Management Of Chronic Non-communicable Diseases Research Articles

Assessment of Health Education in The Prevention of Non-Communicable Chronic Disease Complications: Systematic Review

Objective: To evaluate the effectiveness of health education in the prevention of non-communicable chronic diseases. Method: This is a systematic literature review, guided by the question "In patients with non-communicable chronic diseases (NCDs), does health education compared to conventional clinical practice contribute to the prevention of complications?". The selected articles were extracted from the following databases: Biblioteca Virtual em Saúde (BVS), National Library of Medicine (PUBMED), Scientific Electronic Library Online (Scielo), Regional Online Information System for Scientific Journals from Latin America, the Caribbean, Spain, and Portugal (Latindex), and Cochrane Library. Randomized clinical trials in English, Portuguese, and Spanish from the last 10 years with full-text availability were chosen as eligibility criteria, resulting in a final sample of 10 articles. Results: Positive findings were observed regarding the complications of non-communicable diseases, such as: improvement in quality of life and cardiac anxiety scores; reduction in anxiety and depression; increased therapeutic adherence, diabetic foot care, physical activity stimulation, adoption of healthy eating habits, blood glucose self-monitoring and health literacy improvement; reduction in systolic and diastolic blood pressure; improvement in self-management of Type 2 Diabetes Mellitus; overall prevention of NCDs; promotion of motivation for behavioral change in smoking patients, and improvement in renal function with a considerable decrease in serum creatinine and a stable glomerular filtration rate. Implementing educational programs can be helpful in enhancing the quality of life in chronic diseases. Conclusion: Despite the limitation resulting from the diversity of interventions, the consistency in results highlights the beneficial impact of educational approaches, calling for attention from healthcare professionals and public policymakers to expand the use of these strategies in the management of NCDs.

People and sites as community resources for preventing and managing chronic health conditions: A conceptual analysis.

The prevention and management of chronic non-communicable diseases (NCDs) require community-based efforts-especially as their burden grows, and recognition of the need for engaging diverse stakeholders in care grows. The aim of this conceptual analysis was to categorise existing community resources (people and sites) used to support such efforts, the mechanisms by which they work, and the conditions that constrain their effectiveness. We developed an initial framework for categorising community resources. We then used a sample of the literature- 24 studies from 12 countries-to refine and enrich the framework. We identified seven categories of sites ('where': House, Meeting place, Community health centre, Primary health care centre, Mobile clinic, Pharmacy, and Hospital) and ten categories of people ('who': Community Health Worker, Nurse/Midwife, Health educator, Physician, Primary Health Care Worker, Peer Group, Navigator, Pharmacist, Cultural Advisor, Family caregiver). We identified eight mechanisms through which those resources improve NCD prevention and management: Context specific engagement, Personalised and integrated care, Community health worker led knowledge dissemination, Social support through family and/or friends, Extending the reach of the health system, Social support through peer groups, Task shifting, and Training of health workforce. We identified two broad categories of constraints on these mechanisms: (i) health system barriers such as inadequate workforce, training, coordination and engagement; and (ii) socio-economic, political, and cultural barriers to care. The conceptual categories (of people and sites as resources, the mechanisms through which they work and the contextual constraints on their effectiveness) identified in this analysis may be useful in further analysing current approaches in NCD efforts using community resources, in informing the development of community-based efforts, and in exploring the commonalities and transferable insights between different locations or settings around the world and between different efforts to prevent and manage NCDs within communities.

Management of chronic non-communicable diseases: qualitative study of the practices and challenges in the Volta Region, Ghana

Management of chronic non-communicable diseases: qualitative study of the practices and challenges in the Volta Region, Ghana

Prevalence of non-communicable disease among displaced Rohingya in southern Bangladesh: a first look at a persecuted ethnic minority from Myanmar.

