Non-communicable Diseases Deaths Research Articles

Burden of non-communicable diseases in China and its provinces, 1990-2021: Results from the Global Burden of Disease Study 2021.

Non-communicable diseases (NCDs) are the primary causes of disability and death. The aim of this study is to analyze the disease burden of NCDs in China from 1990 to 2021. This study used data on NCDs in China and its provinces from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The study analyzed the disease burden of NCDs in 2021 and its changes from 1990 to 2021 using indicators including deaths and disability-adjusted life years (DALYs). Between 1990 and 2021, the NCD burden in China exhibited an upward trend. In 2021, China had 10.6 (95% uncertainty interval [UI]: 9.0-12.2)million deaths and 349.3 (95% UI: 301.5-401.2)million DALYs due to NCDs, accounting for 91.0% (95% UI: 90.4-91.7%) of all deaths and 86.7% (95% UI: 86.0-87.4%) of all DALYs. NCDs caused a lower disease burden in females than in males. Cardiovascular diseases and neoplasms were the main NCD level 2 causes of deaths and DALYs, resulting in 5.1 (95% UI: 4.3-5.9) and 2.8 (95% UI: 2.3-3.4) million deaths and 100.2 (95% UI: 84.6-116.6) million and 71.2 (95% UI: 59.3-85.2) million DALYs in 2021, respectively. Chronic respiratory diseases were the third leading cause of NCD deaths, while musculoskeletal disorders were the third leading cause of NCD DALYs. Qinghai, Xizang, and Heilongjiang had the highest age-standardized mortality rates and age-standardized DALY rates (per 100,000) for NCDs, while Hong Kong Special Administration Region (SAR), Macao SAR, and Shanghai recorded the lowest age-standardized mortality rates and age-standardized DALY rates. NCDs caused a high disease burden in China and exhibited heterogeneity across sexes and provinces. China needs to focus on addressing key NCDs and implement intervention measures tailored to the disease distribution characteristics to reduce the NCD burden.

Landscape of esophageal cancer in Northern Kenya: experience from Garissa Regional Cancer Center.

Esophageal cancer (EC) is the ninth most common cancer and the sixth leading cause of cancer deaths worldwide. More than 80% of cases and deaths from EC occur within developing countries. In Kenya, cancer is the second leading cause of non-communicable disease deaths, and the trend of cancer deaths is projected to increase as per the 2020 GLOBOCAN report showing 42,116 new cases annually with a mortality of 27,092 cases. EC is the leading cancer in men and the third most common in women in Kenya. The Garissa Regional Cancer Center (GRCC) is one of the three regional cancer centres in Kenya. Despite the rising EC incidence in the region, there is limited data about the clinicopathological features and treatment outcomes of EC, therefore, this is the first study to look at the landscape of EC in the northern Kenya region. This was a retrospective study involving patients' file review of confirmed EC cases diagnosed or treated at the GRCC from 2019 to 2023. Data collected from each patient's chart included age, sex, risk factors, family history of EC, histological type, stage at diagnosis, treatment type and survival outcomes. For patients who were no longer in contact with the staff through clinic visits, the patients or their next of kin were contacted through phone calls for patients' survival status. Data were collected and stored using the STATA software. Over the study period, 124 esophageal cases were identified, 64 (51.4%) were males and 60 (48.4%) were females with a mean age of 57.56 years. In terms of risk factors, hot beverage consumption was the highest (47 cases, 37.9%), followed by history of peptic ulcer disease (27 cases, 21.8%), smoking (8.9%) and gastresophageal reflux disease (2 cases, 1.6%). Stage of diagnosis at presentation was stage 1 (1 case, 0.8%), stage 2 (22 cases, 17.8%), stage 3 (25 cases, 20.2%), stage 4 (50 cases, 40.3%), not staged (26 cases, 21%). The majority had squamous cell carcinoma (SCC) (105 cases, 84.7%), followed by adenocarcinoma (5 cases, 4%), anaplastic (5 cases, 4%), SCC+ adenocarcinoma (1 case, 0.8%), unknown histology (8 cases, 3.2%). Nearly all patients had triple assessment (Endoscopy, histology and staging scans) accounting for 92 cases (74.2%), 24 cases (20%) had endoscopy+ histology only, and 8 cases (3.2%) had only imaging scans. In terms of family history of EC, 20 cases (16.1%) had a family history of EC.Most of the patients were of ethnic Kenyan-Somali background (108 cases, Kenyan Somali, 87.1%) and majority were from Garissa County 96 cases (77.4%), 12 cases (9.7%) Wajir County, 12 cases (9.7%) from Tana River County and 4 cases (3.2%) from other counties. Many patients lacked health insurance (27 cases, 25.8%), while the majority paid out of pocket (92 cases,74.1%). Only 21% (26 cases) received chemotherapy alone, 5 cases (4%) got radiotherapy alone, 12.9% (16 cases) got chemoradiotherapy and a significant number of patients (77 cases, 62.1%) did not receive hospital-based cancer treatment. This study is the first esophageal study at the GRCC and in northern Kenya in general. Our study confirmed the clinicopathological features of one of the most common cancers in Kenya and more so among Kenyan-Somalis.The study also validates the predominance of histological subtypes of esophageal SCC with the late presentation, short survival and significant loss of follow-up. We recommend future EC studies employing a large prospective design with a large sample size to determine the impact of the new GRCC on the outcomes of EC patients and the local community.

