National Non-communicable Diseases Research Articles

Inclusion of diabetic retinopathy screening strategies in national-level diabetes care planning in low-income and middle-income settings: protocol for a scoping review

IntroductionThe diabetes mellitus (DM) epidemic is a major public health concern globally, with the highest-burden in low-income and middle-income countries (LMICs). Diabetic retinopathy (DR) is a microvascular complication of diabetes,...

Implementing a national non-communicable disease policy in sub-Saharan Africa: Experiences of key stakeholders in Ghana

IntroductionComprehensive national non-communicable disease (NCD) policy development and implementation are crucial for preventing and controlling the increasing NCD burden, particularly in the Africa region where the largest increase in NCD related mortality is expected by 2030. Yet, even where national NCD policies exist, effective implementation remains hindered for reasons not clearly elucidated. This study explored the experiences of key health stakeholders at national and sub-national levels with implementing a national NCD policy in Ghana. MethodsThis was an explanatory, cross-sectional and grounded theory study using in-depth interview guides to collect primary data from 39 purposively sampled health policymakers and implementing officials at the national and sub-national levels in Ghana. A thematic approach was used in data analysis. ResultsSeveral interwoven factors including poor policy awareness, poor coordination and intersectoral engagements and inadequate funding for NCD programs and activities are key challenges thwarting the effective implementation of the national NCD policy in Ghana. At the sub-national levels, inadequate clarity and structure for translating policy into action and inadequate integration further affect operationalizing of the national NCD policy. ConclusionThe findings call for policymakers to adopt a series of adaptive measures including sustainable NCD financing mechanisms, effective intersectoral coordination, policy sensitisation and capacity building for implementing health professionals, which should be coupled with governmental and global resource investment in effective implementation of national NCD policies to make sustained population level gains in NCD control in Ghana and in other resource constrained settings.

Cancer Statistics, 2020: Report From National Cancer Registry Programme, India.

PURPOSEThe systematic collection of data on cancer is being performed by various population-based cancer registries (PBCRs) and hospital-based cancer registries (HBCRs) across India under the National Cancer Registry Programme–National Centre for Disease Informatics and Research of Indian Council of Medical Research since 1982.METHODSThis study examined the cancer incidence, patterns, trends, projections, and mortality from 28 PBCRs and also the stage at presentation and type of treatment of patients with cancer from 58 HBCRs (N = 667,666) from the pooled analysis for the composite period 2012-2016. Time trends in cancer incidence rate were generated as annual percent change from 16 PBCRs (those with a minimum of 10 years of continuous good data available) using Joinpoint regression.RESULTSAizawl district (269.4) and Papumpare district (219.8) had the highest age-adjusted incidence rates among males and females, respectively. The projected number of patients with cancer in India is 1,392,179 for the year 2020, and the common 5 leading sites are breast, lung, mouth, cervix uteri, and tongue. Trends in cancer incidence rate showed an increase in all sites of cancer in both sexes and were high in Kamrup urban (annual percent change, 3.8%; P < .05). The majority of the patients with cancer were diagnosed at the locally advanced stage for breast (57.0%), cervix uteri (60.0%), head and neck (66.6%), and stomach (50.8%) cancer, whereas in lung cancer, distant metastasis was predominant among males (44.0%) and females (47.6%).CONCLUSIONThis study provides a framework for assessing the status and trends of cancer in India. It shall guide appropriate support for action to strengthen efforts to improve cancer prevention and control to achieve the national noncommunicable disease targets and the sustainable development goals.

Towards Population Salt Reduction to Control High Blood Pressure in Ghana: A Policy Direction.

ABSTRACTAlthough population salt reduction is considered a “best buy” in addressing hypertension and cardiovascular disease, Ghana shares a high hypertension burden with a seemingly high salt consumption. This article discusses best practices in reducing population salt intake and provides preliminary data on salt and potassium intake, as well as the process to develop a road map and identification of actions needed to support the development of a strategic national document towards salt reduction in Ghana. In February 2019, a 2-d stakeholder meeting was held with government agencies, researchers, nongovernmental organizations, civil society organizations, and international partners to deliberate on salt reduction strategies and interventions needed in the face of rising hypertension and other noncommunicable diseases (NCDs) in Ghana. Recommendations were developed from the stakeholder meeting and are being considered for inclusion in the revision of Ghana's national NCD policy.