In Cox's Bazar, Bangladesh, 860 356 Rohingya living in refugee camps have experienced decades of persecution. Little is known about disease burden in this population. A retrospective review of deidentified electronic health records (EHR) of 51 270 Rohingya attending two primary health clinics in Kutupalong and Balukahli from October 2017 to October 2019 was performed. A novel EHR system named NIROG was used for patients' medical records'. Females comprised 53.8% of patients. The median age of females was 25 y and for males it was 19 y. Prevalence of adult hypertension and diabetes was 14.1% and 11.0%, respectively. Also, 16.6% of children aged <5 y had moderate or severe acute malnutrition, while 36.6% were at risk of malnutrition. Body mass index (BMI) analysis showed that 34.4% of adults were underweight. Females were more likely to be hypertensive, diabetic, overweight/obese and malnourished. BMI had a statistically significant positive correlation with fasting blood glucose levels and systolic blood pressure. The use of a portable EHR system was highly effective at providing longitudinal care in a humanitarian setting. Significant proportions of the adult population appear to have hypertension or diabetes, pointing to a critical need for management of chronic non-communicable diseases (NCDs). The findings of the current study will help stakeholders to plan effective prevention and management of NCDs among displaced Rohingya and other displaced populations.

2.F. Workshop: Innovations for chronic diseases management: complementing usual care with digital therapeutics

Abstract The management of chronic non-communicable diseases (NCDs), including both physical and mental disorders, remains a pressing global health challenge in high-income countries and low-resource settings. Digital health technology, also known as eHealth, could help improve the management of chronic diseases, in the post-pandemic era, by facilitating data exchange between patients and health professionals. Specifically, digital therapeutics, which utilize technology to deliver evidence-based interventions, have demonstrated potential to complement traditional care approaches and improve outcomes for patients with chronic NCDs. The proposed joint workshop, organized by two EPH sections (chronic disease and digital health and communication), will provide four presentations on innovative approaches to improve the management of major chronic disease, with focus on digital health technologies, which can provide alternative cost-effective options in both high-income countries and low-resource settings. The workshop will explore how digital therapeutics can enhance the management of chronic NCDs, such as diabetes and common mental disorders among others, by complementing existing healthcare practices. The selected speakers are international leaders in the field and will represent different geographic contexts within Europe (Malta, Italy, and Switzerland) and North America (Canada). Key messages • Digital health technologies can provide alternative cost-effective options in chronic disease management. • Digital therapeutics can enhance the management of chronic NCDs by complementing existing healthcare practices.

Nutritional quality, glycemic index and glycemic load of two similar traditional diets consumed in Northeast, Nigeria

Glycemic index (GI) and glycemic load (GL) have been implicated in the development and progression of chronic non communicable diseases (NCDs) and WHO has recommended dietary approach in its management. This study was conducted to assess the nutritional composition of two varieties of Danwaken; fulawa and dawa which are traditional diets consumed in Bauchi and Gombe states with a view to ascertaining its GI in the management of chronic NCDs. Proximate, amino and fatty acids compositions of the Danwake varieties were analyzed using standard procedures. Eighty volunteers were recruited from Bauchi and Gombe metropolitan areas and feed with 50 g of test and reference foods (white bread) and GI was determined by trapezoid method. Danwaken fulawa had a significantly higher moisture and carbohydrate content (p&lt;0.05) and lower protein content compared to Danwaken dawa. Total amino acids and essential amino acids in Danwaken dawa (912, 367 mg/g protein) were higher than Danwaken fulawa (854, 294 mg/g protein) respectively, with higher limiting amino acid score compared with WHO/FAO/UNU requirements except lysine. Both diets had no essential fatty acids with high GI and GL, although Danwaken fulawa had a higher GL value which was significantly different (p&lt;0.05).

Construct Validity of a Questionnaire on Eating and Physical Activity Habits for Adolescents in Mexico City.