Childhood obesity

Abstract Obesity is one of the world's most challenging public health problems. The phenomenon of childhood obesity is increasing in industrialized and emerging countries, with the major impact of the onset of diseases in adolescence and adulthood. The high prevalence of youth obesity is associated with increasing rates of diabetes, hypercholesterolaemia, non-alcoholic fatty liver disease and hypertension, which are risk factors for the development of cardiovascular disease in adulthood, the leading cause of chronic non-communicable disease deaths according to the World Health Organization. A healthy diet associated with an active lifestyle is a valuable tool for the prevention, management and treatment of many diseases, including obesity. In this sense, it is most effective to intervene in the paediatric population in order to establish correct eating habits from the earliest years of life that support current and future nutritional well-being. Among the various nutritional strategies to combat obesity and associated comorbidities, the Mediterranean Diet (DM) has been identified as the most effective. Educational actions to improve dietary behaviour and increase awareness of the health benefits associated with a traditional MD must be designed at school, home and clinic level. Better policies that create a new environment for children and grown-ups to choose better diets and lead active and healthy lives in every country of the WHO European Region are needed.

Mortality attributable to diets low in fruits, vegetables, and whole grains in Brazil in 2019: evidencing regional health inequalities

ObjectiveThe objective of this study was to describe non-communicable disease (NCD) mortality attributable to diets low in whole grains, fruits, and vegetables in Brazil in 2019. Study designEcological study. MethodsData from the Global Burden of Disease 2019 for adults aged ≥25 years of both sexes in Brazil and its 27 states were used to estimate the intake of fruits, vegetables, and whole grains; the NCD mortality attributable to these dietary risk factors; and the correlation between socio-demographic index (SDI), the age-standardised mortality rate (ASMR) per 100,000 population, and intake. ResultsThe Brazilian population had suboptimal consumption of fruits, vegetables, and whole grains, and 62,439 NCD deaths were attributable to these three dietary risk factors in 2019. The highest ASMRs were found for diets low in whole grains (14.4, 95% uncertainty interval [95% UI]: 7.8–18.4), followed by diets low in vegetables (7.6, 95% UI: 4.8–10.3) and fruits (5.0, 95% UI: 3.2–7.0). A similar ranking was observed for all Brazilian states. The SDI was negatively correlated with ASMRs and was positively correlated with the investigated dietary risks. The population from the Northeast and North states presented the lowest SDI and the highest NCD ASMRs attributable to diets low in fruits, vegetables, and whole grains and consumed less of all three health foods. ConclusionDiets low in fruits, vegetables, and mainly whole grains substantially contributed to NCD mortality in Brazil, especially in states with low SDI. Our findings support the need to target food interventions to reduce regional health inequalities within the country.

The estimated dietary and health impact of implementing the recently approved 'high in' front-of-package nutrition symbol in Canada: a food substitution scenario modeling study.

