Non-communicable Disease Prevention Strategies Research Articles

Follow the Arrows: Using a Co-Created Causal Loop Diagram to Explore Leverage Points to Strengthen Population Physical Activity Promotion in British Columbia, Canada.

Population physical activity promotion (PPAP) is one of the most effective noncommunicable disease prevention strategies, yet coordination is lacking around the world. Whole-of-system approaches and complex systems methods are called for to advance PPAP. This paper reports on a project which (1)used an Attributes Framework with system mapping (group model building and causal loop diagramming of feedback loops) and (2)identified potential leverage points to address the challenge of effective coordination of multisectoral PPAP in British Columbia. Key findings from stakeholder interviews and workshops described the current system for PPAP in terms of attributes and dimensions in the framework. These were translated into variables and used in group model building. Participants prioritized the importance of variables to address the coordination challenge and then created causal loop diagrams in 3 small groups. One collective causal loop diagram was created, and top priority variables and associated feedback loops were highlighted to explore potential leverage points. Leverage points included the relationships and feedback loops among priority variables: political leadership, visible policy support and governance, connectivity for knowledge translation, collaborative multisector grants, multisector collaboration, and integrating co-benefits. Leveraging and altering "vicious" cyclical patterns to increase coordinated multisector PPAP are key. The Attributes Framework, group model building and causal loop diagrams, and emergent feedback loops were useful to explore potential leverage points to address the challenge of multisectoral coordination of PPAP. Future research could apply the same methods in other jurisdictions and compare and contrast resultant frameworks, variables, feedback loops, and leverage points.

Development and Validation of the Amharic Version of Self-Efficacy and Outcome Expectancy Measures on Intention to Take Preventive Actions on Noncommunicable Disease.

This study is aimed at developing and accessing the validity and reliability of an Amharic version of the self-efficacy and outcome expectancy measures on noncommunicable disease prevention strategies. The intentions to take protective measures on NCDs' self-efficacy and outcome expectancy scales were created in Amharic using a sequential nine-step process that included translation and contextualization of the items, content validity, pretesting of the questions, sampling, and survey administration. Principal component analysis was conducted on 829 university students which showed a one-factor solution for self-efficacy and a three-factor solution for outcome expectancy scales using split-half measures. Confirmatory factor analyses supported the factor structure, which also demonstrated good internal consistency (.828 self-efficacy, .766 outcome expectancy). The scales had a moderate level of correlation (r = .35, p.001) between them. The study resulted in reliable and valid Amharic versions of self-efficacy (9-item) and outcome expectancy (12-item) scales.

Ethnic disparities in prevalence of chronic non-communicable diseases and its multimorbidity among older adults in rural southwest China

BackgroundAs the population ages, chronic non-communicable diseases (NCDs) multimorbidity has emerged as a major public health issue globally. This study examines ethnic disparities in prevalence of NCDs and its multimorbidity among rural southwest Chinese older adults.MethodsA cross-sectional survey was conducted in rural southwest population aged ≥ 60 years consisting of 5,642 consenting participants of Han and three ethnic minority groups (Dai, Ha Ni, and Bai). Information about participants’ demographic characteristics and lifestyle behaviors was obtained using a standard questionnaire. Anthropometric measurements including height, weight, and waist circumference, fasting blood sugar and blood pressure measurement, as well as post-bronchodilator spirometry test were recorded for each participant.ResultsThe age-standardized prevalence of five common chronic NCDs– hypertension, diabetes, coronary heart disease (CHD), stroke, chronic obstructive pulmonary disease (COPD) – and its multimorbidity was 72.8%, 15.9%, 4.0%, 10.0%, 9.8%, and 27.6%, respectively. Bai participants had both the highest overall and sex-specific prevalence rates of hypertension, diabetes, stroke, and COPD, whereas Han participants had the highest rates of CHD (P < 0.01). The results of multivariate logistic regression analysis indicated that female and older participants had a higher probability of chronic NCDs multimorbidity than their counterparts (P < 0.01). Bai ethnic minority participants were more likely to have NCDs multimorbidity while Ha Ni and Dai ethnic minority participants were less likely to have NCD multimorbidity relative to the Han participants (P < 0.05). Older adults with a higher level of education and family history of chronic NCDs, and who were also current smokers, current drinkers, obese, centrally obese, and physically inactive had a greater probability of developing chronic NCDs multimorbidity (P < 0.01).ConclusionsEthnicity and individual demographic and lifestyle factors significantly impact prevalence of chronic NCDs multimorbidity. Future chronic NCDs prevention and control strategies must be tailored to address ethnicity, and culturally tailored lifestyle interventions may reduce the prevalence of chronic NCDs multimorbidity in rural southwest China.

