Prevention Of NCDs Research Articles

Policy Implications for Diabetes Prevention and Control: An Experience from Iran.

Background: Diabetes and its complications threaten the life of communities at global, national, and sub-national levels. Following the United Nations' call to action and develop a global action plan for the prevention and control of NCDs by The World Health Organization (WHO), all countries have a commitment to halt the rise in diabetes prevalence across the world. But the different situations of disease and risk factors, different priorities, and the context of the health care systems moved the countries to develop adapted targets and action plans. On the same ground, Iran established a national authority construction as the Diabetes Sub-committee which is part of the Iranian Non-Communicable Diseases Committee (INCDC) and incorporated a multi-sectoral mechanism to develop the national service framework for diabetes. Accordingly, this paper is aiming at sharing Iran's experience regarding the policy implications for diabetes prevention and control. Exchange this experience could be beneficiary to other countries to lead a systematic action to prevent disability and mortality due to diabetes.

MIDO COVID: A digital public health strategy designed to tackle chronic disease and the COVID-19 pandemic in Mexico

Screening, prevention, and management of non-communicable diseases (NCDs, including obesity, hypertension, and type 2 diabetes) is the core function of Integrated Measurement for Early Detection (MIDO), a digital strategy developed by the Carlos Slim Foundation in Mexico. An extension of this strategy, MIDO COVID, was developed to address the need for an integrated plan in primary health care during the COVID-19 pandemic. MIDO COVID facilitates planning, surveillance, testing, and clinical management of SARS-CoV-2 infections and the major NCDs and their pre-disease states, to streamline the continuum of care. MIDO COVID screening was applied in 1063 Carso Group workplaces in 190 municipalities of the 32 Mexican states. Staff were trained to screen healthy workers for NCDs using a questionnaire, anthropomorphic measurements, and blood work; healthy individuals returning to work also received a SARS-CoV-2 antibody test. Between June 26 and December 31, 2020, 58,277 asymptomatic individuals underwent screening. The prevalence of obesity, hypertension, and type 2 diabetes was 32.1%, 25.7%, and 9.7% respectively. Only 2.2%, 8.8%, and 4.5% of individuals, respectively, were previously aware of their condition. Pre-obesity was identified in 38.6%, pre-hypertension in 17.4%, and prediabetes in 7.5% of the population. Risk of SARS-CoV-2 infection was highest for individuals with multiple NCDs. Many Mexicans are unaware of their health status and potentially increased risk of COVID-19 and serious complications. As a universal strategy implemented regardless of social factors, MIDO COVID promotes equity in access to health care prevention and early stage detection of NCDs; the information gained may help inform decisionmakers regarding prioritising vulnerable populations for immunisation.

The challenges facing programs for the prevention and control of non-communicable diseases in Iran: a qualitative study of senior managers' viewpoints

BackgroundDespite significant achievements in the prevention and control of NCDs in Iran, these conditions are still the biggest challenges to Iran's healthcare system and are estimated to account for 78.1 percent of all deaths. Therefore, this study aimed to reflect on the potential challenges standing in the way to implement the relevant policies, empower the dimensions of governance, and react in an effective and timely manner by Iran's healthcare system to NCDs.MethodsThis study was conducted with a qualitative approach using the conventional content analysis method. A total of 46 senior managers involved in the prevention and control of NCDs at the medical sciences universities across Iran were recruited through the purposive sampling method and were interviewed via semi-structured interviews. Graneheim and Lundman's approach was utilized to analyze the data.ResultsAccording to the analysis of the senior managers' viewpoints, current challenges to implement the program for the prevention and control of NCDs in Iran could be placed into six main categories, including financing, human resources, infrastructure and inputs, legal, executive, administrative, as well as inter-sectoral collaboration, and management and policy-making challenges with their own sub-categories.ConclusionThe results revealed that financing was the biggest challenge to successfully implementing the program for the prevention and control of NCDs in Iran. However, strengthening Iran's healthcare system in the field of the prevention of NCDs demanded more innovative measures and strategies, such as the empowerment of human resources, the effective use of intra- and inter-sectoral collaboration, and non-governmental organizations and charities, along with the exploitation of evidence-based studies during policy-making and decision-making processes, with no need for financial resources.