Front-of-pack labeling (FOPL) has been identified as a cost-effective policy to promote healthy food environments and to help consumers make healthier food choices. Consumer surveys report that after implementation of mandatory 'high in' FOPL symbols between 30 and 70% of consumers choose or were willing to choose products with fewer 'high in' symbols. Health Canada has recently published FOPL regulations that will require prepackaged food and beverages that meet or exceed thresholds for sodium, total sugars, or saturated fat to display a 'high in' FOPL nutrition symbol. The aims were to estimate the potential (1) dietary impact of substituting foods with similar foods that would display at least one less 'high in' symbol, and (2) the number of diet-related noncommunicable disease (NCD) deaths that could be averted or delayed due to estimated dietary changes. Baseline and counterfactual intakes of sodium, total sugars, saturated fats, and energy were estimated among Canadian adults (n = 11,992) using both available days of 24 h-recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS). Similar foods to those reported in CCHS that would display at least one less 'high in' symbol (n = 239) were identified using a Canadian branded food composition database. Based on current FOPL consumer research, identified foods were substituted for 30, 50, and 70% of randomly selected CCHS-Nutrition adult participants and for all adult participants. Potential health impacts were estimated using the Preventable Risk Integrated ModEl. Mean dietary reductions of between 73 and 259 mg/day of sodium, 2.0 and 6.9 g/day of total sugars, 0.2 and 0.5 g/day of saturated fats, and 14 and 46 kcal/day of energy were estimated. Between 2,148 (95% UI 1,913-2,386) and 7,047 (95% UI 6,249-7,886) of deaths due to diet-related NCDs, primarily from cardiovascular diseases (70%), could potentially be averted or delayed if Canadians choose products with fewer 'high in' symbols. Results suggest that FOPL could significantly reduce sodium and total sugar intakes among Canadian adults, the consequences of which could avert or delay an important number of diet-related NCD deaths. These findings provide relevant data to support the importance of the impending FOPL regulations.

Non-communicable disease mortality in young people with a history of contact with the youth justice system in Queensland, Australia: a retrospective, population-based cohort study

Young people who have had contact with the criminal justice system are at increased risk of early death, especially from injuries. However, deaths due to non-communicable diseases (NCDs) in this population remain poorly described. We aimed to estimate mortality due to NCDs in people with a history of involvement with the youth justice system, compare NCD mortality rates in this population with those in the general population, and characterise demographic and justice-related factors associated with deaths caused by NCDs in people with a history of contact with the youth justice system. In this retrospective, population-based cohort study (the Youth Justice Mortality [YJ-Mort] study), we included all people aged 10-18 years (at baseline) charged with a criminal offence in Queensland, Australia, between June 30, 1993, and July 1, 2014. We probabilistically linked youth justice records with adult correctional records and national death records up to Jan 31, 2017. Indigenous status was ascertained from youth justice and adult correctional records, with individuals identified as Indigenous in either source classified as Indigenous in the final dataset. We estimated crude mortality rates and standardised mortality ratios (SMRs) for comparisons with data from the Australian general population. We identified risk factors for NCD deaths using competing-risks regression. Of 48 670 individuals aged 10-18 years (at baseline) charged with a criminal offence in Queensland, Australia, between June 30, 1993, and July 1, 2014, 11 897 (24·4%) individuals were female, 36 773 (75·6%) were male, and 13 250 (27·2%) were identified as identified as Indigenous. The median age at first contact with the youth justice system was 15 years (IQR 14-16), the median follow-up time was 13·4 years (8·4-18·4), and the median age at the end of the study was 28·6 years (23·6-33·6). Of 1431 deaths, 932 (65·1%) had a known and attributed cause, and 121 (13·0%) of these were caused by an NCD. The crude mortality rate from NCDs was 18·5 (95% CI 15·5-22·1) per 100 000 person-years among individuals with a history of involvement with the youth justice system, which was higher than among the age-matched and sex-matched Australian general population (SMR 1·67 [1·39-1·99]). Two or more admissions to adult custody (compared with none; adjusted sub-distribution hazard ratio 2·09 [1·36-3·22]), and up to 52 weeks in adult custody (compared with none; 1·98 [1·18-3·32]) was associated with NCD death. Young people with a history of contact with the justice system are at increased risk of death from NCDs compared with age-matched and sex-matched peers in the general Australian population. Reducing youth incarceration and providing young people's rights to access clinical, preventive, and restorative services should be a priority. National Health and Medical Research Council.

Future burden of non-communicable diseases attributable to overweight in Chile: a multistate life table modeling study

