Management Of Non-communicable Diseases Research Articles

Lifestyle-Related Factors for Improving Diet Quality

Background/Objectives: Diet quality is important for the prevention of non-communicable diseases (NCDs), which are now responsible for leading causes of death worldwide. Although health professionals often recommend diet improvement for the treatment and management of many NCDs, patients continually struggle to make dietary changes and maintain them long-term. This may be due to an interplay of many factors that affect dietary quality. This paper discusses some lifestyle-related factors that may offer additional points of intervention for health professionals to use to increase diet quality. Methods: This review examines the effects of exercise, sleep, mindfulness practice, meal socialization, social media use, and tobacco and alcohol use on diet quality. Studies examining the effects of these factors on diet were found by searching PubMed, CINAHL, and Google Scholar. Results: Evidence suggests that a positive relationship between exercise, adequate sleep, and all forms of mindfulness have positive effects on diet quality. Meal socialization’s effects on diet quality were nuanced. Individuals tend to eat similarly to those they share a meal with. However, food quantity intake may be affected by the physical characteristics of individuals with whom people share a meal. Social media use was found to have negative effects on diet quality in those who used it excessively and was found to promote disordered eating patterns. Both tobacco and alcohol use were found to have negative impacts on diet quality. Conclusions: Using these findings, health professionals may be able to educate people about lifestyle-related factors that can improve diet quality.

Comprehensive Approach of Hospital Role in Managing Non-Comunicable Disease

Health problems classified as non-communicable diseases (NCDs) are those that cannot be spread from one person to another directly. With 41 million fatalities annually, or 71 percent of all deaths globally, these illnesses rank as the leading cause of death and disability worldwide. 15 million individuals between the ages of 30 and 69 die from non-communicable diseases (NCDs). The most common cause of NCD fatalities is cardiovascular disease, which is followed by cancer, respiratory conditions, and diabetes. Hospitals are crucial to the management of non-communicable diseases (NCDs) in a number of ways, including palliative care, treatment, screening, and detection. The purpose of this study is to examine hospitals' involvement in NCD management. The scoping review technique, a methodical approach and selection procedure, is employed in this study. The last ten years' worth of publications from national and international databases, including PubMed, Scopus, and Ebsco/Springer, are searched for literature sources. According to the study's findings, hospitals, as health service institutions, play a part in global health diplomacy (GHD), or a negotiated process of collective action for global health. This includes three types of diplomacy: informal diplomacy, which takes the form of interactions between international public health actors and their partners, such as officials from the host country, non-governmental organizations, private businesses, and the community, and core diplomacy, which takes the form of formal negotiations between countries. Multi-stakeholder diplomacy is defined as talks between countries and other actors that don't always result in agreement.

Trends in Socioeconomic Inequalities in the Prevalence of Chronic Non-Communicable Diseases in China: Evidence from Shaanxi Province During 2003-2013.

Background: The link between chronic non-communicable diseases (NCDs) and poverty in underdeveloped countries is debated. This study aims to examine socioeconomic inequalities related to NCDs and assess the contributing factors to these disparities. Methods: The study utilized data from the National Health Services Survey in Shaanxi Province for 2003, 2008, and 2013, having 71,766 respondents. The concentration index (CI) was employed to rigorously quantify the degree of socioeconomic inequality in the prevalence of non-communicable diseases (NCDs). The CI decomposition identified the contribution of each variable, while the horizontal inequity (HI) index was calculated annually to assess changes in inequality. Additionally, a Probit model was employed to examine the significant determinants contributing to the occurrence of NCDs. Results: The results show a significant increase in NCD prevalence with age, particularly for individuals aged 60 and above, who experienced a 286.55% rise from 2003 to 2013. Higher education levels are associated with decreased NCD prevalence, as evidenced by a 74.13% reduction for those with high school education or above. Additionally, wealthier individuals had a 15.31% lower prevalence of NCDs, indicating that higher socioeconomic status correlates with a reduced likelihood of chronic diseases. Conclusions: The study finds that NCD prevalence significantly increases with age, while higher education levels and greater wealth are associated with reduced prevalence. These findings highlight the need to target older populations and lower socioeconomic groups for effective NCD prevention and management. Policies should focus on improving educational opportunities and socioeconomic conditions to reduce the burden of NCDs, particularly among older and economically disadvantaged groups.