Overnutrition and COVID Prevalence in India: Evidence and Implications

Overnutrition has emerged as a major public health issue in India. Being overweight or obese lowers immunity and has been linked to non-communicable diseases (NCDs), which in turn is associated with vulnerability and severe illness due to COVID. This paper investigates the association of overnutrition indicators with COVID prevalence and case fatality rates in India. Analysis of data from the nationally representative dataset National Family Health Survey-5 and COVID data shows that overnutrition is significantly associated with NCDs and, therefore, overnutrition indicators are also utilised as a surrogate for NCDs. District-level analysis indicates strong and significant relationships between overnutrition and COVID prevalence and fatality rate. Results underscore the importance of addressing obesity in general for successful NCDs prevention strategies, targeting messages of COVID prevention among obese individuals as well as the development of additional vaccination strategies for COVID that take into account the link between COVID and obesity.

Non-communicable Disease-Related Sustainable Development Goals for 66 Belt and Road Initiative Countries.

Since 2015, the Global Burden of Disease Study (GBD) has measured progress in achieving health-related Sustainable Development Goals (SDGs) annually worldwide. Little is known about the status and attainment of indicators of non-communicable diseases (NCDs) by 65 countries from the Belt and Road Initiative (BRI) proposed by China in 2013. Data from GBDs were used to estimate 24 NCD-related SDG indicators in BRI countries from 1990 to 2017. Each indicator was scored from 0 to 100 to compare multiple indicators over the study period. The natural log of the annual change in each location and year and weighted annual rates of change were used to generate projections for 2030. National-level estimates were determined by socio-demographic index (SDI) quintiles in BRI countries with more than 1 million inhabitants. In 2017, the median overall score of NCD-related SDG index for the 66 BRI countries was 60 points, ranging from 29 points in Afghanistan to 84 points in Israel. More than 80% of countries achieved the SDG 2030 maternal mortality (MM) rate target in 2017, and the national skilled birth attendance rate was above 99% in more than 59% countries. However, none of the BRI countries achieved the goal for children's overweight, modern methods of contraception, and universal health coverage. It was predicted that 80.4% of NCD-related SDG targets would be achieved in these countries by 2030. The overall score of NCD-related SDG index were positively associated with SDI quintiles. For many indicators, the achieved progress in many countries is less than the annual rate necessary to meet SDG targets, indicating that substantial efforts need to be made in the coming years. Progress should be accelerated through collaborations between countries, implementation of NCD prevention and control strategies, and monitoring of inequalities in NCD-related SDGs within populations.

Strengthening implementation of diet-related non-communicable disease prevention strategies in Fiji: a qualitative policy landscape analysis

BackgroundNoncommunicable diseases (NCDs) are the leading cause of death globally, and the World Health Organization (WHO) has recommended a comprehensive policy package for their prevention and control. However, implementing robust, best-practice policies remains a global challenge. In Fiji, despite political commitment to reducing the health and economic costs of NCDs, prevalence of diabetes and cardiovascular disease remain the highest in the region. The objective of this study was to describe the political and policy context for preventing diet-related NCDs in Fiji and policy alignment with WHO recommendations and global targets. We used a case study methodology and conducted (1) semi-structured key informant interviews with stakeholders relevant to diet-related NCD policy in Fiji (n = 18), (2) documentary policy analysis using policy theoretical frameworks (n = 11), (3) documentary stakeholder analysis (n = 7), and (4) corporate political activity analysis of Fiji’s food and beverage industry (n = 12). Data were sourced through publicly available documents on government websites, internet searches and via in-country colleagues and analysed thematically.ResultsOpportunities to strengthen and scale-up NCD policies in Fiji in line with WHO recommendations included (1) strengthening multisectoral policy engagement, (2) ensuring a nutrition- and health-in-all policy approach, (3) using a whole-of-society approach to tighten political action across sectors, and (4) identifying and countering food industry influence.ConclusionDiet-related NCD policy in Fiji will be strengthened with clearly defined partner roles, responsibilities and accountability mechanisms, clear budget allocation and strong institutional governance structures that can support and counter industry influence. Such initiatives will be needed to reduce the NCD burden in Fiji.