Health sector readiness for the prevention and control of non-communicable diseases: A multi-method qualitative assessment in Nepal.

In Nepal, deaths attributable to NCDs have increased in recent years. Although NCDs constitute a major public health problem, how best to address this has not received much attention. The objective of this study was to assess the readiness of the Nepalese health sector for the prevention and control of NCDs and their risk factors. The study followed a multi-method qualitative approach, using a review of policy documents, focus group discussions (FGDs), and in-depth interviews (IDIs) conducted between August and December 2020. The policy review was performed across four policy categories. FGDs were undertaken with different cadres of health workers and IDIs with policy makers, program managers and service providers. We performed content analysis using the WHO health system building blocks framework as the main categories. Policy documents were concerned with the growing NCD burden, but neglect the control of risk factors. FGDs and IDIs reveal significant perceived weaknesses in each of the six building blocks. According to study participants, existing services were focused on curative rather than preventive interventions. Poor retention of all health workers in rural locations, and of skilled health workers in urban locations led to the health workers across all levels being overburdened. Inadequate quantity and quality of health commodities for NCDs emerged as an important logistics issue. Monitoring and reporting for NCDs and their risk factors was found to be largely absent. Program decisions regarding NCDs did not use the available evidence. The limited budget dedicated to NCDs is being allocated to curative services. The engagement of non-health sectors with the prevention and control of NCDs remained largely neglected. There is a need to redirect health sector priorities towards NCD risk factors, notably to promote healthy diets and physical activity and to limit tobacco and alcohol consumption, at policy as well as community levels.

Impact of a Group-Based Video and Interactive Group Session Addressing Diarrheal Disease, Helminthic and Schistosomiasis Infections, Hypertension and Diabetes on Short and Long-Term Improvement in Knowledge and Healthy Behaviors in Seroconcordant HIV-Negative Zambian Couples

Non-communicable and neglected tropical diseases (NCD and NTD) contribute to high morbidity and mortality in Zambia. While the public health importance of NTD has long been recognized, prevalence of disease remains high. NCD are emerging as causes of morbidity and mortality. Knowledge of risk factors, diagnosis, management, and prevention of NCDs and NTDs in the general population is poor and as a result, low-cost commodities are insufficiently used.

Insights of literacy on preventive behaviors of non-communicable diseases in Bangladesh: descriptive types of cross-sectional study among female university students

Background: Non-communicable diseases were the leading global causes of mortality, causing more deaths compare to all other causes combined, which strike hardest at world's low and middle-income countries. The aim of the study was to ascertain the health literacy and its practical application among the young generation to prevent major non communicable diseases. Methods: This was a descriptive type of cross-sectional study with 400 participants drawn from female university students of Dhaka, Bangladesh. Data were gathered by pre-tested, self-administered, structured and anonymous online questionnaires. Analysis was performed by using multivariate techniques followed by regression modelling and the margin of error was considered as 0.05. Results: Socio-demographic characteristics of the respondents showed that, majority of the female students belonged to age group <25 years. Study found that 63.5% of all university students had poor literacy on prevention of NCDs with female propensity. It was observed that highest level of poor literacy was about cancer (73.20%) and hypertension (75.20%) among all other NCDs. Statistically significant analysis observed that monthly lower family income <468 USD (AOR/p=1.73/0.01), respondents of businessman father (AOR=1.68/0.06) and residing in a family with >4 members (AOR/p=0.67/0.00) were the predictors for poor literacy about preventive health behavior on NCDs. Conclusions: This study revealed that the status of literacy on preventive health behaviors of NCDs among female university students was not satisfactory and very few had overall good literacy. This study found several important predictors under socio-demographic consequence played a significant role regarding poor literacy.