Prevalence of undetected hypertension and its association with socio-demographic and non-communicable diseases risk factors in Brunei Darussalam

This study estimated the prevalence of undetected, untreated and uncontrolled hypertension in Brunei Darussalam and the associations with socio-demographic and non-communicable diseases (NCDs) risk factors. Participants were aged 18–69 years old from the national NCDs and risk factors survey in Brunei Darussalam, conducted from August 2015 to April 2016. Multiple logistic regression was applied to estimate the associations of undetected, untreated and uncontrolled hypertension with socio-demographic and NCDs risk factors. The crude prevalence of hypertension was estimated to be 40.4% [95% confidence interval (CI) = 37.2–43.6] in men and 32.3% (95% CI = 29.6–35.0) in women. Multivariable adjustment using logistic regression found that those who were currently married [odds ratio (OR) = 0.34, p < 0.001], have family history of hypertension (OR = 0.43, p < 0.001), reported buying food with low salt content (OR = 0.67, p = 0.039) and diabetic (OR = 0.28, p < 0.001) were found to be significantly less likely to have undetected hypertension. Amongst those who were previously diagnosed with hypertension, younger age groups, tobacco use and having no other NCDs diagnosis were found to have significantly higher odds of having untreated hypertension. Amongst those who were on antihypertensive treatment, having body mass index (BMI) 30 kg/m2 and above was significantly associated with lower odds of uncontrolled hypertension. More than one-third (35.8%) of the adult population in Brunei Darussalam were found to have hypertension. Among them, over one-quarter (28.6%) of hypertension cases were not previously detected. Amongst those previously diagnosed with hypertension, more than one-third (35.1%) were not treated or on antihypertensive medication. Screening for hypertension should be emphasised in public health education and media campaigns so that hypertension can be detected and treated earlier.

Predictors of non-communicable diseases screening behaviours among adult population in Brunei Darussalam: a retrospective study

To explore sociodemographic factors, anthropometric measurements, and non-communicable disease risk factors as predictors of screening behaviours in Brunei Darussalam. Data from the National Non-communicable Diseases survey (STEPS) involving 3808 participants were extracted. Multivariable regression analyses were applied to explore factors associated with screening behaviours. Highest prevalence of cardiovascular disease screening was blood pressure (81.0%, 95% CI: 79.7, 82.2), followed by glucose measurement (64.9%, 95% CI: 63.3, 66.4) and cholesterol monitoring (63.4%, 95% CI: 61.9, 65.0). For prevalence of cancer screenings, pap smear was the highest (56.5%, 95% CI: 54.3, 58.6), followed by mammography (11.3%, 95% CI: 10.0, 12.7), colonoscopy (7.9%, 95% CI: 7.1, 8.8) and prostate (6.5%, 95% CI: 5.4, 7.8). Marital status, age, tobacco use, co-morbidity and family history were significant predictors of cardiovascular screening behaviours. Whereas family history, age, lifestyle factors, glucose levels, fruit and vegetable intake, work status, and knowledge on cancer were significant predictors of cancer screening behaviours. Identifying specific predictors of screening behaviours could help policymakers introduce tailored guidelines and effective approaches for screening and early detection programmes. Causal relationships and barriers to screening, including healthcare provider’s role and health service utilisation, are highly recommended in future studies.