The Developmental Origins of Health and Disease: Adolescence as a Critical Lifecourse Period to Break the Transgenerational Cycle of NCDs-A Narrative Review.

Noncommunicable diseases (NCDs), including type 2 diabetes and cardiovascular disease, represent a significant and growing global health burden. To date, a primary focus has been on treatment approaches to NCDs once manifested rather than strategies aimed at prevention. In this context, there is clear evidence that a range of adverse early life exposures can predispose individuals towards a greater risk of developing NCDs across the lifecourse. These risk factors can be passed to future generations, thus perpetuating a cycle of disease. This concept, preferentially termed “developmental programming”, forms the basis of the Developmental Origins of Health and Disease (DOHaD) framework. To date, DOHaD has focused on preconception, pregnancy, lactation and, more recently, paternal health at the time of conception. However, it is becoming increasingly clear that investment in the window of adolescence is perhaps the most critical developmental window. Adolescence is a period where lifestyle behaviours become entrained. Therefore, a focus on adolescent behaviours, health literacy and emotional development may afford the best opportunity to break the cycle of NCDs. As the next generation of parents, adolescents should therefore be considered a priority group in advancing appropriate and informed actions aimed at reducing NCD risk factors across the lifecourse. This advancement requires a more comprehensive community understanding and uptake of DOHaD knowledge and concepts. NCD prevention strategies have typically entailed siloed (and often disease-specific) approaches with limited efficacy in curbing NCD prevalence and breaking the transgenerational transmission of disease traits. Recent findings across various disciplines have highlighted that a lifecourse systems approach is required to establish a comprehensive and sustainable framework for NCD intervention. A whole community approach with a particular focus on adolescents as potential agents of change is necessary to break the disease cycle.

Analyzing the Implementation of Policies and Guidelines for the Prevention and Management of Type 2 Diabetes at Primary Health Care Level in Nepal.

BackgroundNepal, in recent years, is witnessing an increasing problem of type 2 diabetes that has resulted significant premature deaths and disability. Prevention and management of non-communicable diseases (NCDs) including diabetes have been prioritized in the national policies and guidelines of the Nepal Government. However, research looking at the overview of the implementation of the existing policies and guidelines for diabetes prevention and control is scarce. Hence, this study reviewed diabetes related existing policies and its implementation process at the primary health care level in Nepal.MethodsThis study involved two phases: Phase I: situation analyses through review of documents and Phase II: qualitative exploratory study. In phase I, four databases (Medline, Web of Science, Embase and PubMed) were systematically searched using key search terms related to diabetes care and policies between January 2000 and June 2021. Also, relevant gray literature was reviewed to understand the trajectory of policy development and its translation with regards to diabetes prevention and management at primary health care level in Nepal. Following the phase I, we conducted in-depth interviews (IDI) and key informant interviews (KII) with health care providers, policy makers, and managers (IDI = 13, and KII = 7) at peripheral and central levels in Kavrepalanchowk and Nuwakot districts of Nepal. The in-depth interviews were audio recorded, transcribed, and coded. The triangulation of data from document review and interviews was done and presented in themes.ResultsFour key themes were identified through triangulating findings from the document review and interviews including (i) limited implementation of policies into practices; (ii) lack of coordination among the different levels of service providers; (iii) lack of trained human resources for health and inadequate quality services at the primary health care level, and (iv) inadequate access and utilization of diabetes care services at primary health care level. Specifically, this study identified some key pertinent challenges to the implementation of policies and programs including inadequate resources, limited engagement of stakeholders in service design and delivery, lack of trained health care providers, lack of financial resources to strengthen peripheral health services, fragmented health governance, and weak reporting and monitoring systems.ConclusionThis study revealed that the policies, plans, and strategies for prevention and management of NCDs in Nepal recognized the importance of diabetes prevention and control. However, a major gap remains with adequate and lack of clarity in terms of implementation of available policies, plans, strategies, and programs to address the problem of diabetes. We suggest the need for multisectoral approach (engaging both health and non-health sectors) at central as well as peripheral levels to strengthen the policies implementation process, building capacity of health care providers, ensuring adequate financial and non-financial resources, and improving quality of services at primary health care levels.

