparalleled opportunity to put noncommunicable diseases (NCDs), including cancer, diabetes mellitus, cardiovascular disease, stroke, and chronic respiratory disease, on the global health and development agenda. It also has the potential to secure political commitments from heads of government for a coordinated global response to NCDs, to promote multisectoral action to addressing NCDs within countries, and to ensure that resource allocations for addressing NCDs are more commensurate with their contribution to the global disease burden. Such actions will provide the urgent and necessary momentum to dramatically improve the prevention and management of NCDs for future generations. Our 3 organizations, as well as other partners, are working together to maximize the impact of this meeting. The world can no longer afford to ignore the ever-expanding global social and economic threat posed by chronic diseases. NCDs account for >60% of all deaths globally, and the overall burden of chronic diseases continues to grow.1 By 2030, it is estimated that NCDs will be responsible for 7 in 10 deaths worldwide.2 In addition to the human toll, the economic impact of chronic disease is staggering and will continue to rise. The World Health Organization estimates that the cumulative estimated national income losses attributable to chronic disease from 2005 to 2015 could exceed $1 trillion in just 3 countries: China ($558 billion), Russia ($303 billion), and India ($237 billion).1 Moreover, the chronic disease mortality burden is heaviest in less affluent nations. Of the world's roughly 35 million annual deaths attributable to NCDs, ≈80% occur in low- and middle-income countries.3 …

Clinical usage of hypolipidemic and antidiabetic drugs in the prevention and treatment of cancer

Factors predisposing hormone-dependent tissues to the development of tumors coincide, at least partly, with hormonal-metabolic promoters (like insulin resistance, glucose intolerance, visceral obesity, etc.) of other main non-communicable diseases. This important knowledge poses the question of whether the same approach which is applied for prevention/treatment of a metabolic syndrome and the associated endocrine disorders might also be used in preventive and therapeutic oncology. Whereas an answer to this question remains controversial and is based mainly on experimental evidence, there is accumulating clinical data suggesting a practical significance of such a strategy, even though it is not to be considered as directly cytostatic. Among the many drugs under discussion, three groups of medicines (statins, antidiabetic biguanides, and thiazolidinediones) are the most attractive. The concept of metabolic rehabilitation is proposed and used practically in an adjuvant setting for the correction of the above-mentioned endocrine-metabolic disorders commonly found in cancer patients. The current use and aim of this approach is to improve the survival of patients and limit cancer progression. Nonetheless, it also appears potentially useful as a neoadjuvant therapy as well as a prophylactic treatment earlier in life for specific groups of people with hormone-associated enhanced oncological risk. It seems possible that certain hypolipidemic and antidiabetic medicines with pleiotropic effects might be combined with traditional antisteroid prevention/therapeutic approaches in routine clinical situations as well as for overcoming resistance to standard cancer hormonal therapies including receptor-negative cases. Characteristic at the end of the 20th and at the beginning of the 21st century is an epidemic of diabetes and obesity, which might further increase the incidence of certain cancers. This makes it timely to apply hypolipidemic and antidiabetic drugs (in combination with reasonable dieting, increased physical fitness, and an in-depth knowledge of drug-gene interactions) as an approach warranting further study.

日本衛生学雑誌第15巻第4号 正誤表

日本衛生学雑誌第15巻第4号 正誤表

Analysis of deaths due to main noncommunicable diseases in communities of an area with mild climate

Analysis of deaths due to main noncommunicable diseases in communities of an area with mild climate