Prevention Considerations in Cardiovascular Diseases regarding the premature mortality reduction

Introduction. Cardiovascular diseases are recognized as worldwide (1) and national public health issue (2, 3). This is argued by having a leading position in the structure of general mortality and disability, the substantial loss of quality of life and the health system needs for increased costs. Prevention and control of cardiovascular disease has become one of the priority directions for global and national noncommunicable disease control strategies developed to reduce premature mortality (1, 5). The major cardiovascular diseases mortality was identified some aspects of premature mortality among the adult population in the Republic of Moldova. Overall decrease of mortality due to cardiovascular diseases among adults (-5.9%) has been accompanied by a relatively slower decrease in premature mortality (-2.4%) in the Republic of Moldova (6). Primary, secondary and tertiary prevention measures are essential in reducing the burden of cardiovascular disease and contribute to improving cardiovascular health at the population level. Nature is helping people to maintain their health through mechanisms much closer to them than pharmaceutical ones through the curative action of the various natural factors that form the climate of the respective territorial area. Material and method. There is a descriptive study based on statistical data of the World Health Organization and official vital statistics of the Republic of Moldova. Results and discussions. The climatic conditions of Moldova are favorable to cardiovascular prevention and rehabilitation. Moldova is located in the temperate continental climate influenced by the proximity of the Black Sea and the interference of warm-humid air from the Mediterranean. The annual air temperatures average in the country is 9,30C. In the Republic of Moldova the warm weather with a confortable temperature lasts 175 days and the relative humidity oscillates in the average from 66 to 87%. The country's thermal regime is the most important curative factor for treating chronic diseases and opportunity for the amplification of medical rehabilitation programs for patients with cardiovascular diseases. Application of methods based on the action of climatic factors in cardiovascular rehabilitation process contributes to its efficiency. Increasing the role of tertiary prevention is a good practice for the quality improvement of medical services for this category of patients. By making appropriate, timely and complex measures of primary, secondary and tertiary prevention cardiovascular disease can be substantially prevented. Conclusions. Strengthening cardiovascular prevention centered on a complex approach to all its primary, secondary, and tertiary components is an opportunity to reduce premature mortality in the population. Key words: Cardiovascular diseases, prevention, premature mortality,

Prevalence and Associated Factors of Metabolic Syndrome Among Patients with Severe Mental Illness at Hawassa, Southern-Ethiopia.

BackgroundPatients with severe mental disorders have a high risk of metabolic-related complications like metabolic syndrome (MetS), diabetes mellitus (DM), hypertension and lipid derangements, and these factors may predispose them to a high mortality rate. Data is very scarce regarding MetS among patients with severe mental illness in Ethiopia. Therefore, this study aimed to assess the prevalence of MetS and its associated factors among patients with severe mental illness.MethodsA cross-sectional study was conducted in Hawassa University Comprehensive Specialized Hospital from January to June 2019 among adult patients attending a psychiatric outpatient department, Southern Ethiopia. A systematic random sampling technique was used to select 245 study subjects. Socio-demographic and other data were collected using a structured questionnaire. Both the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) guidelines were used to define MetS.ResultsThe prevalence of MetS was 24.5% and 26.9% by NCEP-ATP and IDF criteria respectively. In both definitions, females had significantly higher MetS when compared to males (31.4% vs 19.6%; p=0.03 by NCEP), and (34.3% vs 21.7%; p =0.03 by IDF), respectively. Duration >5 years with mental illness indicated higher MetS when compared to duration ≤ 5 years (42.9% vs 19.9%, p=0.001; and 46.9% vs 21.9%, p<0.0001) in NCEP and IDF, respectively. In addition, marital status [AOR (95% CI): 2.4 (1.1–5.3)], and BMI [AOR (95% CI): 8.4(4.0–17.6)], duration > 5 years with mental illness [AOR (95% CI): 2.8(1.2–6.5)], and age >40 years [AOR (95% CI): 2.7(1.2–6.1)] were significantly associated factors of MetS by NCEP. While BMI, age >40 years and duration > 5 years with mental illness were associated with MetS by IDF.ConclusionLong-time experience with severe mental illness and antipsychotic therapy might predispose patients to metabolic complications with significant risks of cardiovascular events. Therefore, intensive screening of patients for MetS/components is required during follow-up based on national non-communicable diseases guideline. Besides, the proper intervention of patients concerning lifestyle changes and averting risk full behaviors is mandatory.