BackgroundPrevious studies have quantified the current burden of diseases attributable to overweight in Chile. However, no study has estimated the attributable burden of overweight in the future. Herein, we estimated the potential impact of different trajectories in the prevalence of overweight on the incidence and mortality from non-communicable diseases (NCDs) in Chilean adults from 2019 to 2030.MethodsA multistate life table modelling was used to estimate the business-as-usual (BAU: if the current rate of increase in BMI persist through the next 11 years; i.e., 0.4% per year from 2003 to 2017) and three counterfactual scenarios (1: the increase rate of overweight is reduced by half; 2: maintanance of the current prevalence of overweight; 3: the prevalence of overweight is reduced by 6.7%) over a 11-year simulation period for burden of NCDs attributable to overweight in Chilean adults aged 20 to 80 years. The model inputs included nationally representative data of body mass index, national official demographic records, NCDs from the Global Burden of Disease study in 2019, and relative risks from a published meta-analysis.ResultsIf the current trends of increase in overweight are maintained in Chile, approximately, 669 thousand cases and 117 thousand deaths from NCDs will occur from 2020 to 2030. In case the increase rate of overweight is reduced by half during this period, around 7 thousand cases and 1.4 thousand deaths from NCDs would be prevented, while achieving no increase in the prevalence of overweight would avert 10 thousand cases and 2 thousand deaths. In the optimistic scenario of reducing the prevalence of overweight by 6.7% until 2030, approximately 25 thousand cases and 5 thousand deaths from NCDs would be prevented.ConclusionWe estimated that the number of NCDs cases and deaths that could be avoided by decreasing the prevalence of overweight in Chilean adults. Preventive programs aimed to reduce overweight may have a high impact on the future burden of NCDs in Chile.

Burdens of non-communicable disease attributable to metabolic risk factors in Australia, 1990–2019: joinpoint regression analysis of the Global Burden of Disease Study

BackgroundLong-term and comparative assessments of trends in non-communicable disease (NCD) burden attributable to metabolic risk are sparse. This study aimed to assess burdens and trends of NCD attributable to metabolic...

Peran Penting Inflamasom NLRP3 pada Aterosklerosis

Cardiovascular diseases (CVDs) still contribute as the main cause of mortality and premature mortality worldwide. In Indonesia, CVDs contribute to 35% of the main cause of death in non-communicable diseases followed by diabetes at 6%. The ischemic heart disease and acute ischemic stroke is the main cause of death in Indonesia due to atherosclerosis. Atherosclerosis is a multifactorial cause, with chronic inflammation which causes myocardial infarction and acute ischemic stroke. Research demonstrated that one of the underlying mechanisms of atherosclerosis is inflammation. The current research suggested that inflammation could activate a complex of cytosol proteins, namely nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3) inflammasome. The NLRP3 inflammasome is known as a protein sensor as a response to danger signals known as pathogen-associated molecular patterns (PAMPs) or damage/danger-associated molecular patterns (DAMPs). The NLRP3 inflammasome will convert the pro-IL1β and pro-IL-18 into their mature forms which initiates the cell death (pyroptosis) through the cleavage of Caspase-1. This NLRP3 inflammasome has a central role in the initiation and progression of atherosclerosis by affecting the sequences of its cellular and molecular targets. To date, several small molecules and drugs have been identified as NLRP3 inflammasome inhibitory pathways and potential therapeutic agents for atherosclerosis. In this review, we will discuss further the structure of NLRP3 inflammasome and its roles in atherosclerosis, and the potential candidates of the small molecules and drugs targeted in the inflammasome pathway.

Handy EKG: a low-cost 3-lead electrocardiograph for primary care

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Universidad Nacional Autonoma de Honduras. Introduction Cardiovascular diseases constitute the majority of Noncommunicable Diseases deaths worldwide. In Honduras, cardiovascular diseases represent the fifth cause of death between 45 to 49 years old; 20% of emergency room visits are due to cerebrovascular events, heart failure and acute myocardial infarction. Purpose Create a low-cost ECG and digital platform that provides portability and connectivity with mobile devices and automated diagnosis to support clinicians in primary care. Methods A low-cost 3-lead ECG (Handy EKG) was developed under the technological project approach, which has two general stages: (i) platform design and (ii) field validation. The hardware design was carried out by comparing microcontrollers, 3D printing the cases and beta testing with volunteers to accomplish prototype stability. Second, the mobile application and web platform were designed to host the reference database and establish live communication between the mobile phone and the machine learning process. During the validation stage, an automatic learning model was designed to allow the device to learn from each reading and provide a possible automatic diagnosis to the user. Fifty-one device readings were performed on volunteers and compared with those obtained with a conventional 12-lead ECG and interpreted by clinicians. The results were analysed by calculating central tendency and standard deviation measures, comparing the duration, amplitude and morphology of the different ECG waves, complexes and relevant segments both on the conventional and those made with the prototype. Results The device provided readings of lead 1 of a standard 12-lead ECG to monitor and diagnose bradyarrhythmia and tachyarrhythmias. In addition, it was found that it is possible to obtain leads II and III by alternating the positioning of the electrodes. 96% (49) of the readings showed a similarity in morphology, amplitude and duration of waves, segments and complexes that allowed an interpretation of the trace. In the two cases (4%) where there was a difference, the diagnosis with the conventional ECG was pathological (abnormal). However, the diagnosis with the prototype was non-pathological (normal). Conclusion The clinical study results indicated that the designed platform was safe, had good quality in its operation at all levels and provided results that allow diagnoses equivalent to those of a conventional ECG in most cases. However, the 3-lead capacity shows a lower capacity to detect other pathologies that require a 12-lead or 15-lead ECG. The tests also showed that the prototype is more sensitive to noise (interference) than the conventional device, which made some readings difficult, which is considered one of the immediate steps to improve. The current results open the way to developing more prototypes and conducting larger-scale studies where cardiologists and a more significant number of patients with diagnosed cardiac pathologies.