Microalga Nannochloropsis gaditana as a Sustainable Source of Bioactive Peptides: A Proteomic and In Silico Approach.

The impact of the world's growing population on food systems and the role of dietary patterns in the management of non-communicable diseases underscore the need to explore sustainable and dietary protein sources. Although microalgae have stood out as alternative sources of proteins and bioactive peptides, some species such as Nannochloropsis gaditana remain unexplored. This study aimed to characterize N. gaditana's proteome and evaluate its potential as a source of bioactive peptides by using an in silico approach. A total of 1955 proteins were identified and classified into functional groups of cellular components, molecular functions, and biological processes. In silico gastrointestinal digestion of identified proteins demonstrated that 202 hydrophobic and low-molecular-size peptides with potential bioactivity were released. Among them, 27 exhibited theorical antioxidant, antihypertensive, antidiabetic, anti-inflammatory, and/or antimicrobial activities. Seven of twenty-seven peptides showed ≥20% intestinal absorption, suggesting potential systemic effects, while the rest could act at local level. Molecular docking demonstrated strong affinities with key enzymes such as MPO, ACE, and DPPIV. Resistance to the digestion, capacity to be absorbed, and multifunctionality were demonstrated for peptide FIPGL. This study highlights N. gaditana's potential as a sustainable source of novel potential bioactive peptides with promising local and systemic biological effects.

EFFECTIVENESS OF HEALTH COACHING AI APPLICATIONS FOR NON-COMMUNICABLE DISEASES’ MANAGEMENT: IMPACT ON BEHAVIOR CHANGE

The rising prevalence of noncommunicable diseases (NCDs) such as diabetes, cardiovascular disease, and chronic respiratory illnesses underscores the urgent need for effective management strategies. This study investigates the effectiveness of health coaching applications enabled by artificial intelligence (AI) in promoting behavior change among individuals having NCDs. Utilizing a mixed-methods approach, the research evaluates user engagement, adherence to treatment regimens, and the impact of application features including personalized interventions, real-time feedback, and community support. Data was collected through surveys distributed among NCD patients using various health coaching applications. Preliminary findings indicate that personalized health coaching significantly enhances user adherence and engagement, with specific features being instrumental in driving positive health outcomes. Additionally, barriers to effective use, such as data privacy concerns and technology access, were identified. This research contributes to the understanding of how AI applications can optimize NCD management and offers insights for developers and healthcare providers to enhance the usability and effectiveness of these technologies. Ultimately, findings aim to inform the design of future health coaching applications, ensuring they better meet the needs of patients managing chronic health conditions.

Service Delivery Redesign for Noncommunicable Disease Management: Assessment of Needs and Solutions Through a Co-Creation Process in Argentina.