Assessing association of waist-height ratio (WHtR) and body mass index (BMI) with non-communicable disease risk factors

The aim of this study is to determine the potential of the waist-height ratio (WHtR) and body mass index (BMI) as predictors of non-communicable disease (NCD) risk factors. A retrospective study using data from the 2016 National NCD survey (STEPS). A total of 3808 data points were retrieved including sociodemographic factors, anthropometric measurements, NCD prevalence and risk factors. Multiple logistic and linear regression was applied for analysis. Men (OR = 0.77, 95% CI: 0.63, 0.95), aged ≥ 45 years (OR = 4.24, 95% CI: 3.15, 0.97), of Malay ethnicity, with no formal schooling, and with existing hypertension and diabetes had significantly higher odds of having WHtR > 0.5. BMI ≥ 25 and BMI ≥ 30 are significantly associated with age group, ethnicity, education level, alcohol consumption, hypertension, diabetes and hypercholesterolaemia. Both WHtR and BMI were important predictors of NCD prevalence. These findings can contribute to the validity of the WHtR in clinical application and encourage the use of these anthropometric indices in clinical settings.

Prevalence and incidence of chronic kidney disease in Cuba.

Chronic kidney disease (CKD) is a health problem worldwide. This article's objective is to describe CKD's integration into Cuba's National Noncommunicable Diseases (NCD) Program and the main outcomes regarding the burden of CKD and associated risk factors in Cuba. Cuba offers free health services to all its citizens on the basis of a strong primary healthcare system focused on prevention. The CKD National Program is coordinated by the Institute of Nephrology and includes the National Program for Prevention of CKD, which addresses all levels of prevention. The following indicators for renal replacement treatment are from 2016. The incidence of new patients on dialysis was 109 per million population (pmp); the two main causes were hypertension (34.4%) and diabetes mellitus (29.2). In 6.3% of patients, CKD cause could not be determined because they presented at advanced stages. The prevalence of patients on dialysis was 289 pmp; 90% of dialysis patients were on hemodialysis. The main causes of death were cardiovascular diseases (30.25%), cerebrovascular diseases (11.1%), and infections (29.5%). The kidney transplant rate was 14.3 pmp. Kidney transplants performed with cadaveric donors were 86.5% of total, with living related donors 13.5%. The Isle of Youth Study (ISYS) was designed to assess predialysis chronic kidney disease patterns; its methodology has been published previously. Results: Risk factors: age > 59 years 32%, women 67.8%, overweight 34.3%, obesity 22.8%, hypertension 41.5%, diabetes 13%. Estimated CKD prevalence was 9.63%. The integration of CKD into Cuba's NCD Program has gathered knowledge of burden and trends of CKD and better risk factor control.

Identification of dietary patterns associated with elevated blood pressure among Lebanese men: A comparison of principal component analysis with reduced rank regression and partial least square methods

BackgroundTo examine the associations of dietary patterns with odds of elevated Blood Pressure (BP) among Lebanese adult males using principal component analysis (PCA), and compare the results to two other data reduction methods, including reduced rank regression (RRR) and partial least-squares (PLS) regression.MethodsData from the National Nutrition and Non-Communicable Disease Risk Factor Survey conducted in Lebanon between years 2008 and 2009 were used. Dietary intake data were collected by a 61-item food frequency questionnaire (FFQ). In addition, anthropometric and blood pressure measurements were obtained following standard techniques. For the purpose of this study, data of males older than 20 years with no history of chronic diseases were selected (n = 673). Elevated BP was indicated if the systolic blood pressure was > = 130mm Hg and/or the diastolic blood pressure > = 85 mm Hg. Dietary patterns were constructed using PCA, PLS and RRR and compared based on the performance to identify plausible patterns associated with elevated BP. For PLS and RR, the response variables were BMI, waist circumference and percent body fat. Multiple logistic regression was used to evaluate the associations between the dietary pattern scores of each method and risk of elevated BP.ResultsThree dietary patterns were identified using PCA: Western, Traditional Lebanese, and Fish and alcohol. Both the Western and the Traditional Lebanese patterns were associated with higher odds of elevated BP in the study population (OR = 1.23, CI 1.03, 1.46; OR = 1.29, CI 1.09, 1.52 respectively). The comparison among the three methods for dietary patterns derivation showed that PLS and RRR derived patterns explained greater variance in the outcome (PCA: 1.2%; PLS: 14.1%; RRR: 15.36%) and were significantly associated with elevated BP, while the PCA dietary patterns were descriptive of the study population’s real dietary habits (PCA: 23.6%; PLS: 19.8%; RRR: 11.3%).ConclusionsThe Western and Traditional Lebanese dietary patterns were associated with higher odds of elevated BP among Lebanese males. The findings of this study showed that, compared to PCA, the use of RRR method resulted in more significant associations with the outcome while the PCA-derived patterns were more related to the real habits in the study population.