Non-Laboratory-Based Screening of Cardiovascular Disease Risk–Possibilities and Challenges

Non-Communicable Diseases (NCDs) are now attributing to 71% of the total global deaths and hence in 2011, United Nations set a target to reduce premature NCD death by 25% by 2025.[1] Among all the major NCDs, Cardiovascular Diseases (CVD) especially ischemic heart disease and stroke are the chief contributors of death and disability.[2] Globally 19.1 million deaths are reported in the year 2020 only due to CVD. It is now imparting a dual burden of disease due to steadily escalating cases and disease occurring at relatively early age especially in developing countries. This results in significant clinical and cost implications imparting huge burden on health system. Cardiovascular disease management cost which was around 863 US$ is expected to rise at around 1044 US$ by 2030.[3] So, in order to achieve the NCD targets for 2025, it is imperative to design robust strategies for prevention and control of CVDs and its risk factors. With early identification and robust primary health care systems, developed nations are witnessing reduction in CVD incidences, however developing countries still share 50% of total mortality and 80% of the disease burden. These countries have additional challenge of resource limitation along with larger proportion of the population to be catered and hence they require cost-effective and contextual solutions for the disease. Most effective strategy for managing CVD is prevention and early identification of warning signs. This includes both primordial and primary preventive checkups of the population in very early age (from 30 years) through affordable solutions. Read more...

How Many Diet-Related Non-Communicable Disease Deaths Could Be Averted or Delayed If Canadians Reduced Their Consumption of Calories Derived from Free Sugars Intake? A Macrosimulation Modeling Study.

Free sugars are a major source of calories in diets and contribute to the burden of many non-communicable diseases (NCDs). The World Health Organization (WHO) recommends reducing free sugars intake to less than 10% of total energy. This study aimed to estimate the number of diet-related NCD deaths which could be averted or delayed if Canadian adults were to reduce their calorie intake due to a systematic 20% reduction in the free sugars content in foods and beverages in Canada. We used the Preventable Risk Integrated ModEl (PRIME) to estimate the potential health impact. An estimated 6770 (95% UI 6184-7333) deaths due to diet-related NCDs could be averted or delayed, mostly from cardiovascular diseases (66.3%). This estimation would represent 7.5% of diet-related NCD deaths observed in 2019 in Canada. A 20% reduction in the free sugars content in foods and beverages would lead to a 3.2% reduction in calorie intake, yet an important number of diet-related NCD deaths could be averted or delayed through this strategy. Our findings can inform future policy decisions to support Canadians' free sugars intake reduction, such as proposing target levels for the free sugars content in key food categories.

Noncommunicable Disease Conditions and HIV in Rural and Urban South Africa: 2005-2015.

Hypertension, obesity, hyperlipidemia, and type 2 diabetes contribute primarily to noncommunicable disease deaths and together with human immunodeficiency virus contribute largely to mortality in South Africa. Our longitudinal study provides the necessary data and insights over a 10-year period to highlight the areas where improved management is required in urban and rural localities. This study included 536 rural and 387 urban Black participants aged 32 to 93 years from the North-West province, South Africa. Disease prevalence, treatment, and control were determined in 2005 and were re-evaluated in 2015. Multiple measures analyses were used to determine the trends of blood pressure and waist circumference. The initial prevalence of hypertension was 53.2%, obesity was 23.6%, hyperlipidemia was 5.1%, diabetes was 2.9%, and human immunodeficiency virus was 10.7% in 2005. By 2015, the rural population had higher rates of hypertension (63.7% versus 58.5%) and lower rates diabetes (4.3% versus 7.9%) and hyperlipidemia (6.6% versus 18.0%) with similar obesity rates (41.7% versus 42.4%). The average blood pressure levels of urban hypertensives decreased (Ptrend<.001), whereas levels were maintained in the rural group (Ptrend=.52). In both locations, treatment and control rates increased from 2005 to 2015 for all conditions (all ≥6.7%), except for diabetes in which a decrease in control was observed. Waist circumference increased (Ptrend>.001) in both sex and locality groups over the 10-year period. Although average blood pressure of urban hypertensive individuals decreased, urgent measures focused on early identification, treatment, and control of the respective conditions should be implemented to decrease the burden of noncommunicable diseases.