European Code against Cancer: Europe’s key cancer prevention tool in informing the general public how to reduce their cancer risk

Abstract The European Code against Cancer (ECAC), launched in 1987 and after several periodical updates now used in its 4th edition published in 2014-15 in all official European languages, is a key cancer prevention tool that translates scientific evidence into unambiguous public health recommendations for the general public of how to reduce their risk of getting or dying from cancer. The 4th edition is the most comprehensive one, providing context and background information for a better understanding of the twelve recommendations. It is further supported by a recently launched self-learning course for health promoters, hosted in the E-Learning Center of Europe's leading network of cancer prevention research institutions: Cancer Prevention Europe (CPE). With an abundance of rather confusing “cancer news” the public receives through media and the Internet almost everyday, there is indeed a need for a reliable, authoritative and evidence-based information source for cancer prevention. For that reason, the ECAC recommendations follow three key scientific principles: it only recommends scientifically established actions for reducing cancer risk, its messages are relevant for a broader general public, and it communicates them in a non-scientific language so they are easy to follow. In 2020, IARC/WHO, CPE, Association of European Cancer Leagues and other ECAC stakeholders, have developed a roadmap for the ECAC's sustainability within the innovative Partnership on Action Against Cancer (iPAAC). This plan being essential towards achieving the 80% awareness goal, its main elements include a scientific revision, an expansion to include scientifically established successful interventions in cancer prevention on both individual and population levels, an expansion on the target groups encompassing health professionals and policymakers, and an outreach for synergies with other non-communicable diseases prevention strategies.

Health-promoting university: the implementation of an integrated guidance post for non-communicable diseases (Posbindu PTM) among university employees.

Non-communicable diseases (NCDs) remain a challenge globally and in Indonesia. Workplace environments may place employees at risk for NCD behavioral factors. This study aimed to develop an integrated guidance post for NCD (in Indonesian, 'pos pembinaan terpadu penyakit tidak menular' [Posbindu PTM] early detection among employees in one of the Indonesian universities. Posbindu PTM is a community-based program oriented towards promotive and preventive efforts to control NCDs where the community acted as change agents. We conducted a process evaluation based on a quantitative approach through a survey (n = 313) and a qualitative method using in-depth interviews (n = 12) to support our findings that Posbindu PTM was acceptable and feasible to implement in a university context. High participation in Posbindu PTM showed that the program could encourage the university employees to join NCD prevention strategies from early detection to counseling and referral. All participants positively accepted Posbindu PTM for its benefits to health, the flexibility of the program, and the quality service provided by cadres. A need-based program planning, commitment from university leaders, adequate human resources and facilitation, and cooperation between departments, the clinic, and local primary health center and health department determined the success of Posbindu PTM implementation. In contrast, external activities negatively affected participants to join Posbindu PTM. There is a need for more routine scheduling and online-based application to enhance the program's performance. Posbindu PTM is essential for engaging employees with their health and may serve as a model for NCD prevention and control in similar settings. With Posbindu PTM implementation's success, a further stage is required to empower and sustain the Posbindu PTM program towards health-promoting universities.

Insufficient physical activity level among Sahrawi adults living in a protracted refugee setting

BackgroundThe Sahrawi people fled their homes in 1975 as the conflict in Western Sahara escalated and settled down near Tindouf, Algeria, where they still live. High prevalence of overweight and obesity and type 2 diabetes had been found in this protracted refugee setting. Scaling up national policy efforts to promote physical activity (PA) is critical to reducing the prevalence of noncommunicable diseases (NCDs) in the near future. One possible barrier to the inclusion of PA in NCD prevention strategies is the lack of research on PA level, which may reduce political support and policy development for PA. Thus, the aim of this study was to investigate the PA level among adults living in Sahrawi refugee camps and socioeconomic factors associated with PA.MethodsA cross-sectional survey was carried out in 2014 in five refugee camps near Tindouf, Algeria. A total of 180 women and 175 men were included. PA was measured using the international physical activity questionnaire short form (IPAQ-SF).ResultsThere was a large amount of variance in reported PA for both genders, ranging from 10 min of total PA per week to above 40 h. Forty-three percent of the participants had a low PA level (defined as not meeting the PA recommendations of 150 min of moderate to vigorous PA per day). The chi-square test of independence showed that males, those aged ≥ 60 years and people with higher education were more likely to be in the low PA level category. No significant relationship was found between PA level and BMI status. Most of the participants thought that engaging in PA would be wise, valuable, right and good but thought to a lesser degree that PA would be easy, comfortable and interesting.ConclusionsAlmost half of the participants were categorised as insufficiently physically active, however, most of the Sahrawi refugees express a positive attitude towards PA. PA is a low-cost approach to reducing deaths and NCDs, government initiatives to increase PA levels in refugee camps are advised.