In Argentina, the implementation of a national strategy to reduce the prevalence of noncommunicable diseases (NCDs) has been hampered by challenges at the provincial level. We aimed to design a new model of care for NCDs at the primary care level by conducting a multimodal system assessment and co-design of potential solutions in the province of Mendoza. We carried out a mixed-methods study with 7 components: evaluation of patterns of care, patient focus groups, cross-sectional standardized population-based phone survey, an electronic cohort follow-up of patients with type 2 diabetes, in-depth interviews with stakeholders, a knowledge test for health care providers on chronic condition management, and a Delphi consensus to provide recommendations from stakeholders. Focus group and in-depth interviews revealed access to primary health care for NCDs was associated with problems with long waiting times and time-consuming procedures for referral to laboratory tests, hospital care, and provision of medication. Mental health care services were particularly limited. Survey respondents (N=1,190) were predominantly covered through public (41%) or social security sectors (54%); 41% fell in the lowest income group. Contact with the health system was high (5.7 annual visits), but 19.7% reported unmet health care needs. Public sector providers perceived they provided high-quality care despite insufficient material and human resources. Within the social security sector, the main challenge was insufficient staff, particularly affecting mental health care. Health care providers showed a higher percentage of correct answers to depression-related questions, but worse results were seen in hypertension and diabetes care. Actions supported by evidence and expert agreement were identified for implementation to guide future system changes. Our research highlights the potential for Argentina's primary care system to initiate transformative, system-level changes aimed at improving health outcomes. We propose an innovative methodological assessment and co-design for improving primary care.

Effect of Ice Massage to Abdomen on Blood Glucose Level and Cardiovascular Function in Healthy Individuals: A Single-group Pre-test and Post-test Experimental Study.

Ice massage is commonly employed in the management of non-communicable diseases like hypertension and diabetes. However, there is a paucity of evidence regarding abdominal ice massage on blood glucose level (BGL) and cardiovascular function either in healthy or pathological conditions. Thus, this study was conducted to assess the effects of ice massage to the abdomen on BGL and cardiovascular functions in healthy individuals. In our single-group pre-test and post-test experimental study, 50 healthy (27 females and 23 males) volunteers aged 24.72 ± 5.48 years were recruited. All the subjects underwent only one session of ice massage to the abdomen for 20 min. Random BGL and cardiovascular functions such as systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), pulse pressure, mean arterial pressure (MAP), rate pressure product (RPP), and double product (Do-P) were assessed before, immediately after, and 20 min after the intervention. The study showed a significant reduction in PR, RPP, and Do-P in the post-test assessments, whereas in the follow-up assessment (i.e., 20 min after the intervention), a significant reduction was found in random blood glucose, SBP, DBP, PR, MAP, RPP, and Do-P compared to the pre-test assessments. No adverse effects were reported by any of the participants during and after the intervention. Twenty minutes of ice massage to the abdomen improves cardiovascular function immediately after the intervention, whereas after 20 min of intervention, it reduces BGL in addition to improving cardiovascular function in healthy individuals. However, long-term randomized controlled trials in patients with diabetes are recommended with a larger sample size to warrant the clinical efficacy of this study.

Nutritive, Polyphenolic, and Antioxidative Properties of Locally Produced Cereals and Pseudograins

Cereals and pseudograins are known for their bioactive components and hence used as functional food worldwide. Recently, locally grown cheena, kaon, quinoa, and chia are available in Bangladeshi markets. The study aimed to determine the macronutrients, polyphenols, and flavonoids contents of selected cereals (bajra, zob, cheena, and kaon) and pseudograins (quinoa and chia) along with their antioxidant properties. Cheena (13.48%) and kaon (13.55%) showed higher protein content among cereals, whereas chia of commercial and local sources showed high quantities of protein (22.40% and 22.35%, respectively) among pseudograins. A high amount of carbohydrate was found in kaon and quinoa (64.57% and 59.79%, respectively), whereas chia contained a high amount of fat (20.88 to 29.77%) and dietary fiber (31.46% to 36.85%). Locally grown bajra exhibited a markedly higher concentration of total phenolics (135.75±0.33 mg/g GAE dw) and total flavonoids (17.44±0.05 mg/gm QE dw) compared to other foods studied. Regarding antioxidant activity determined by 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay and half-maximal inhibitory (IC50) values, chia from Dinajpur field showed the best results. Therefore, cereals and pseudograins studied and reported here could provide utilizable nutritional and functional bioactive polyphenolic components that may have the potential in the nutritional management of noncommunicable diseases. J. of Sci. and Tech. Res. 6(1): 89-98, 2024

Barriers and facilitators for the use of telehealth by healthcare providers in India-A systematic review.