Label copresence for healthier choices: How sugar content per daily limit and sugar warning labels balance out the health halos of nutrient-content claim

Excessive sugar consumption is a major cause of obesity and many non-communicable diseases (NCDs). Overconsumption of sugar has been associated with a higher number of NCD deaths. To curb sugar consumption, this study examined the label copresence effect of sugar content per daily limit, sugar warning, and nutrient-content claim on consumer choices, using the mixed logit model on conjoint choice data of orange juice among 390 college students in Thailand, illustrating that food labels affect consumer food choice decision. Results showed that nutrient-content claims are the most influential label on choice selection, followed by sugar content per daily limit, and sugar warning. Consumer characteristics and unobserved heterogeneity on label importance affect intermediary steps on choice decisions. Additionally, sugar content per daily limit labels significantly induced healthy choices whereas nutrient-content claims significantly encouraged any choice selection. Sugar warning label were found to be significantly influential among overweight people. The health halo effects of nutrient-content claims were found, swaying consumers toward unhealthy choices. This health halo effect can be alleviated by sugar content per daily limit and sugar warning labels. Evidently, male consumers prefer sweeter choices compared to female consumers, whereas healthy eaters prefer low sugar content. Unobserved heterogeneity in sugar warning importance was found to be more dispersed than that of nutrients-content claim, explaining why sugar warning label cannot override the positive health halo effects of nutrient-content claim. The optimal copresence label design for healthier choices was discussed. Further behavioral validation is essential before the insights can be applied.

Estimating the dietary and health impact of implementing front-of-pack nutrition labeling in Canada: A macrosimulation modeling study.

Front-of-pack labeling (FOPL) has been identified as a cost-effective policy to promote healthy diets. Health Canada has recently published FOPL regulations that will require food and beverages that meet or exceed set thresholds for sodium, sugars, or saturated fat to display a 'high in' symbol on the front of the package. Although a promising measure, its potential impact on dietary intakes and health have not yet been estimated in Canada. This study aims to estimate (1) the potential dietary impact of implementing a mandatory FOPL among Canadian adults; and (2) the number of diet-related non-communicable disease (NCD) deaths that could be averted or delayed due to these estimated dietary changes. Baseline and counterfactual usual intakes of sodium, total sugars, saturated fats, and calories were estimated among Canadian adults (n = 11,992) using both available days of 24 h recalls from the 2015 Canadian Community Health Survey-Nutrition. The National Cancer Institute method was used to estimate usual intakes, and adjusted for age, sex, misreporting status, weekend/weekday, and sequence of recall. Estimated counterfactual dietary intakes were modeled from reductions observed in experimental and observational studies that examined changes in sodium, sugars, saturated fat, and calorie content of food purchases in the presence of a 'high in' FOPL (four counterfactual scenarios). The Preventable Risk Integrated ModEl was used to estimate potential health impacts. Estimated mean dietary reductions were between 31 and 212 mg/day of sodium, 2.3 and 8.7 g/day of total sugars, 0.8 and 3.7 g/day of saturated fats, and 16 and 59 kcal/day of calories. Between 2,183 (95% UI 2,008-2,361) and 8,907 (95% UI 8,095-9,667) deaths due to diet-related NCDs, mostly from cardiovascular diseases (~70%), could potentially be averted or delayed by implementing a 'high in' FOPL in Canada. This estimation represents between 2.4 and 9.6% of the total number of diet-related NCD deaths in Canada. Results suggest that implementing a FOPL could significantly reduce sodium, total sugar, and saturated fat intakes among Canadian adults and subsequently prevent or postpone a substantial number of diet-related NCD deaths in Canada. These results provide critical evidence to inform policy decisions related to implementing FOPL in Canada.

Trend analysis of noncommunicable diseases and their risk factors in Afghanistan.