Noncommunicable diseases and health system responses in Saudi Arabia: focus on policies and strategies. A qualitative study

BackgroundNoncommunicable diseases (NCDs) are responsible for an increasing disease and economic burden in Saudi Arabia, particularly those due to chronic diseases such as diabetes and cardiovascular disease. Efforts are being made to improve chronic disease control through greater prevention and disease management. This research examines the scope, comprehensiveness and perceived effectiveness of Saudi Arabia’s national policies and strategies to prevent and control NCDs and their risk factors.MethodsSemi-structured interviews were conducted with 25 managers of the Ministry of Health in Saudi Arabia. The interviewees were public health leaders, national programme directors and programme implementation staff. The interviews were transcribed and coded into key themes.ResultsInterviewee responses indicated a belief that Ministry of Health programmes for the prevention and control of NCDs have achieved initial success, but have not yet been adequately evaluated. Interviewees reported faster development and implementation of policies for tobacco, sugar-sweetened drinks and obesity than for physical activity. Major challenges identified included inefficient programme management and low community awareness. There was a reported need for greater emphasis on health promotion and improving the effectiveness of existing multisectoral coordination.ConclusionEffective national NCD policies and strategies have a critical role to play in the control of chronic disease epidemics. In Saudi Arabia, opportunities exist to improve the policy and strategies in response to NCDs by establishing a comprehensive surveillance system and linking epidemiological surveillance with health programme evaluation, as well as using a multisectoral and integrated approach. For better management and control of NCDs, a cohesive multisectoral collaboration with a comprehensive surveillance programme and adequate evaluation is urgently needed.

Readiness of Health Professionals, Undergraduate Medical Curriculum and on-the-job Training on Noncommunicable Diseases in Bangladesh to achieve Program Objectives- an Operational Research Study

Health professionals need competency in the assessment and outcome evaluation of several health behaviors related to NCDs and their risk factors. Assessment of the curricula in health professional education programs with respect to health promotion competencies is a compelling and potentially costeffective initial means of preventing and reversing the trend of non-communicable diseases. Learning evidence-based health promotion competencies within an inter-professional context would help students maximize the use of nonpharmacologic/ non-surgical approaches and the contribution of each member of the health team. This operational research study was initiated by Noncommunicable Disease Control Program (NCDC) of GOB to assess the readiness of the medical graduates to achieve the primary program objective “to reduce premature (40-69 years age group) death by 33% by the year 2030”. The program also wanted to review the existing undergraduate curriculum to determine the need for a change to achieve program objectives. The activity was delegated to Bangladesh College of Physicians & Surgeons (BCPS), to develop the recommendations for the NCD program. The study was designed as a cross-sectional mixed-method study adopting both quantitative and qualitative methods. Quantitative data were obtained from new graduates (12 medical colleges’ public & private) and older graduates from the existing public healthcare services. In-depth interviews (IDI), Key informant interviews (KII) & opinion gathering workshops were adopted to collect qualitative data. Senior medical teachers teaching NCD subjects were included in the qualitative process. Quantitative data were analyzed by using SPSS 20.0. Qualitative data was audio-recorded and transcribed by the anthropologist team. The curriculum review was done manually by using content analysis of the whole curriculum. The total number of respondents for the quantitative survey was 678, new graduates 348 (51%), older graduates 330 (49%). Among older graduates, 178 (54%) had no previous training, and 152 (46%) received some form of on-the-job training on NCDs by the program. The 12 IDI, 7 KII and 4 workshops participated by 88 senior teachers participated in recommendations development. The knowledge of 4 major NCDs, four major risk factors, PEN, and contribution of death from major NCDs was incorrect, suggesting a lack of conceptual and contextual understanding of the NCD prevention and control program. Qualitative investigation & opinion of the teachers suggested a lack of awareness of teachers regarding the control program, revealing a lack of communication and coordination between the program and academia, and the present curriculum is inadequate for NCD learning by the students. It can be concluded that the existing curriculum is inadequate in terms of program orientation and necessary skills to achieve the program objectives. A structured training program using a training module covering the concept and content on prevention and control of NCDs in a country perspective is essential for the current graduates. Major NCD education in the existing curriculum requires to be urgently updated and could be best offered by using a teaching-learning module on major NCDs. J Bangladesh Coll Phys Surg 2022; 40: 95-105