It is widely assumed that telehealth tools like mHealth (mobile health), telemedicine, and tele-education can supplement the efficiency of Healthcare Providers (HCPs). We conducted a systematic review of evidence on the barriers and facilitators associated with the use of telehealth by HCPs in India. A systematic literature search following a pre-registered protocol (https://doi.org/10.17605/OSF.IO/KQ3U9 [PROTOCOL DOI]) was conducted on PubMed. The search strategy, inclusion, and exclusion criteria were based on the World Health Organization's action framework on Human Resources for Health (HRH) and Universal Health Coverage (UHC) in India with a specific focus on telehealth tools. Eligible articles published in English from 1st January 2001 to 17th February 2022 were included. One hundred and six studies were included in the review. Of these, 53 studies (50%) involved mHealth interventions, 25 (23.6%) involved telemedicine interventions whereas the remaining 28 (26.4%) involved the use of tele-education interventions by HCPs in India. In each category, most of the studies followed a quantitative study design and were mostly published in the last 5 years. The study sites were more commonly present in states in south India. The facilitators and barriers related to each type of intervention were analyzed under the following sub-headings- 1) Human resource related, 2) Application related 3) Technical, and 4) Others. The interventions were most commonly used for improving the management of mental health, non-communicable diseases, and maternal and child health. The use of telehealth has not been uniformly studied in India. The facilitators and barriers to telehealth use need to be kept in mind while designing the intervention. Future studies should focus on looking at region-specific, intervention-specific, and health cadre-specific barriers and facilitators for the use of telehealth.

Identifying relevant diabetes and hypertension control management guidelines in primary healthcare and community settings in Indonesia: A Delphi survey.

The burden of non-communicable diseases (NCDs) in Indonesia is increasing, as evidenced by the latest Indonesian National Health Research, which shows an increase in diabetes prevalence, from 6.9% in 2013 to 10.9% in 2018, and hypertension, from 25.8% in 2013 to 34.1% in 2018. Hence, effective actions in community and primary health care (PHC) facility settings are necessary to tackle the burden of diabetes and hypertension, especially in low- and middle-income countries. The Indonesian government has issued numerous guidelines regarding NCDs. However, not all these guidelines can be applied to communities or PHCs. This study aimed to identify priority guidelines to support the community and PHC for NCD management using the Delphi survey method. These prioritized guidelines will serve as valuable resources for developing relevant, operational and comprehensive modules for community cadres and PHC staff involved in NCD management. The Delphi survey involved 25 experts and comprised three rounds using a questionnaire: 1) identification and assessment of guidelines, 2) assessment of the importance of guidelines, and 3) nomination of the three main priority guidelines. The results revealed three priority guidelines: NCD management guidelines, technical guidelines for Pos Pembinaan Terpadu (POSBINDU) NCDs, and integrated services for NCDs in PHC facilities. Additionally, priority guidelines were used to develop operational modules for community cadres and PHC staff in NCDs management. In conclusion, utilizing the Delphi method serves as a scientific approach to identify priority guidelines crucial for supporting the community and PHC in managing NCDs, particularly in countries with contexts similar to Indonesia.

Benefits of Clinical Decision Support Systems for the Management of Noncommunicable Chronic Diseases: Targeted Literature Review.