The assessment of eating and physical activity habits is an important step in promoting healthy behaviors among the adolescent population and is key in the prevention and management of chronic non-communicable diseases, such as obesity, diabetes, and cardiovascular disease. For this purpose, reliable and valid measuring instruments are essential. In this context, the aim of this article is to present the validation of a self-report questionnaire on eating and physical activity habits among adolescents in Mexico City. In order to validate the questionnaire, a cross-sectional study was conducted with a sample of 2710 adolescents between 11 and 12 years of age, the piloting of the questionnaire was carried out in September 2022 with a focus group, and the programming of the anthropometric measurements was established with the Federal Educational Authority of CDMX, as well as the application of the questionnaire to 33 schools, with these activities being scheduled from 7 November 2022 to 3 February 2023 and having an application duration of 15-25 min for each of the groups to which it was applied; the questionnaire that was applied consists of 31 questions that refer to the frequencies, quantity, or performance of behaviors related to the frequency and type of food, type of physical activity and behaviors related to the act of eating referring to the place where it is carried out (home or away from home) and with whom it is carried out (alone or in company), and about the individual's lifestyle. Subsequently, the reliability of the instrument was evaluated using Cronbach's alpha coefficient, and an exploratory factor analysis was conducted to determine the structure of the questionnaire. The results obtained showed that the questionnaire was adequately reliable (α = 0.778) with an eight-factor structure: four questions on mealtime frequencies, four questions on physical activity and lifestyles, six questions on the consumption of high-calorie foods, four questions on company and food consumption, four questions on the consumption of vegetables and fruits, four questions on the place of food consumption, two questions on the consumption of alcoholic beverages, and three questions on the consumption of sugary drinks, plain water, and milk. In conclusion, the self-report questionnaire on eating and physical activity habits among adolescents in Mexico City is reliable, has adequate internal consistency, and can therefore be used as a useful tool for the evaluation of eating and physical activity habits in this population.

Management of chronic non-communicable diseases in Ghana: a qualitative study of patients’ coping strategies and the role of caregivers

BackgroundChronic Non-Communicable Diseases (CNCDs) has become a major cause of mortality and disability globally. We explored the coping strategies adopted by CNCD patients and the roles of caregivers in the management of CNCDs in Ghana.MethodsThis was a qualitative study that adopted an exploratory design. The study was carried out at the Volta Regional Hospital. Purposive convenience sampling procedures were used to sample patients and caregivers. Data for the study were collected using in-depth interview guides. Data were collected among 25 CNCDs patients and 8 caregivers and analysed thematically using ATLAS.ti.ResultsPatients adopted a variety of strategies to cope with their condition. These strategies were emotion-oriented coping, task-oriented coping, and avoidance-oriented coping. Family members were the main caregivers, who provided social and financial support for patients. Financial challenges, inadequate family support, poor attitudes of health workers, delays at the health facility, unavailability of drugs at the facility, and patients’ non-adherence to the medical advice were major challenges that militated against caregivers’ efforts in supporting patients in the management of their CNCDs.ConclusionWe found that patients adopted various strategies to cope with their conditions. The roles of the caregivers in supporting patients in the management practices were identified as very important as they contribute immensely to the financial and social support for the patients in their management of CNCDs. It is crucial that health professionals actively involve caregivers in every aspect of the day-to-day management of CNCDs as these caregivers spend more time with these patients and understand them better.

Circulatory System Diseases. Problems of Management

This paper aims to give a comprehensive account of the management of patients with diseases of the circulatory system, the main focus has been shifted to primary health care. We assume that the quality of life of patients with diseases of the circulatory system will improve significantly with the involvement of specialists from multidisciplinary teams in their management. It is important to avoid stereotyping in relation to specialists - to patients, providing the patients with complete assistance of their main diagnosis. Particular interest of functioning models for the management of chronic noncommunicable diseases, as well as individual components of such models that have been successfully implemented in other countries, not only at the level of hospital care, but also at the level of primary health care facilities. Great importance is given to the possibility of implementing the components of models for the management of chronic noncommunicable diseases with the existing resources of primary health care facilities. To expand the resource of facilities allows the involvement in the direct care and management of patients with diseases of the circulatory system, both the patients themselves and their close relatives, and nursing staff with the proper level of joint responsibility for the health of patients.

The WW‐FINGERS‐SARS‐CoV‐2 initiative: a multinational survey to assess the effects of the COVID‐19 Pandemic on Lifestyle and Psychosocial factors relevant to Brain Health