Achieving Sustainability and Scale-Up of Mobile Health Noncommunicable Disease Interventions in Sub-Saharan Africa: Views of Policy Makers in Ghana.

BackgroundA growing body of evidence shows that mobile health (mHealth) interventions may improve treatment and care for the rapidly rising number of patients with noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA). A recent realist review developed a framework highlighting the influence of context factors, including predisposing characteristics, needs, and enabling resources (PNE), for the long-term success of mHealth interventions. The views of policy makers will ultimately determine implementation and scale-up of mHealth interventions in SSA. However, their views about necessary conditions for sustainability and scale-up remain unexplored.ObjectiveThis study aimed to understand the views of policy makers in Ghana with regard to the most important factors for successful implementation, sustainability, and scale-up of mHealth NCD interventions.MethodsMembers of the technical working group responsible for Ghana’s national NCD policy were interviewed about their knowledge of and attitude toward mHealth and about the most important factors contributing to long-term intervention success. Using qualitative methods and applying a qualitative content analysis approach, answers were categorized according to the PNE framework.ResultsA total of 19 policy makers were contacted and 13 were interviewed. Interviewees had long-standing work experience of an average of 26 years and were actively involved in health policy making in Ghana. They were well-informed about the potential of mHealth, and they strongly supported mHealth expansion in the country. Guided by the PNE framework’s categories, the policy makers ascertained which critical factors would support the successful implementation of mHealth interventions in Ghana. The policy makers mentioned many factors described in the literature as important for mHealth implementation, sustainability, and scale-up, but they focused more on enabling resources than on predisposing characteristics and need. Furthermore, they mentioned several factors that have been rather unexplored in the literature.ConclusionsThe study shows that the PNE framework is useful to guide policy makers toward a more systematic assessment of context factors that support intervention implementation, sustainability, and scale-up. Furthermore, the framework was refined by adding additional factors. Policy makers may benefit from using the PNE framework at the various stages of mHealth implementation. Researchers may (and should) use the framework when investigating reasons for success (or failure) of interventions.

Alcohol use among adults in Kenya: Results from the National Non-Communicable Diseases Risk Factor survey, 2015

The aim of this study was to assess the prevalence and correlates of alcohol use among Kenyan adults. We analysed data from the Kenya cross-sectional national Non-Communicable Diseases Risk Factor survey, 2015. The survey sampled 4 469 adults (median age 38.0 years, interquartile range = 23, age range of 18–69 years). Results indicate that 6.7% were hazardous or harmful alcohol users and 12.8% past month binge-drinkers. In adjusted logistic regression analysis, being male, middle aged, belonging to the Luhya or Kalenjin ethic group, tobacco use, and having hypertension increased the odds for hazardous or harmful alcohol use. Socio-demographic and health factors appear to influence risk for hazardous or harmful alcohol use among adults in Kenya.