Clinical decision support systems (CDSSs) are designed to assist in health care delivery by supporting medical practice with clinical knowledge, patient information, and other relevant types of health information. CDSSs are integral parts of health care technologies assisting in disease management, including diagnosis, treatment, and monitoring. While electronic medical records (EMRs) serve as data repositories, CDSSs are used to assist clinicians in providing personalized, context-specific recommendations derived by comparing individual patient data to evidence-based guidelines. This targeted literature review (TLR) aimed to identify characteristics and features of both stand-alone and EMR-integrated CDSSs that influence their outcomes and benefits based on published scientific literature. A TLR was conducted using the Embase, MEDLINE, and Cochrane databases to identify data on CDSSs published in a 10-year frame (2012-2022). Studies on computerized, guideline-based CDSSs used by health care practitioners with a focus on chronic disease areas and reporting outcomes for CDSS utilization were eligible for inclusion. A total of 49 publications were included in the TLR. Studies predominantly reported on EMR-integrated CDSSs (ie, connected to an EMR database; n=32, 65%). The implementation of CDSSs varied globally, with substantial utilization in the United States and within the domain of cardio-renal-metabolic diseases. CDSSs were found to positively impact "quality assurance" (n=35, 69%) and provide "clinical benefits" (n=20, 41%), compared to usual care. Among CDSS features, treatment guidance and flagging were consistently reported as the most frequent elements for enhancing health care, followed by risk level estimation, diagnosis, education, and data export. The effectiveness of a CDSS was evaluated most frequently in primary care settings (n=34, 69%) across cardio-renal-metabolic disease areas (n=32, 65%), especially in diabetes (n=13, 26%). Studies reported CDSSs to be commonly used by a mixed group (n=27, 55%) of users including physicians, specialists, nurses or nurse practitioners, and allied health care professionals. Overall, both EMR-integrated and stand-alone CDSSs showed positive results, suggesting their benefits to health care providers and potential for successful adoption. Flagging and treatment recommendation features were commonly used in CDSSs to improve patient care; other features such as risk level estimation, diagnosis, education, and data export were tailored to specific requirements and collectively contributed to the effectiveness of health care delivery. While this TLR demonstrated that both stand-alone and EMR-integrated CDSSs were successful in achieving clinical outcomes, the heterogeneity of included studies reflects the evolving nature of this research area, underscoring the need for further longitudinal studies to elucidate aspects that may impact their adoption in real-world scenarios.

Decentralization Matters: Association of Adherence to Treatment and Distance for the Management of Non-Communicable Diseases in Rural Tanzania.

Since March 2019, a non-communicable diseases program has been established at hospital level, with enrollment and clinical reassessment every 6 months. Since July 2023, monthly enrollment and visits have also been conducted at health center level. This study aimed at assessing the adherence to scheduled follow-up visits following the decentralization of the integrated NCDs program from Hospital to Health Center level and investigate factors influencing follow-up adherence. The study was performed in a rural district in Iringa Region, Tanzania. Adherence was measured at both levels. Multivariate regression analysis was conducted to describe socio-demographic and clinical factors influencing attendance at the 6-month hospital-level visit. Among 2198 patients enrolled at the hospital level, weighted adherence over 42 months was 40.8% (95% CI 39.0-42.6%) at the 6-month visit. Multivariate analysis revealed that as the distance from the hospital increased, the probability of attendance decreased (OR 0.17; 95% CI: 0.08-0.39). Among 571 patients enrolled at the residence level, adherence over the first 10 months of program implementation was 91.6% (90.4-92.8%). The findings showed that distance was by far the most important barrier to follow-up adherence and suggested that decentralizing the program from the hospital to peripheral health centers may ensure high follow-up rates.

Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: A systematic review protocol.