AbstractBackgroundglobal population aging and forecasted trends of modifiable risk factors for dementia and Alzheimer’s disease (AD) make prevention of these conditions an urgent priority. The World‐Wide FINGERS (WW‐FINGERS) global network of multidomain trials for dementia risk reduction and prevention is at the forefront of efforts to find effective and sustainable solutions for diverse population. The COVID‐19 pandemic has caused changes in the mental and physical health of older adults, which can influence dementia risk and prevention opportunities.MethodsThe WW‐FINGERS‐SARS‐CoV‐2 survey was developed to assess direct and indirect effects of the COVID‐19 pandemic in older adults. The questionnaire measures changes in lifestyle factors (e.g., diet, physical activity), management of chronic noncommunicable diseases (e.g., diabetes, hypertension), and psychosocial factors ‐including depressive symptoms, sleep disorders, social isolation‐ that are relevant to cognition. Both a pen‐and‐paper and a digital version of the survey have been developed in several languages. The digital version is supported through REDCap (Research Electronic Data Capture), which is used also for harmonized data collection.Results30 countries are participating in the survey. As for January 2022, data have been collected from 20 countries, with 23000+ participants. Local adaptations and piloting were done to optimize implementation in clinical‐based and population‐based settings. Participants are in the at‐risk spectrum for dementia: from normal cognition to pre‐dementia cognitive symptoms. Timing of the survey implementation varies across populations, allowing to capture short, medium and long‐term effects of the pandemic and restrictions measures. Some countries have used the survey to recruit participants in multimodal prevention trials. An updated report of the survey status and main results will be presented.ConclusionThe WW‐FINGERS‐SARS‐CoV2 survey is a joint global action of the WW‐FINGERS network which can inform better care of older adults in the context of a pandemic. The survey is also a valuable tool for pre‐screening of participants for prevention trials, and results can inform adaptions to ensure successful recruitment and adherence in forthcoming multidomain trials for dementia prevention in older adults.

Applications of Medical Digital Technologies for Noncommunicable Diseases for Follow-Up during the COVID-19 Pandemic.

Background: Noncommunicable chronic diseases (NCDs) are multifaceted, and the health implications of the COVID-19 pandemic are far-reaching, especially for NCDs. Physical distancing and quarantine can lead to the poor management of NCDs because the visual tracking of them has been replaced with medical digital technology, that is, smartphone apps. This study aimed to explore medical digital technology applications for NCDs for follow-up during the COVID-19 pandemic. Methods: The participants in this study were 400 adult patients with NCDs; they were selected by systematic random sampling. A descriptive cross-sectional design was used. The study was conducted in the outpatient department of Yanbu General Hospital and primary-care health centers in Yanbu Al-Baher, Al-Madinah Al-Munawwarah, in the Kingdom of Saudi Arabia. The tools used in this study were a structured questionnaire to collect the sociodemographic characteristics of the patients and their health history, an NCD questionnaire to assess follow-up of the patients during the COVID-19 pandemic, and a medical digital technologies questionnaire to explore the medical digital technology applications. Results: The mean age of the patients was 47.32 ± 14.362 years, and 62.8% of them were female and 372 were male. Of the patients, 69.2% and 57.5% had been diagnosed with diabetes mellitus and hypertension, respectively; 52.4% were followed up monthly, and 29.75% used medical digital technology applications such as Tabeby Online to monitor their health. Furthermore, 71.75% and 75.5% of the patients used the Sehhaty and Tawakkalna medical digital applications, respectively. Overall, 38.7% of the patients were satisfied with using medical digital technology applications used for follow-up during the COVID-19 pandemic. Conclusions: The study concluded that the services that use networks, smartphones, and medical digital technology applications on the Saudi Ministry of Health website and mobile applications to improve the quality of the health-care system, and that provide health services for noncommunicable or communicable diseases, are not effective. This is because the patients lack awareness of these services, with most of the chronic patients being elderly with lower levels of education and computer literacy.

Improving Management of Non-communicable Chronic Diseases in Primary Healthcare Centres in The Saudi Health Care System

Evaluation of patient perceptions of quality and adequacy of care is a critical component of continuous improvement in chronic disease care. The purpose of this study was to ascertain how patients with non-communicable diseases (NCDs) assess their routine care in primary care centres in Saudi Arabia and to identify areas for improvement. This cross-sectional study used the PACIC questionnaire to assess the quality of care received by these patients in primary care centres in Saudi Arabia. Data collection took place between May 2019 and July 2019. The questionnaire was self-completed anonymously by 315 patients with NCD attending primary health care centres in Riyadh, Saudi Arabia. The results showed that the average overall PACIC score was 2.97 (SD = 0.65), the mean scores for the subscales ranged from 2.76 (SD = 0.78) for the subscale of goal settings/tailoring to 3.17 (SD = 0.78) for delivery system design/decision support. PACIC scores varied significantly with age, occupation, monthly income, type and duration of chronic illness and educational attainment. In conclusion, patients with NCDs prioritised improvements in organised care that; is comprehensive, focussed on their needs, helps them identify clear goals for their treatments and become more involved in their condition(s) management.