English

Objective: To determine the status of existing violence and injury prevention (VIP) efforts and surveillance systems in the Caribbean. Methods: The Caribbean Public Health Agency (CARPHA) undertook a survey to gather evidence of VIP in 24 CARPHA member states. The survey was administered to national epidemiologists and non-communicable disease focal points in October 2015 using an online tool, ‘Survey Monkey’. Questions were asked about the availability in each country of VIP representative surveys, policies, action plans, laws, victim support services, and surveillance systems. Results: Nineteen (79%) countries completed the VIP survey. Only three (16%) countries indicated having conducted a nationally representative survey. Twelve (63%) had not developed a national policy, and 14 (74%) had not implemented an action plan on VIP. Each country reported the existence of VIP laws and offered victim support services, though average law enforcement ranged from 40% to 79%. Nine (47%) countries indicated using an injury registry, and 15 (79%) reported collecting injury data using in-patient records, mainly from public hospitals. All 19 countries confirmed that records of reported violent incidents were maintained by the police. Unique identifiers were generally lacking in registries and data collected by the police. Only four (44%) countries with registries, 10 (67%) countries with in-patient injury data, and 12 (63%) countries with police records indicated that the data were shared with other organizations. Conclusion: Each country reported some level of injury surveillance system. However, such systems should be harmonized to produce more complete baseline data. The use of unique identifiers is required to reduce duplication and effectively link surveillance systems available in countries.

A2993 Prevalence of uncontrolled hypertension and patient characteristics in a middle-income sub-Saharan African country

Objectives: According to a 2014 national non-communicable diseases (NCD) risk factors survey, Botswana has 29.3% prevalence of hypertension among adults aged 15–69 years. There is a need to understand whether healthcare services are responding by controlling this high burden of disease, and if not who is affected. We thus aimed to describe the prevalence of uncontrolled blood pressure (BP), and factors associated with uncontrolled BP, among known hypertensives. Methods: Out of 4,070 adults surveyed, a subset of 1,080 known hypertensives was analyzed. Descriptive and bivariate analyses using STATA v12 were performed to describe patient demographic, behavioral and clinical characteristics and to assess association with uncontrolled BP (defined as mean systolic BP > 140 or mean diastolic BP > 90, of three BP measurements). Results: Median age 44 years(IQR: 33–55), 838(78%) female. 446(41%) on BP medicines. 575(53%) had uncontrolled BP; 104(10%) severe (systolic BP > 180 or diastolic BP > 110). Uncontrolled BP was associated with male gender (p = 0.008), age > 30 years (p < 0.000), low education (p < 0.000), tobacco use (p = 0.001), BMI > 25 (p < 0.000), being on antihypertensive medicines (p < 0.000), receiving lifestyle counseling (p = 0.008). Conclusion: We found high proportion of uncontrolled BP, and an association (unadjusted) with being male, of low socioeconomic status and having modifiable risk factors. Findings from logistic regression modelling will be presented, and may suggest areas of targeted public health and healthcare service interventions to improve control of hypertension. Further studies are needed to understand better how patient and health system factors contribute to uncontrolled hypertension in Botswana.

A11120 Characterizing quality of current hypertension management in primary healthcare in a middle-income sub Saharan African country

Objectives: According to Botswana's 2014 national non-communicable diseases (NCD) risk factors survey, 53% of adults with known hypertension have uncontrolled disease. In addition to patient factors, understanding of the health system factors contributing to uncontrolled hypertension in Botswana - where over 95% residents live within 8 km of a health facility and primary healthcare services are free - is needed. We aimed to describe current quality of care for hypertension at outpatient primary healthcare clinics in Botswana. Methods: A cross-sectional study where purposive sample of consecutive consultations for patients with hypertension was observed, at six outpatient clinics in two districts. Consultations were assessed using a checklist, and were observed by a general practitioner knowledgeable in Botswana's recently endorsed National Primary Healthcare Guidelines aligned with World Health Organization (WHO-PEN) guidelines. Results: Eighty-two observations were descriptively analyzed, of which 78(95%) were follow-up visits. Median age of 59 years(IQR: 46,73); 23(28.1%) were male. BP was measured 100% of the time, weight 28%, height or waist circumference 0%. Titration of medicines was appropriate 71% of the time, assessment of medication adherence was 54%. Counseling patients about disease was provided 2% of the time, advise on lifestyle changes was 24%. Conclusion: While limited in sample size and purposive sampling, this study provides helpful preliminary information on gaps in quality of hypertension management in our setting, and may be relevant to similar settings. Training during implementation of the Primary Healthcare Guidelines in Botswana is needed to improve knowledge, skills and practice of primary healthcare providers in managing hypertension.