Non-Communicable Diseases

NCDs such as Diabetes mellites, cardiac disorders, cardiac failure, obesity, renal diseases, lung disease, dyslipidemia and stroke are among the few. NSDs have become a primary health concern and a major cause of mortality and morbidity around the globe. These diseases are progressive, asymptomatic and chronic and patient do not realize until the complications arise and symptoms appear. World Health Organization (WHO) reported in 2016 that 86% death from NCDs and 16% of premature deaths were in the age range of 30-70 years worldwide. Among these NSDs, 49% contribution was from cardiovascular diseases alone, 12% from caner, 5% from respiratory diseases and 5% from diabetes [1].
 Disease burden of NCDs can be assessed by several indicators e.g. the disability adjusted life years (DALYs) which is the equivalent of losing one year in good and healthy life due to early death or any illness including disability [2]. NCDs were recognized as public health concern by United Nations and hence, policies were devised, Sustainable Development Goals (SDGs) for the prevention and management of NCDs by 2030 were also planned [3]. The global NCDs action plan by WHO was initiated and implemented from 2013-2020 aiming to attain the set goals and priorities by 2025. The main goal which comprises of 25%, is to reduce the premature deaths from NCDs by 2025 [4].
 Currently, the world is going through COVID-19 pandemic which has changed the whole world in terms of health, economics, psyphy and behaviours adversely. Although COVID-19 is a communicable disease but it has been observed that the patients who already have been contracted with NCDs such as heart, renal or lung disease are at much higher risk for COVID-19 infection as compared to others. Therefore, it is suggested that every one should get proper health screening at regular intervals even if you are healthy. Annual visit for checkups and screening should be conducted after the age of 40 years and after every 6 months is appreciated if you are above 50 years of age. A better governance and implementation of the Global strategy by WHO and United Nations is an urgent need of the recent times.

Innate Immune Activation and Circulating Inflammatory Markers in Preschool Children.

Early childhood is characterised by repeated infectious exposures that result in inflammatory responses by the innate immune system. In addition, this inflammatory response to infection is thought to contribute to the epidemiological evidence linking childhood infection and adult non-communicable diseases. Consequently, the relationship between innate immune responses and inflammation during early life may inform prevention of NCDs later in life. In adults, non-genetic host factors such as age, sex, and obesity, strongly impact cytokine production and circulating mediators, but data in children are lacking. Here, we assessed cytokine responses and inflammatory markers in a population of healthy preschool children (mean age 4.2 years). We studied associations between cytokines, plasma inflammatory markers and non-genetic host factors, such as sex, age, adiposity, season, and immune cell composition. Similar to adults, boys had a higher inflammatory response than girls, with IL-12p70 and IL-10 upregulated following TLR stimulation. Adiposity and winter season were associated with increased circulating inflammatory markers but not cytokine production. The inflammatory markers GlycA and hsCRP were positively associated with production of a number of cytokines and may therefore reflect innate immune function and inflammatory potential. This dataset will be informative for future prospective studies relating immune parameters to preclinical childhood NCD phenotypes.

Engaging Female Community Health Volunteers (FCHVs) for cardiovascular diseases risk screening in Nepal.

IntroductionNon-Communicable Diseases (NCDs) have become the leading public health problems worldwide and the cardiovascular diseases (CVDs) is one of the major NCDs. Female Community Health Volunteers (FCHVs) in Nepal are the key drivers to implementing frontline health services. We explored the potential for engaging FCHVs for CVD risk screening at the community level in Nepal.MethodsWe used multiple approaches (quantitative and qualitative) for data collection. The trained FCHVs administered CVD risk screening questionnaire among 491 adults in rural and urban areas and calculated the CVD risk scores. To maintain consistency and quality, a registered medical doctor also, using the same risk scoring chart, independently calculated the CVD risk scores. Kappa statistics and concordance coefficient were used to compare these two sets of risk screening results. Sensitivity and specificity analyses were conducted. Two focus group discussions among the FCHVs were conducted to determine their experiences with CVD risk screening and willingness to engage with CVD prevention and control efforts.ResultsThe mean level of agreement between two sets of risk screening results was 94.5% (Kappa = 0.77, P<0.05). Sensitivity of FCHV screening was 90.3% (95% CI: 0.801–0.964); and the specificity was 97% (95% CI: 0.948, 0.984). FCHVs who participated in the FGDs expressed a strong enthusiasm and readiness to using the CVD risk screening tools. Despite their busy workload, all FCHVs showed high level of motivation and willingness in using CVD risk screening tools and contribute to the prevention and control efforts of NCDs. The FCHVs recommended needs for providing additional training and capacity building opportunities.ConclusionWe conclude that there is a potential for engaging FCHVs to use simple CVD risk screening tools at the community level. The findings are promising, however, further studies engaging larger number of FCHVs and larger population would warrant feasibility of such tools within the existing healthcare systems in Nepal.