Afghanistan is suffering from 40-year chronic conflicts, displacement, and demolition of its infrastructure. Afghanistan mortality survey 2010 shows nearly 46% of all deaths in the country were attributed to noncommunicable diseases (NCDs). In this study, we aimed to understand the differences in mortality and premature death due to NCDs by sex and the trend for the next 8 years. We applied trend analysis using the secondary data from the Institute for Health Metrics and Evaluation, Global Burden of Diseases 2019. The information on NCD mortality, NCD deaths attributed to its risk factors, NCD percent of total years lived with disability (YLDs) attribution to each risk factor extracted from this database from 2008 to 2019. We investigated the trend from 2008 to 2019 for the mentioned factors and then forecast their trends until 2030. Our study shows that Afghanistan has had an increasing death number due to NCDs from 2008 to 2019 (50% for both sexes) and this will reach nearly 54% by 2030. Currently, half of NCDs deaths are premature in Afghanistan. The mortality rate and prevalence of risk factors are higher among women. More than 70% of YLDs will be due to NCDs in Afghanistan till 2030. Five risk factors including high systolic blood pressure (28.3%), high body mass index (23.4%), high blood glucose (20.6%), high low-density lipoproteincholesterol (16.3%), and smoking (12.3%) will have the highest contribution to NCDs death in 2030, respectively. In general, our study indicates that without any specific intervention to address NCDs in Afghanistan, not only the Sustainable Development Goal target for NCDs will not be met, but an increase in almost all risk factors prevalence, as well as NCD mortality,will be seen in Afghanistan.

Evidence for Choosing Qigong as an Integrated Intervention in Cancer Care: An Umbrella Review.

Cancer is the second leading cause of noncommunicable disease death, with an increasing incidence. Qigong practice can moderate non-intrinsic, modifiable risk factors that act on the stress response using physical movements, breathing, and focused attention. The purpose of this umbrella review is to provide a concise summary to facilitate an evidence-based decision to integrate Qigong into cancer patients' care. Relevant systematic reviews and meta-analyses were identified and retrieved from the JBI database, Cochrane Library, PubMed, Embase, and CINAHL. Of all of the studies assessed, none found evidence of a risk to cancer patients, indicating that Qigong is a safe practice that can be used even by frail patients. The overall quality of life, cancer-related fatigue, and cognitive impairment were improved by Qigong. Different Qigong programs have different impacts on sleep quality and gastrointestinal problems, suggesting that longer practice sessions are required to achieve improvements. To maintain Qigong's effectiveness, an ordinary practice is essential, or such effectiveness will wear off. The use of biological markers in efficacy assessments needs to be more systematically studied. However, positive WBC, RBC, and CRP trends in Qigong practitioners are evident. Higher-quality clinical studies are necessary to measure variables more closely related to Qigong functioning and consider cancer's multifactorial nature.

Behavioral and Metabolic Risk Factors for Noncommunicable Diseases among Population in the Republic of Srpska (Bosnia and Herzegovina).

Noncommunicable diseases (NCDs) are the major cause of death worldwide, and they are attributable to genetic and physiological determinants, behavioral risk factors and environmental impacts. The aim of this study is to assess behavioral risk factors for metabolic disease using demographic and social-economic aspects of the population characterized by risk factors, and to investigate relations among lifestyle risk factors (alcohol consumption, tobacco use, physical inactivity, intake of vitamins, fruits and vegetables) that are responsible for the majority of NCD deaths in the Republic of Srpska's (RS's) population. This is a cross-sectional study based on the analysis of a survey conducted among 2311 adult (≥18 years) persons (54.0% women, and 46.0% men). The statistical analysis was carried out by using Cramer's V values, clustering, logistic regression (binomial, multinomial and ordinal), a chi-square test and odds ratios. In the case of logistic regression, we provide the prediction accuracy in percentages. A significant statistical correlation between demographic characteristics (gender and age) and risk factors was observed. The highest difference according to gender was observed in alcohol consumption (odds ratio (OR) = 2.705, confidence interval (95% CI) = 2.206-3.317), particularly in frequent consumption (OR = 3.164, 95% CI = 2.664-3.758). The highest prevalence of high blood pressure was registered in the elderly (66.5%); the same holds for hypertension (44.3%). Additionally, physical inactivity was one of the most common risk factors (33.4% physically inactive respondents). A significant presence of risk factors was confirmed among the RS population, with higher involvement of metabolic risk factors among the older population, while the prevalence of behavioral factors was related to younger age groups, particularly in the case of alcohol consumption and smoking. A low level of preventive awareness was observed among the younger population. Therefore, prevention is one of the most important instruments related to decreasing NCD risk factors in the RS population.