A Research Agenda for Cancer and Noncommunicable Disease Prevention and Control in India

Background: Noncommunicable diseases (NCDs), including cancer, account for approximately 38 million deaths each year, and almost 75% of these deaths occur in low and middle-income countries. NCDs contribute to 60% of total deaths in India, and of concern are the premature deaths, which account for a staggering 48% mortality and can be prevented. Aim: Establish a consensus research agenda for cancer and NCD prevention and control that has the potential to impact polices, programs and health care delivery. Methods: To develop a NCD research agenda for India, we engaged our community collaborative board (CCB), which included NCD-focused global, national- and state-level stakeholders, and our scientific advisory group (SAG), which included global and national NCD experts, in a three-step process using two Web-based surveys and one in-person meeting. First, we used Delphi methodology to generate topics. Eighteen stakeholders from both CCB and SAG responded to the first Web-based survey generating 165 research ideas during the first round. After accounting for clustering and duplication, we had 56 unique research ideas. Second, these ideas were deliberated upon during the in-person meeting where each participant with a set of 10 stickers placed them next to the research priority(ies) that they felt are important for prevention and control of cancer and NCDs in India. This generated 23 research ideas, which were subjected to SWOT analysis in pairs by the stakeholders using Snowcard methodology with SAG and CCB. The stakeholders prioritized the shortlisted topics based on level of effort and potential to impact NCDs in India. Finally, 15 low effort, high impact priority research ideas for various health outcomes across research disciplines were identified based on discussion with the larger group to reach consensus. The second Web-based survey resulted in identification of 5 key priority research ideas by all stakeholders as being the most important. Results: The 5 prioritized research ideas in order of importance are: (1) development of interventions to empower primary physicians and health workers in early diagnosis of NCDs; (2) evaluation of health system strengthening programs for NCD control; (3) feasibility of integrated care models at primary care level to address multimorbid chronic conditions; (4) development of India specific methods and tools for monitoring trends on NCD morbidity, mortality and risk factors; and (5) identification of effective strategies to mobilize individuals toward NCD screening activities. Conclusion: Development of a consensus research agenda for India is a critical gap needed to pursue resources required to address pressing needs in cancer and other NCDs. The rising mortality and morbidity resulting from cancer and NCDs with similar risk factors, warrants the timely implementation of this agenda. This will generate the evidence-base from which new policies and practices can be used to reduce cancer and other NCDs in India.

The role of contextual and individual factors on periodontal disease in Uruguayan adults.

The present study aimed at understanding the relationship between periodontitis and socio-contextual and individual determinants of health. Data from "The First Uruguayan Oral Health Survey, 2011", which included 223 and 455 individuals with 35-44 and 65-74 years old respectively, were used. A stratified, multistage cluster sampling design was adopted (cities with ≥ 20.000 residents). Periodontitis was assessed using the modified Community Periodontal Index (CPI) and clinical attachment loss (CAL) (periodontal pocket and CAL ≥ 4 mm). Independent variables included contextual socioeconomic status (SES) measured by proportion of houses with Unsatisfied Basic Needs (UBN) and individual demographic and behavioral factors. Logistic regression multilevel models were generated. Living in contexts with a higher UBN was associated with higher odds for periodontitis in both age groups, even when adjusting for individual level variables (odds ratio [OR] = 1.51, 95%CI = 1.42-1.60 and 1.31, 95%CI = 1.21-1.42, respectively). Being male or heavy smoker increased the odds of periodontitis in this population for both age groups. Social structure impacts periodontal disease by modifying individual socioeconomic situations: in better socioeconomic context, UBN acts increasing the protector role of socioeconomic situation but in a poverty context the role is attenuated. Conclusions for this study are that periodontitis varies across contextual socio-demographic groups being higher in the population with a lower SES, challenging health authorities to integrate oral health into national non-communicable diseases programs.