The contribution of employment and working conditions to occupational inequalities in non-communicable diseases in Europe.

BackgroundSocial inequalities in non-communicable diseases (NCDs) are evident across all European regions. Employment and working conditions are important determinants of NCDs, however, few comparative studies have examined how these conditions contribute to health inequalities. This study therefore examines the association of non-standard employment and poor working conditions with occupational inequalities in multiple NCDs and whether there are differences by gender and across European regions.MethodsWe used cross-sectional data from 20 European countries for women and men aged 25–75 (n = 19 876), from round 7 of the European Social Survey. Data were analyzed for self-rated health (SRH) and 9 NCDs: heart/circulatory problems, high blood pressure, arm/hand pain, breathing problems, diabetes, severe headaches, cancer, obesity and depression. We used logistic regression models, stratified by gender, and adjusted rate ratios to examine whether occupational inequalities in NCDs were reduced after adjusting for non-standard employment and poor working conditions, across European regions.ResultsAfter adjustment, occupational inequalities were significantly reduced across all regions of Europe. Reductions were particularly large among the lowest occupational group and for poor-SRH, depression and obesity. For these conditions, reductions were in the range of 60–99%.ConclusionsEmployment and working conditions are important determinants of occupational inequalities in NCDs. Labour market regulations should therefore be considered in the formulation of NCD prevention strategies.

International Investment Law and Non-Communicable Diseases Prevention

Abstract It is increasingly acknowledged that non-communicable diseases (NCDs) create immense human and economic costs, disproportionately affecting developing countries. This article, which serves as an introduction to this Special Issue on international investment law and NCD prevention, outlines the international framework for the prevention of NCDs, noting the more advanced development of tobacco control policies compared to policies relating to other NCD risk factors, such as unhealthy diets and alcohol consumption. Drawing on the Philip Morris v Uruguay case, the article explains how international investment law and NCD prevention interact and the problems this interaction may raise for States willing to adopt robust NCD prevention strategies involving the regulation of the tobacco, alcohol and food industries. It concludes by introducing other contributions in this Special Issue and by highlighting the need to build legal expertise in this area.

The QUEST for Effective and Equitable Policies to Prevent Non-communicable Diseases: Co-Production Lessons From Stakeholder Workshops.

Background: Non-communicable diseases (NCDs) account for some 90% of premature UK deaths, most being preventable. However, the systems driving NCDs are complex. This complexity can make NCD prevention strategies difficult to develop and implement. We therefore aimed to explore with key stakeholders the upstream policies needed to prevent NCDs and related inequalities. Methods: We developed a theory-based co-production process and used a mixed methods approach to engage with policy- and decision-makers from across the United Kingdom in a series of 4 workshops, to better understand and respond to the complex systems in which they act. The first and fourth workshops (London) aimed to better understand the public health policy agenda and effective methods for co-production, communication and dissemination. In workshops 2 and 3 (Liverpool and Glasgow), we used nominal group techniques to identify policy issues and equitable prevention strategies, we prioritised emerging policy options for NCD prevention, using the MoSCoW approach. Results: We engaged with 43 diverse stakeholders. They identified ‘healthy environment’ as an important emerging area. Reducing NCDs and inequalities was identified as important, underpinned by a frustration relating to the evidence/ policy gap. Evidence for NCD risk factor epidemiology was perceived as strong, the evidence underpinning the best NCD prevention policy interventions was considered patchier and more contested around the social, commercial and technological determinants of health. A comprehensive communications strategy was considered essential. The contribution of ‘elite actors’ (ministers, public sector leaders) was seen as key to the success of NCD prevention policies. Conclusions: NCDs are generated by complex adaptive systems. Early engagement of diverse stakeholders in a theory-based co-production process can provide valuable context and relevance. Subsequent partnership-working will then be essential to develop, disseminate and implement the most effective NCD prevention strategies.