Remote patient monitoring for chronic heart failure in France: When an innovative funding program (ETAPES) meets an innovative solution (Satelia® Cardio).

IntroductionRemote patient monitoring (RPM) is a telehealth activity to collect and analyze patient health or medical data. Its use has expanded in the past decade and has improved medical outcomes and care management of non-communicable chronic diseases. However, implementation of RPM into routine clinical activities has been limited. The objective of this study was to describe the French funding program for RPM (known as ETAPES) and one of the RPM solution providers (Satelia®) dedicated to chronic heart failure (CHF).MethodsA descriptive assessment of both the ETAPES funding program and Satelia® RPM solution was conducted. Data were collected from official legal documents and information that was publicly available online from the French Ministry of Health.Results and DiscussionETAPES was formally created in 2016 based on previous legislation pertaining to the national health insurance funding strategy. However, it only started to operate in 2018. Patients with CHF were only eligible if they were at medium or high risk of re-hospitalization with a New York Heart Association (NYHA) score superior or equal to two and a BNP>100 pg/ml or NT pro BNP>1000 pg/ml. Medical monitoring was supported through the therapeutic education of a patient on the RPM model of care with a minimum of three training sessions during the first six months. The use of Satelia® Cardio is noteworthy since it relies only on symptomatic monitoring through which the patient manually reports their information by answering a simple questionnaire on a regular basis and does not rely on any connected devices.ConclusionInnovative funding programs and solutions for RPM need real-world evaluation in the future.

The WW‐FINGERS‐SARS‐CoV2 initiative: Impact of the COVID‐19 pandemic on brain health and prevention strategies

BackgroundOlder adults have higher risk of cognitive impairment and dementia, and they also represent the group most severely affected by the SARS‐CoV‐2 (COVID‐19) pandemic in terms of higher morbidity and mortality. The World‐Wide FINGERS (WW‐FINGERS) global network of multidomain trials for dementia risk reduction and prevention (Kivipelto et al., 2020) provides a unique framework to explore how the pandemic has affected factors related to mental and physical health of populations at increased risk of dementia, while accounting also for country‐specific strategies to contain the spread of the infection.MethodsThe WW‐FINGERS‐SARS‐CoV2 survey has been developed to explore direct and indirect effects of the pandemic in midlife and older age. The questions aim to measure changes in lifestyle factors (e.g., diet, physical activity), management of chronic noncommunicable diseases (e.g., diabetes, hypertension), as well as psychosocial factors ‐ including depressive symptoms, sleep disorders, social isolation ‐ that are relevant to cognition and are expected to be affected by the pandemic. The survey measures also established and possible epidemiologic risk factors for severe COVID‐19. To facilitate distribution is different settings, both a pen‐and‐paper and a digital version of the survey have been developed in several languages. The digital version is supported through REDCap (Research Electronic Data Capture), a secure web‐based software that is being also used for harmonized data collection.ResultsOver 25 countries are taking part in the survey. Local adaptations and piloting are being done to optimize implementation in both clinical‐based and population‐based settings. Participants are in the at‐risk spectrum for dementia: from cognitively normal persons to individuals with pre‐dementia cognitive symptoms. An updated report of the survey status will be presented.Conclusionthe survey is a joint global action of the WW‐FINGERS network which can inform better care of older adults in the context of a pandemic. The survey is also a valuable tool for pre‐screening of participants for prevention trials, and results can inform adaptions to ensure successful recruitment and adherence in forthcoming multidomain trials for dementia prevention in older adults.