Trade challenges at the World Trade Organization to national noncommunicable disease prevention policies: A thematic document analysis of trade and health policy space.

BackgroundIt has long been contested that trade rules and agreements are used to dispute regulations aimed at preventing noncommunicable diseases (NCDs). Yet most analyses of trade rules and agreements focus on trade disputes, potentially overlooking how a challenge to a regulation’s consistency with trade rules may lead to ‘policy or regulatory chill’ effects whereby countries delay, alter, or repeal regulations in order to avoid the costs of a dispute. Systematic empirical analysis of this pathway to impact was previously prevented by a dearth of systematically coded data.Methods and findingsHere, we analyse a newly created dataset of trade challenges about food, beverage, and tobacco regulations among 122 World Trade Organization (WTO) members from January 1, 1995 to December 31, 2016. We thematically describe the scope and frequency of trade challenges, analyse economic asymmetries between countries raising and defending them, and summarise 4 cases of their possible influence. Between 1995 and 2016, 93 food, beverage, and tobacco regulations were challenged at the WTO. ‘Unnecessary’ trade costs were the focus of 16.4% of the challenges. Only one (1.1%) challenge remained unresolved and escalated to a trade dispute. Thirty-nine (41.9%) challenges focussed on labelling regulations, and 18 (19.4%) focussed on quality standards and restrictions on certain products like processed meats and cigarette flavourings. High-income countries raised 77.4% (n = 72) of all challenges raised against low- and lower-middle–income countries. We further identified 4 cases in Indonesia, Chile, Colombia, and Saudi Arabia in which challenges were associated with changes to food and beverage regulations. Data limitations precluded a comprehensive evaluation of policy impact and challenge validity.ConclusionsPolicy makers appear to face significant pressure to design food, beverage, and tobacco regulations that other countries will deem consistent with trade rules. Trade-related influence on public health policy is likely to be understated by analyses limited to formal trade disputes.

Current status on prevalence, treatment and management of hypertension among Chinese adults in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases

Objective: To investigate the current status of prevalence, treatment, and management on hypertension among Chinese adults from the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases. Methods: We selected a total of 4 000 residents aged ≥18 years for this questionnaire-based survey by multi-stage clustering sampling in 10 National Demonstration Areas between November and December, 2016. Results: There were 3 891 effective questionnaires. The self-reported prevalence of hypertension among aged ≥35 years was 31.47% (1 011/3 213). For the past two weeks, the self-reported treatment of hypertension was 86.75%(877/1 011), with the rates of guidance as 56.87% (575/1 011) on physical activity, 40.95% (414/1 011) on diet, 38.33% (385/1 011) on weight management, and 22.75% (228/1 011) on smoking cessation. For the past 12 months, 74.68% (755/1 011) of the residents aged ≥35 years were under the proper management and 62.12% (628/1 011) of them were under the standardized management programs. The follow-up program lasted for 4 (P(25)-P(75): 4-12) times per year, with 15 (P(25)-P(75): 10-20) minutes per each visit. Hypertensive patients would mainly visit the outpatient clinics (53.51%), followed by home visits (22.91%) and telephone calls (13.64%). Rate of satisfaction on management services was 94.83% (716/755) from the hypertensive patients. Multivariate analysis showed that the rate of self-reported treatment (OR=1.986, 95%CI: 1.222-3.228) and self-reported standardized management (OR=2.204, 95%CI: 1.519-3.199) on hypertension were higher in the Demonstration Areas with higher implementation scores of self-reported non-communicable diseases management. Conclusions: Prevention and management on hypertension in the Demonstration Areas had met the requirement set for the Demonstration Areas during the "12th Five-Year Plan" . Projects on setting up the National Non-communicable Diseases Demonstration Areas had played an active role in promoting the standardized management program on hypertension.