Trends in the proportionate mortalities attributed to noncommunicable diseases in sub-Saharan Africa for the period 2000 to 2016.

Noncommunicable diseases (NCDs) remain a growing global health issue and sub-Saharan Africa (SSA) is no exception. Using secondary data obtained from the World Bank on 48 SSA countries, we describe the trends in the proportionate mortalities attributed to NCDs in SSA between 2000 and 2016. The baseline proportionate mortalities attributed to NCDs in SSA increased from 22.49% in 2000 to 33.69% in 2016, representing about 11% increase. The trend was replicated across the low-, middle-, and high-income countries in SSA. The highest change in the NCD mortalities in low-income SSA countries was seen in Eritrea where NCD mortalities increased from 19.3% in the year 2000 to 45.2% in 2016. In Rwanda, it rose from 24.8% to 44% during the same period. Ghana, a lower-middle-income country, also witnessed an increase from 27.3% in 2000 to 42.7% in 2016. The general increasing trend in the burden of NCD mortalities in SSA implies the need for higher prioritization of NCD prevention and control initiatives. There is a need for a greater contribution of nontraditional stakeholders in health through a multi-sectoral approach. We also recommend integrating NCD prevention and control strategies into existing public health structures being used for communicable disease control.

Governing Noncommunicable Diseases Through Political Rationality and Technologies of Government: A Discourse Analysis.

In the last two decades, global action to address noncommunicable diseases (NCDs) has accelerated, but policy adoption and implementation at the national level has been inadequate. This analysis examines the role of rationalities of governing, or governmentality, in national-level adoption of global recommendations. Critical discourse analysis was conducted using 49 formal institutional and organizational documents obtained through snowball sampling methodology. Text were coded using a framework of five forms of governmentality and analyzed to describe the order of discourse which has emerged within the global NCD policy domain. The dominant political rationality used to frame NCDs is rooted in risk governmentality. Recommendations for tobacco control and prevention of harmful alcohol use rely on a governmentality of police mixed with discipline. The promotion of physical activity relies heavily on disciplinary governmentality, and the prevention of unhealthy diet mixed disciplinary measures, discipline, and neoliberal governmentalities. To translate global NCD prevention and control strategies to national action, acceptability for the political rationalities embodied in policy options must be nurtured as new norms, procedures, and institutions appropriate to the political rationalities of specific interventions are developed.

Uso de medicamentos en pacientes crónicos de un Centro de Salud Comunitario en Tabasco.

Introducción: Las enfermedades no transmisibles (ENT) son patologías de larga duración cuyo resultado es la combinación de diversos factores donde la farmacoterapia (FT) incluye diversos tratamientos de eficiencia altamente variable.&#x0D; Método: La presente investigación evaluó el grado de utilización de la FT en pacientes ambulatorios diabéticos e hipertensos de un Centro de Salud Comunitario (CSC) de Cunduacán, Tabasco durante el Periodo Enero - Diciembre del 2015 mediante un estudio descriptivo, transversal y retrospectivo que incluyó la revisión del historial clínico de los pacientes ambulatorios. La población se dividió según el diagnóstico clínico: 1) diabetes (DT2), 2) hipertensión (HTA) y 3) diabetes con hipertensión (DT2-HTA).&#x0D; Resultados: El fármaco de mayor prescripción para DT2-HTA y DT2 fue la metformina-glibenclamida, mientras que para la HTA fue el losartán. Se identificaron interacciones medicamentosas (IM) de severidad leve (7.69%), moderada (90.77%) y grave (1.54%); errores de medicación (EM) hasta en un 45.45% y problemas relacionados con la medicación (PRM) en un 77.92%.&#x0D; Conclusiones: La participación del farmacéutico y su integración en equipos multidisciplinarios en el ámbito de la salud pública, contribuirá a mejorar la eficiencia de la FT del paciente, incrementará su calidad de vida y redituará en beneficios tangibles dentro de campañas de prevención y control de ENT.