Type 2 diabetes is a major global public health challenge, particularly in the African region. Though evidence exists on pharmacological agents and non-pharmacological interventions in maintaining blood glucose concentration, the healthcare systems' ability to meet patients' needs may be inadequate. The management of non-communicable diseases, particularly diabetes, has been postulated to depend on functioning health systems. This systematic review will, therefore, summarize the current evidence on existing health systems interventions in primary health settings for type 2 diabetes care and health outcomes in West Africa and will explore the impact of these system-level interventions on service availability, accessibility and quality, as well as individualized outcomes such as glycemic control, disease awareness and treatment adherence. The review will be conducted according to the reporting guidance in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). The health system framework by Witter et al., 2019 will guide the system-level interventions and the search strategy to be explored in this review. This framework was designed to integrate the six building blocks of the World Health Organization (WHO) health systems framework and it delineates how they work synergistically to improve specific health outcomes. We will search the following databases PubMed, Google Scholar and Cumulated Index to Nursing and Allied Health Literature (CINAHL) between January 2000 to January 2024. We will also search Cairn.info for articles published between January 2005 to January 2024. The Cochrane Collaboration tool for assessing Risk of Bias will be implemented in each included study. We will conduct a narrative synthesis and make comparisons across findings using Excel-generated tables. In Conclusion, this systematic review will outline the existing system-level interventions that aim to or already improve type 2 diabetes services in primary health settings in West Africa and will offer suggestions for the strengthening and co-production of successful interventions that can be generalized to the entire sub-region.

Nutrition Education and Practice in University Dental and Oral Health Programmes and Curricula: A Scoping Review.

Dentists and oral health practitioners have a potential role in supporting the prevention and management of noncommunicable diseases. However, the extent to which university education prepares practitioners to provide nutrition care is unclear. This scoping review identifies and synthesises the evidence related to university-level nutrition education provided to dental and oral health students globally. A scoping review identified relevant literature through search terms "dentistry," "oral health," or "oral hygiene"; "dental students" or "dental education"; "nutrition education" or "nutrition science." Articles were included that examined nutrition education in undergraduate oral health training; or nutrition knowledge, attitudes, confidence, or skills or dietary habits; experts' opinion papers; and position statements. No limitations on the publication years or languages of the articles were applied. A total of 136 articles were included. Half were surveys of students (n = 49) or academic staff (n = 21). The remainder comprised reports of curriculum initiatives (n = 26), opinion papers or narrative reviews (n = 24), position statements (n = 6), curriculum development (n = 6) and curriculum guidelines (n = 9). While dental and oral health students and curriculum experts overwhelmingly recognised the importance of nutrition, most studies that assessed nutrition knowledge of students revealed limited knowledge. Students were not confident in their skills to provide nutrition care. Lack of nutrition experts on teaching teams and unclear expectations about developing nutrition competencies were identified as barriers to greater nutrition education. Nutrition education in university dental and oral health degrees is highly variable. The potential for oral health professionals of the future to promote oral health through nutrition is unrealised.

7.G. Round table: Primary prevention and management of NCDs – the added value of joint actions across Europe

Abstract Two ambitious European joint action projects, funded through the EU4Health programme, are ongoing to reduce the burden of non-communicable diseases (NCDs) and related risk factors in Europe, targeting both individual and societal levels. Together, these projects aim to scale up effective prevention and management strategies, strengthen public health policies and promote equitable and sustainable healthcare systems across Europe. The Joint Action on CARdiovascular Diseases and DIabetes (JACARDI), with 21 participating countries and a total budget of over €66 million, is focusing on enhancing the implementation of evidence-based innovative pilot projects across the entire patient journey. This includes efforts to improve prevention, early diagnosis, and proactive management of NCDs. The Joint Action Prevent Non-Communicable Diseases (JA PreventNCD), with 25 participating countries and a total budget of over €95 million, particularly aims to enhance joint capacities of countries for implementing, scaling up and evaluating prevention policies and actions at various levels. These projects represent complementary responses to calls for action in Europe’s Beating Cancer Plan and the Healthier Together - EU NCD Initiative, with JA PreventNCD emphasizing primary prevention and policy while JACARDI focuses on secondary prevention and health systems strengthening. Both projects will generate new policy-relevant evidence based on implementation, monitoring and scaling-up of best and innovative practices and policies across Europe. The projects share a focus on equity, diversity, scalability and sustainability, while avoiding fragmentation and duplication of actions. Under the EU4Health programme, launched to strengthen European health collaboration in the wake of the COVID-19 pandemic, the EU has recently invested over €200 million in public health initiatives, with additional investments from national authorities participating in the joint actions. With this new wave of funding, real population impact should be anticipated, but what can we realistically expect to be the outcomes and what are the criteria for success? In this round table discussion 1) these two joint action projects will be presented, highlighting their innovative aspects; 2) views on the added value and potential in cross-national collaborations for prevention and management of NCDs will be debated, and 3) how synergies will be leveraged for maximum impact will be explored. Panelists will share their perspectives on the projects’ potential to change the public health landscape in Europe. Workshop participants will subsequently be encouraged to engage in the discussion with the objective that views and experiences are exchanged, opportunities for collaboration and engagement are shared and energy is mobilized to harness the benefits of such large-scale policy-relevant collaborations. Key messages • Synergies and collaboration to drive policy development and foster increased capacity are the pillars to build a healthier Europe. • Two large-scale Joint Actions drive impact by highlighting innovative NCD prevention strategies and fostering collaborative engagement.