Estimates of major non-communicable disease risk factors for India, 2010 & 2015: A summary of evidence.

The National Monitoring Framework for the prevention and control of NCDs in India has set targets for reduction of risk factors relative to the measure recorded in 2010. Estimates for 2010 and 2015 were established using meta-analyses in the absence of a national risk factor survey till 2017. We searched national survey reports and also articles published in English from India between 2008 and 2017 in PubMed, Google Scholar and Cochrane review databases for specific risk factors among 18-69 yr Indians. Quality of studies was evaluated using Joanna-Briggs tool, but all studies were included in analyses. Estimates for each of the eight strata by age, gender and place of residence, respectively, were generated. MetaXL was used to calculate the pooled estimate for 2010 and 2015 using a random effects model. Strata-specific estimates were combined to arrive at national estimate using population weight of each stratum. The credibility of the estimates was determined using four parameters - average Briggs score; representativeness of the contributing studies and precision and stability of the estimates. The estimates [95% confidence interval (CI)] for 2010 for different risk factors were as follows: current alcohol use, 15.7 per cent (13.2-18.2); current tobacco use, 27 per cent (21.4-32.6); household solid fuel use, 61.5 per cent (50.2-72.5); physical inactivity, 44.2 per cent (37.8-50.6); obesity, seven per cent (3.8-10.2) and raised blood pressure, 20.2 per cent (18.4-22.1). In 2015, compared to 2010, tobacco use showed a relative decline of 18 per cent, household solid fuel use of nine per cent and physical inactivity of 15 per cent. The estimates were stable for alcohol use, raised blood pressure and obesity between 2010 and 2015. All estimates varied between moderate and high degrees of credibility. The estimates are consistent with other available estimates and with current national-level initiatives focused on tobacco control and improving access to clean fuel. These estimates can be used to monitor progress on non-communicable disease risk factor targets for India.

Formative Exploration of the Feasibility of Embedding Community Assets Into Primary Health Care: Barbershop and Place of Worship Readiness in Guyana.

Community engagement is key to improving the quality of primary health care (PHC), with asset-based interventions shown to have a positive impact on equity and health outcomes. However, there tends to be a disconnect between community-based interventions and PHC, with a lack of evidence on how to develop sustainable community-primary care partnerships. This paper reports on the formative phases of 2 studies exploring the feasibility of embedding community assets, namely places of worship and barbershops, into the PHC pathway for the prevention and control of NCDs in deprived settings. It describes the participatory approach used to map and gather contextual readiness information, including the enablers and constrainers for collaborative partnerships with PHC. Grounded in community-based participatory research, we used elements of ground-truthing and participatory mapping to locate and gather contextual information on places of worship and barbershops in urban and rural communities. Local knowledge, gathered from community dialogs, led to the creation of sampling frames of these community assets. Selected places of worship were administered a 66-item readiness questionnaire, which included domains on governance and financing, congregation profile, and existing health programs and collaborations. Participating barbershops were administered a 40-item readiness questionnaire, which covered barbers' demographic information, previous training in health promotion, and barbers' willingness to deliver health promotion activities. Fourteen barbershops were identified, of which 10 participated in the readiness survey, while 240 places of worship were identified, of which 14 were selected and assessed for readiness. Contextual differences were found within and between these assets regarding governance, accessibility, and reach. Key enablers for both include training in health promotion, an overwhelming enthusiasm for participation and recognition of the potential benefits of a community-primary care partnership. Lack of previous collaborations with the formal health system was common to both. The participatory approach extended reach within underserved communities, while the readiness data informed intervention design and identified opportunities for partnership development. Contextual differences between community assets require comprehensive readiness investigations to develop suitably tailored interventions that promote reach, acceptance, and sustainability.