Gender differences in self care in type 2 diabetes in rural Kerala

Background: Noncommunicable Diseases (NCDs) were estimated to have contributed to almost 60% of deaths in the world and 43% of the global burden of disease in 1999. NCDs are rapidly becoming a major public health threat in the developing world. The W.H.O fact file on NCDs states that healthy diet, regular physical activity, maintaining a normal body weight (self-care) are ways to prevent or delay the onset of type 2 diabetes or its complications. Thus, self-care in diabetes is the corner stone in achieving good glycemic control, thereby preventing the onset of diabetes complications which increases the morbidity and mortality of the disease. This study was undertaken to understand the effect of self-care on HbA1C (blood sugar control) among males and females with Type -2 diabetes in a rural population in Kerala. The study tries to draw out the differences in self-care among males and females taking into consideration the patriarchal nature of the society and to understand the gender differences in approaches to self-care. Sex- based differences should be considered when developing awareness and treatment programs for people with diabetes, more precisely in NCD preventive measures specifically for the Indian subcontinent.&#x0D; Materials and methods: A cross sectional study was conducted in a stratified random sample of diabetes patients belonging to the three religious groups found in the study area, in a diabetes treatment center in Kanjirapally taluk of Kottayam district. Based on pilot study, a sample of 300 is chosen with 138 males and 162 females. For part 1 of the questionnaire, demographic details were entered by the researcher and the medical records were accessed to record the relevant details like height, weight, A1C, B.M.I., F.B.S. and chronic conditions of the patients. The selfcare activity of the patients were assessed with the SDSCAS (Summary of diabetes self-care activity scale). It&#x0D; consists a core set of 12 questions to assess the dietary habits, exercise regimen, blood sugar testing, foot care and smoking status for the past 7 days. &#x0D; Results: Since the representative sample is not made of equal number of males and females, comparison of blood sugar control (HbA1C) based on self-care activities for males and females were calculated. The independent sample t-test is highly significant at 0.01 level with respect to general diet, specific diet, dietary adherence and podiatric care. The t-test again shows significance at 0.05 level with respect to physical activities on comparison. &#x0D; Conclusions: The self-care activities varied greatly between males and females. The self-care activities of the females were very poor when compared with the males. The poor self-care activities of the females could be attributed to behaviour conditioned by gender relations prevalent in the society. Women seem to assimilate or internalize the patriarchal subjectivity of the society. But this is a feature of most households not only in the study area but of the country as a whole. This gender difference in self-care can be annihilated by stringent awareness and health education campaigns. NCD prevention strategies should include gender sensitive health promotion measures to achieve the WHO Global Strategy for the Prevention and Control of Noncommunicable Diseases (NCD Action Plan).

Capacity and readiness of primary health care centers for implementation of the basic strategy for prevention and control of non-communicable diseases in Saudi Arabia. A case study from the Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.

Objectives:To assess the capacity and readiness of primary healthcare centers (PHC) for the implementation of basic strategies for the prevention and control of non-communicable diseases (NCDs) at the Ministry of National Guard-Health Affairs (MNG-HA) in Saudi Arabia.Methods:Facility-based face-to-face interviews were conducted in 41 PHCs included in this survey, using the World Health Organization (WHO) questionnaire. Main area survived were: availability of human resources, medical equipment, infrastructure, medicines, service utilization, referral systems, and community outreach.Results:Approximately 90% of the PHC centers were located in urban areas of the country. The level of staff training on NCD prevention and control strategies was reported to be inadequate, particularly for nurses and other healthcare providers. As for diagnostic equipment, diagnostic tests, essential medication, access to referral facilities and medical records most of them were available in all the PHCs among the different categories.Conclusions:The MNG-HA PHCs appear to have the capacity to integrate strategies for the prevention and control of NCDs as part of their daily functions. However, improvements are required in some areas to facilitate the integration process and training the health care workers (HCWs) on prevention and control of NCDs as part of their daily practice.

The Role of Environmental Disruptor Chemicals in the Development of Non Communicable Disease.

The increasing prevalence of non communicable diseases (NCDs) poses main challenges to global public health. Various environmental exposures to different chemicals and pollutants might interact with genetic and epigenetic mechanisms resulting in the development of NCDs. Among these environmental exposures, endocrine disrupting chemicals (EDCs) consist of a group of compounds with potential adverse health effects and the interference with the endocrine system. They are mostly used in food constituents, packaging industries and pesticides. Growing number of in vitro, in vivo, and epidemiological studies documented the link of EDC exposure with obesity, diabetes, and metabolic syndrome, which are the underlying factors for development of NCDs. Prevention of exposure to EDCs and reduction of their production should be underscored in strategies for primordial prevention of NCDs.