Management of chronic non-communicable diseases in Ghana: a qualitative study\xa0using the chronic care model

BackgroundWhile the burden and mortality from chronic non-communicable diseases (CNCDs) have reached epidemic proportions in sub-Saharan Africa (SSA), decision-makers and individuals still consider CNCDs to be infrequent and, therefore, do not pay the needed attention to their management. We, therefore, explored the practices and challenges associated with the management of CNCDs by patients and health professionals.MethodsThis was a qualitative study among 82 CNCD patients and 30 health professionals. Face-to-face in-depth interviews were used in collecting data from the participants. Data collected were analysed using thematic analysis.ResultsExperiences of health professionals regarding CNCD management practices involved general assessments such as education of patients, and specific practices based on type and stage of CNCDs presented. Patients’ experiences mainly centred on self-management practices which comprised self-restrictions, exercise, and the use of anthropometric equipment to monitor health status at home. Inadequate logistics, work-related stress due to heavy workload, poor utility supply, and financial incapability of patients to afford the cost of managing their conditions were challenges that militated against the effective management of CNCDs.ConclusionsA myriad of challenges inhibits the effective management of CNCDs. To accelerate progress towards meeting the Sustainable Development Goal 3 on reducing premature mortality from CNCDs, the Ghana Health Service and management of the respective hospitals should ensure improved utility supply, adequate staff motivation, and regular in-service training. A chronic care management policy should also be implemented in addition to the review of the country’s National Health Insurance Scheme (NHIS) by the Ministry of Health and the National Health Insurance Authority to cover the management of all CNCDs.

Health behavior patterns of sugar-sweetened beverage consumption among Brazilian adolescents in a nationally representative school-based study.

Studies on sugar-sweetened beverage consumption patterns can help in the individual and population level management of chronic non-communicable diseases and other conditions. This study aimed to identify the association between health behavior patterns and the consumption of sugar-sweetened beverages among Brazilian adolescents from a nationally representative school-based study. A cross-sectional study analyzed data from 71,553 adolescents aged 12–17 years who attended public and private schools in Brazilian cities, from the Study of Cardiovascular Risk in Adolescents. Principal component analysis was performed to identify health behavior patterns, and ordered logistic regression was performed to identify the association between health behavior patterns and sugar-sweetened beverage consumption. Sugar-sweetened beverage consumption (mL/day) was used as the dependent variable. The analyses were performed using Stata software version 14.0 with a significance level of 0.05. Patterns 2 (alcoholic beverage and smoking habit) and 3 (ultra-processed food and screen time) of health behaviors and regularly purchasing snacks in the school cafeteria increased the odds of sugar-sweetened beverage consumption, while pattern 1 (water, unprocessed and minimally processed food and physical activity) decreased these odds. The adoption of healthy habits can indirectly stimulate the adoption of other habits beneficial to health. These results indicate the importance of adopting a set of regulatory measures to reduce sugar-sweetened beverage consumption.

Management Of Chronic Noncommunicable Diseases After Natural Disasters In The Caribbean: A Scoping Review.

Extreme weather events in the Caribbean region are becoming increasingly severe because of climate change. The region also has high rates of poorly controlled chronic noncommunicable diseases (NCDs), which were responsible for at least 30percent of deaths after two recent hurricanes. We conducted a scoping review of literature published between 1974 and 2020 to understand the burden and management of chronic NCDs in the Caribbean after natural disasters. Of the twenty-nine articles included in this review, most described experiences related to Hurricanes Dorian (2019) and Irma and Maria (2017) and the Haiti earthquake (2010). Challenges included access to medication, acute care services, and appropriate food, as well as communication difficulties and reliance on ad hoc volunteers and outside aid. Mitigating these challenges requires different approaches, including makeshift points of medication dispensing, disease surveillance systems, and chronic disease self-management education programs. Evidence is needed to inform policies to build resilient health systems and integrate NCD management into regional and national disaster preparedness and response plans.

Implications of COVID-19 for the management of chronic non-communicable diseases in sub-Saharan Africa: application of the chronic care model.