The Integrated Local Plan for Health Promotion of the Lombardy Region:a planning tool for prevention

IssueThe Health Protection Agencies (ATS) of the Lombardy Region play a role in the governance through the technical-methodological support to achieve health objectives. Through Local Health Promotion Plans (PIL), ATS are tasked with programming campaigns for health promotion and prevention of NCDs at the territorial level, following regional (PRP) and national (PNP) guidelines. The PIL foster the integration of different sectors and activate non-health policies, through networks and stakeholders from different territories. The COVID-19 pandemic has further highlighted the need for an integrated and, intersectorial plan able to promote the development of partnerships, in order to focus more on the social and environmental determinants of health. This strategy guarantees responses to the needs of the population during an emergency, as well as equitable and sustainable prevention programs.Description of the problemAs part of its planning activities, each ATS defines and annually updates the PIL according to a methodology consistent with the regional situation and, based on analyses of health and the equity context. Implementation of the PIL is part of the prevention performance indicators and it is monitored at the regional level through collaborative work networks encompassing, research, training and sharing of best practices.ResultsThe comparative reading of the 8 PIL makes it possible to identify the contents defined in the various territories, highlighting of intersectorial relations present at the regional level. The mapping of interventions clearly highlights the settings in which the greatest number of resources are invested (school and work), thus becoming a tool for planning action programs in subsequent years.LessonsIn addition to being a planning tool, the PIL allows the sharing of the local health profile and priorities with all territorial actors, becoming one of the tools in which the Health Profile is declined.Key messages The analysis of PIL is the starting point for the systemization of good practices, identifying possible organizational synergies and the preventive effects of the actions and programs implemented.Comparative reading of PIL allows for benchmarking of health promotion interventions.

Community capacity building for culturally sensitive prevention and control of NCDs

Abstract In Southeast Asia, it is common practice to have community-based interventions targeting health promotion, prevention and management of diseases. Often interventions developed by WHO or health programmes in the regions are copied. From literature it is known that community-based interventions are more effective when tailored to the local language, including the lingo, and custom traditions and adapted to preferences, needs, values, interests, religion, and other sociocultural specific aspects. Cultural and contextual adaptation of an intervention is difficult and dynamic, and to date there is no practical and scientific base how to do this. In this presentation the developing of contextual and culturally sensitive and responsive capacity building materials for health promotion and screening by community volunteers and community groups will be elaborated by the following topics: Development of general capacity building methods and curricula, taking into account local training needs of community workers Tools for pre-test post-test of training to assess the level of understanding by participants Tools for measuring contextual and cultural sensitivity of training modules and training activities Tools for adjustment of training and materials to context and culture, building on the findings in the previous tools The presentation will show the application of these tools and the final outcome when applying them in practice.

Health communication to reduce sugar consumption in Thailand

Excessive sugar consumption is one of the critical health behaviors contributing to Non-Communicable Diseases or NCDs, which are the leading causes of mortality among the Thai population. It is reported that Thai people have a continuous increase in sugar consumption every year associated with higher incidences of NCDs in the country. Therefore, health communication to raise awareness and modify the sugar consumption behavior in Thailand focuses on integrative communication in terms of public policies in accordance with the National NCDs Strategic Plan, guidelines and knowledge in sugar consumption including healthy and unhealthy sugar sources, sugar substitutes and their use in functional foods, health problems related to sugar consumption, the use of GDA Nutrition label, and the application of Healthier Choices standards with appropriate sugar content. With changing lifestyles, social media and technologies play a higher role in health communication regarding sugar consumption, resulting in the development of health applications in conjunction with IoT technology that can be used via smartphones. All these communications aim to promote the reduction of sugar consumption in the prevention of NCDs, thus reducing the premature death rate of the Thai population accordingly.Keywords: health communication, sugar consumption, sugar, sweetener, sugar tax, social media, non-communicable diseases, NCDs, nutrition label, GDA label, IoT