Cross-cutting integration of equity and diversity lens in public health: a novel approach of JACARDI

Abstract Issue/Problem Health inequities persist across European countries, impacting the distribution, prevention, and management of non-communicable diseases. With increasing population diversity and improved understanding of the intersectional nature of drivers of health inequities, narrowing inequities calls for systematic integration of diversity perspectives into equity-driven policy and practice. Description of the problem The EU-co-funded Joint Action on CVDs and diabetes (JACARDI, 11/2023-10/2027) project with 76 partners from 21 countries and 142 national-level projects (later pilots), applies a structured approach for integrating equity and diversity perspectives within all project structures. This is achieved through design of a common methodological framework and terminology glossary for all thematic work packages (WPs) and their pilots, which are further supported through capacity building sessions and consultations. Results The “4Cs” framework (Critical reflection; Context and data; Co-design; and inclusive and accessible Communications) for integrating equity and diversity principles in JACARDI was developed based on results of focus group interviews with WP leaders (n = 24) and review of previous literature. This framework was applied as a lens to be applied in the planned activities by WPs and pilots, elaborated in an equity and diversity maturity matrix aligned with the XV methodological steps for pilot implementation. Additionally, equity and diversity indicators were integrated into harmonized context analysis questionnaires for national focal points of each partner country, as well as into the methodology for pilot assessment and reporting. Lessons Equity and diversity perspectives should be integrated into the core structures of project implementation, supported by practical tools, trainings and practical consultations to improve adherence and collaborative understanding across project partners. Key messages • Equity and diversity integration into core structures are essential for tackling health inequities and the NCD-related social gradient in Europe. • Encouraging critical reflection among JACARDI partners is pivotal for initiating a paradigm shift towards equity and diversity inclusion.

Patient referral pathways to leisure providers: impacts on physical activity and falls risk

Abstract Background Physical activity aids prevention and management of noncommunicable diseases. Yet many UK adults, particularly those with long-term health conditions, do not meet recommended activity levels. In 2021, West Suffolk Foundation Trust commissioned local leisure provider Abbeycroft to offer 24 week tailored physical activity programs as part of respiratory and frailty patient pathways. Objectives Evaluation of activity and outcome data for all 1670 individuals referred between January - December 2023 to determine future commissioning decisions. Results 256 participants had completed a 24 week pathway by the time of analysis. Compared to baseline, they demonstrated statistically significant (p < 0.05) self-reported improvements on the Short Warwick Edinburgh Mental Well-being Scale (median 25 to 27) amongst 68.9% of participants; and on the self-reported International Physical Activity Questionnaire 62.1% reduced time spent sitting (average 436 to 300 minutes/ week), 75% increased metabolically active minutes (average 955 to 2632 minutes/week) and the proportion of participants with a low (inactive) score decreased by 61%. Of 40 frailty patients, 87.5% lowered their self-reported Short Falls Efficacy Scale Score (14.6 to 10.4) and observed Timed Get up and Go (13.55 to 9.53 seconds), indicative of moving from a higher risk to lower falls risk (p < 0.05). 24 week retention exceeded 80% for all ages except 16-20 years. 17.8% of participants were >75 years. Lessons Both pathways have been recommissioned and new tailored pathways for Parkinson’s disease, COPD and cancer are planned. This partnership working is a sustainable, integrated way to embed prevention in the community but needs time to build relationships and streamline data sharing. Key messages • Hospital and community referral pathways to leisure providers significantly improve patient well-being, physical activity and falls risk. • These pathways are affordable, adaptable across conditions and show high retention.