PS-P13-7: O.N.E. (ONWARD NONCOMMUNICABLE DISEASE EDUCATION) CAVITE INITIATIVE: A COLLABORATIVE PROJECT TO IMPLEMENT PHILPEN AMONG PRIVATE PRACTITIONERS

Objective: Cardiovascular diseases account for most noncommunicable disease (NCD) deaths about 17.9 million people annually. The Philippine Department of Health (DOH) began implementing the PhilPEN (Philippine Package of Essential Noncommunicable Disease interventions) nationwide in 2014. The protocol screens adult Filipinos seen in the public health facilities for major cardiovascular disease risk factors and includes interventions such as lifestyle advice and medications to achieve target goals. ONE Cavite Project is a collaboration between DOH, the Philippine Society of Hypertension (PSH), and private practitioners in Cavite- a densely populated semi-urbanized province in the Philippines. The primary objective of the One Cavite Project is to engage private medical practitioners in Cavite in screening, diagnosing, and managing adult patients (20 years old and above) for the following significant cardiovascular risk (CV) factors: hypertension, type 2 diabetes mellitus, dyslipidemia, smoking and to complement the PhilPEN implementation by the DOH in all its public health facilities in Cavite by private general physicians. Design and Methods: The first phase of the project is to organize a series of seminars to gather, enroll, and engage private doctors to ensure proper screening, monitoring, and follow up of patients with hypertension, diabetes, dyslipidemia, and other CV risk factors. The second phase is to enroll the patients of these private doctors, where patient data was collected, collated, and submitted to PSH for descriptive analysis by a third party. Results: A total of 680 doctors were engaged with a total of 41,477 patients screened. Preliminary data showed that out of the 41,477 patients, 61% have hypertension, 17% have diabetes, 22% have dyslipidemia, and 16% are smokers. Moreover, 21% have both hypertension and diabetes, 19% have hypertension and dyslipidemia, while 7% have hypertension, diabetes, and dyslipidemia. On follow-up after six months, out of 18,348 patients with hypertension, 88% of patients with hypertension had their blood pressure under control. For the 5,024 patients with diabetes, 15% had a fasting blood sugar &lt; 110 mg/dL, and 32% had an HBA1c&lt; 6.5 mg/dl. Out of 7,146 patients with dyslipidemia, 14% had an LDL &lt; 130 mg/dl, while for the 3,510 smokers, 56% quit smoking on follow-up. Conclusion: The One Cavite Project has shown that engagement of private medical practitioners in screening, diagnosing, and managing adult patients for significant cardiovascular risk (CV) factors have complemented the implementation of PhilPEN by the DOH and this led to active prevention and control of these risk factors.

Cost of a routine (planned) cardiac by-pass surgery at the National Hospital of Sri Lanka

Background: Non-communicable disease (NCD) has become a major challenge in Sri Lanka. Over the last 40 years, ischemic heart disease (IHD) has been identified as one of the leading causes of NCD deaths in Sri Lanka. Coronary artery bypass graft (CABG) is a revascularization procedure that has been identified as an effective method for managing a patient with IHD. Therefore, estimating the approximate cost of CABG surgery in a public hospital would help in economic evaluations and managerial decision-making in public sector investments.Objective: To estimate the approximate cost of an uncomplicated routine (planned) cardiac bypass surgery at the National Hospital of Sri Lanka (NHSL), Colombo.Methods: This study was primarily based on secondary data. The data required for costing the procedure was extracted from 52 BHTs of patients who underwent CABG surgery at the NHSL during the last three months of the year 2019. Extracted data was used to determine the costing elements of each cost center. Direct and indirect cost centers were identified, and the cost of each center was determined by apportioning the available cost data by the step-down method using a weighted factor where applicable.Results: The approximate cost of an uncomplicated CABG was Rs. 1.3 million per patient. Out of the total cost, 89% (Rs. 1.16 million) was expended on direct labor as salaries of different categories of staff. A major portion of it (56%) was spent on ICU care (Rs. 0.654 million) followed by post-surgical care at the ward settings (33.9%, Rs. 0.393 million). The highest cost of the material was recorded at the theatre which was 6% of the total cost (Rs. 78,960.00). The cost of total overheads was Rs. 29,517.00 which was about 2.2% of the total. Conclusion: Although the approximate cost of a routine uncomplicated CABG surgery was Rs.1.3 million ($ 7,027) as of December 2019 at the National Hospital of Sri Lanka, compared to more developed countries this is a fairly low cost. However, when the differences between health system organization and per capita health expenditure are concerned, this is quite evident to claim that the Sri Lankan health system has low-cost but effective models of delivering its care to people.