About 41 million people die of chronic non-communicable diseases (CNCDs) each year, accounting for 71% of all global deaths. The high prevalence of CNCDs is particularly problematic for sub-Saharan Africa (SSA) since CNCDs are already a major cause of mortality in the sub-region. While the case fatality rate of COVID-19 is quite low, it is worth noting that people with underlying CNCDs constitute the majority of those who die from this virus. Underpinned by the chronic care model (CCM), we present a commentary on the implications of COVID-19 for the management of CNCDs in SSA. We realized that despite the World Health Organisation’s guidelines for countries to maintain essential services while putting necessary measures in place to prevent and control the spread of COVID-19, myriad of health systems and community-level factors militate against effective management of the CNCDs in SSA. This results in disruptions in management of the conditions as well as possible long-term effects such as the deterioration of the health status of CNCD patients and even deaths. Without immediate interventions to salvage the status quo, SSA countries may not be able to achieve the Sustainable Development Goal 3.4 target of reducing by one-third, premature mortality from CNCDs by the year 2030. We recommend that financial constraints could be ameliorated through short- and long-term loan facilities from the International Monetary Fund and the World Bank to augment national efforts at strengthening health systems while combating COVID-19. We also recommend increased community engagement and public education by COVID-19 response teams to enhance community support for persons living with CNCDs and to reduce social stigmatization

Improving antioxidant and anti‐hyperglycemic activity in cereal and apple‐based food formulations using bioactive ingredients from apple peel

Edible ingredients derived from phenolic bioactive enriched fruits such as apple can be integrated into food formulations to improve overall human health-relevant functionalities. High phenolic bioactive enriched apple peels were used as a source of dehydrated edible ingredients for formulating cereal-based muffin and apple puree. Prior to utilizing in food formulations, proximate composition, dietary fiber, mineral composition, and phenolic-linked antioxidant activity of the source material, and apple peel dehydrated (APD) powder were evaluated. Furthermore, chemical composition, phenolic-linked antioxidant, anti-hyperglycemic properties (α-amylase and α-glucosidase enzyme inhibitory activities), and sensory properties of the formulated food, muffin, and apple puree, with and without APD powder integration were determined. Total phenolic content, dietary fiber content, total antioxidant activity, and anti-hyperglycemic properties increased with the incorporation of APD powder, specifically in muffin. These results suggested that the APD powder can be rationally utilized as edible ingredients to improve overall nutritional qualities, especially for type 2 diabetes-linked benefits. Practical applications The practical application of this study is to optimize the processing strategy (selection of the anti-browning agent and hot air drying process) for improving the stability and retention of human health-promoting phenolic bioactives and associated antioxidant and anti-hyperglycemic functionalities in apple peel dehydrated (APD) powder. Additionally, phenolic bioactive enriched APD was integrated as high-value edible ingredients in common cereal-based food formulation (muffin) and apple puree to improve overall type 2 diabetes-relevant benefits linked with anti-hyperglycemic and antioxidant properties. This innovation can be advanced to design novel cereal-based food formulations by integrating phenolic bioactive enriched edible ingredients derived from fruits and vegetables for improved nutritional and health benefits targeting dietary prevention and management of non-communicable chronic diseases, such as type 2 diabetes.

Nonmedical Factors and Health-Related Quality of Life in CKD in India.

Patient-reported outcomes have gained prominence in the management of chronic noncommunicable diseases. Measurement of health-related quality of life is being increasingly incorporated into medical decision making and health care delivery processes. The Indian Chronic Kidney Disease Study is a prospective cohort of participants with mild to moderate CKD. Baseline health-related quality of life scores, determined by the standardized Kidney Disease Quality of Life 36 item instrument, are presented for the inception cohort (n=2919). Scores are presented on five subscales: mental component summary, physical component summary, burden, effect of kidney disease, and symptom and problems; each is scored 0-100. The associations of socioeconomic and clinical parameters with the five subscale scores and lower quality of life (defined as subscale score <1 SD of the sample mean) were examined. The main socioeconomic factors studied were sex, education, occupation, and income. The key medical factors studied were age, eGFR, diabetes, hypertension, and albuminuria. The mean (SD) subscale scores were physical component summary score, 43±9; mental component summary score, 48±10; burden, 61±33; effects, 87±13; and symptoms, 90±20. Among the socioeconomic variables, women, lower education, and lower income were negatively associated with reduced scores across all subscales. For instance, the respective β-coefficients (SD) for association with the physical component summary subscale were -2.6 (-3.4 to -1.8), -1.5 (-2.2 to -0.7), and -1.6 (-2.7 to -0.5). Medical factors had inconsistent or no association with subscale scores. The quality of life scores also displayed regional variations. In this first of its kind analysis from India, predominantly socioeconomic factors were associated with quality of life scores in patients with CKD.