Characteristics of Diseases in Developing Countries

In the urgent realm of global health, it is imperative to acknowledge and promptly address the distinct characteristics of diseases that afflict developing countries. These nations face a unique set of challenges that contribute to the burden of illness and significantly impact the quality of life for their populations. By promptly exploring the key features of diseases in developing countries, we can better understand the complex interplay between socioeconomic factors and health outcomes [1]. One of the primary characteristics of diseases in developing countries is their disproportionate impact on vulnerable populations. Socio-economic disparities, limited access to healthcare, inadequate sanitation infrastructure, and poor nutrition contribute to the heightened susceptibility of marginalized communities to preventable infectious diseases such as hydatid cysts, malaria, tuberculosis, and diarrheal illnesses. The lack of resources and infrastructure further exacerbates the spread of these diseases, creating a cycle of sickness and poverty [2,3]. Furthermore, the prevalence of neglected tropical diseases (NTDs) is a defining feature of the disease landscape in developing countries. These illnesses, which include dengue fever, Chagas disease, and schistosomiasis, predominantly affect populations in low-resource settings and often go unnoticed on the global health agenda. The burden of NTDs is compounded by limited funding for research and treatment, leaving affected communities without adequate support and interventions [4]. In addition to infectious diseases, non-communicable diseases (NCDs) are on the rise in developing countries, posing a dual burden of illness alongside contagious diseases. Factors such as urbanization, lifestyle changes, and an aging population contribute to the increasing prevalence of conditions like cardiovascular diseases, diabetes, and cancer. The inadequate healthcare infrastructure in many developing countries further hinders NCDs' prevention, diagnosis, and management, leading to poorer health outcomes for those affected [5]. Addressing the characteristics of diseases in developing countries requires a multi-faceted approach that encompasses strengthening the healthcare system, investing in public health infrastructure, and, most importantly, providing equitable access to essential medicines. By ensuring fair access to these medicines, we can work towards achieving health equity and reducing the burden of disease in developing countries.

Implementation of Standard Physiotherapy Service Policies In Puskesmas: Literature Review

The growing prevalence of non-communicable diseases (NCDs) such as hypertension, stroke, diabetes, joint disorders, lack of physical activity, injury, and disability has resulted in an increasing need for physiotherapy services within healthcare facilities, especially at community health centers. Despite many unresolved public health issues, the rise of NCDs continues to pose significant challenges. According to the Minister of Health Regulation No. 65 of 2015, physiotherapy services are crucial in primary healthcare as part of promotive and preventive efforts, without neglecting curative and rehabilitative functions. This study aims to highlight the importance of physiotherapy in community health centers in providing both preventive and supportive care to address the public's increasing healthcare demands. The findings emphasize the strategic role of physiotherapists in disease prevention and health promotion at the primary level. The novelty of this research lies in its focus on the integration of physiotherapy into primary care services as a proactive approach to managing NCDs. The contribution of this research is to support healthcare policy and practices that prioritize physiotherapy services to improve public health outcomes, particularly in the prevention and management of NCDs.

Evidence gaps in conservative non-pharmacological interventions and guideline implementation for high-burden non-communicable diseases: protocol for an overview of reviews

Non-communicable diseases (NCDs) represent a high burden for the society and affected individuals. Conservative non-pharmacological interventions play a first-line role in the treatment and management of most NCDs. Systematic reviews...