Evaluation on the quality of 236 National Demonstration Areas for comprehensive prevention and control of chronic diseases betweem 2017 and 2019

Objective: To evaluate the quality of the National Demonstration Area for Comprehensive Prevention and Control of NCDs (referred to as "the Demonstration Area"). Methods: Based on the evaluation scores of the Demonstration Area field survey from 2017 to 2019, we counted the scores of each indicator, comparing the scores among indicators and regions. x±s was used to describe the scores. The 95%CI of the score was used to test the statistical difference among regions. Each score was converted into a hundred-mark system to compare the scores among indicators. Results: Of 236 Demonstration Areas, the total score was 83.5. The scores of the first-level indicator listed from high to low appeared as Integrating System of NCD Prevention and Control (92.8), Policy Perfection (90.3), Building Supportive Environment for NCD Prevention and Control (88.4), Implementation of Health Education and Health Promotion (87.4), Whole-course Management of NCDs (78.1), Innovation and Guidance (76.5), Surveillance and Evaluation (75.1). Total scores were higher in the east (259.2±18.8) comparing to the middle (243.2±15.2) or the west (245.4±19.7) regions. Conclusions: Substantial variations on the quality in the Demonstration Area existed across different regions in China. These disparities are important to the government when developing health policies and allocating resources. Whole-course Management of NCDs, Surveillance and Evaluation, and Innovation and Guidance in the Demonstration Area also needs to be improved.

Burden of non-communicable diseases in Cyprus, 1990\u20132017: findings from the Global Burden of Disease 2017 study

BackgroundNon-communicable diseases (NCDs) accounted for over 90% of all deaths in the Cypriot population, in 2018. However, a detailed and comprehensive overview of the impact of NCDs on population health of Cyprus over the period of 1990 to 2017, expressed in disability-adjusted life years (DALYs), is currently not available. Knowledge about the drivers of changes in NCD DALYs over time is paramount to identify priorities for the prevention of NCDs in Cyprus and guide evidence-based decision making. The objectives of this paper were to: 1) assess the burden of NCDs in terms of years of life lost (YLLs), years lived with disability (YLDs), and DALYs in Cyprus in 2017, and 2) identify changes in the burden of NCDs in Cyprus over the 28-year period and assess the main drivers of these changes.MethodsWe performed a secondary database descriptive study using the Global Burden of Disease (GBD) 2017 results on NCDs for Cyprus from 1990 to 2017. We calculated the percentage change of age-standardized DALY rates between 1990 and 2017 and decomposed these time trends to assess the causes of death and disability that were the main drivers of change.ResultsIn Cyprus in 2017, 83% (15,129 DALYs per 100,000; 12,809 to 17,707 95%UI) of total DALYs were due to NCDs. The major contributors to NCD DALYs were cardiovascular diseases (16.5%), neoplasms (16.3%), and musculoskeletal disorders (15.6%). Between 1990 and 2017, age-standardized NCD DALY rates decreased by 23%. For both males and females, the largest decreases in DALY rates were observed in ischemic heart disease and stroke. For Cypriot males, the largest increases in DALY rates were observed for pancreatic cancer, drug use disorders, and acne vulgaris, whereas for Cypriot females these were for acne vulgaris, psoriasis and eating disorders.ConclusionDespite a decrease in the burden of NCDs over the period from 1990 to 2017, NCDs are still a major public health challenge. Implementation of interventions and early detection screening programmes of modifiable NCD risk factors are needed to reduce occurrence and exacerbation of leading causes of NCDs in the Cypriot population.

MEDICAL AND SOCIAL JUSTIFICATION OF MULTI-FACTOR PREVENTION OF MAJOR NONCOMMUNICABLE DISEASES

Purpose – to substantiate and propose a model of multi-factor prevention of majornoncommunicable diseases (NCDs) at the level of primary health care (PHC).Material and methods. The analysis of the results of a cross-sectional sociologicalstudy (N=1252); copying from the medical documentation of inpatients (n=1543) andtheir survey data (n=57) were the materials and basis for the development of the model.Content analysis, conceptual modelling method, and statistical methods (PIVOT, χ2test,step-by-step logistic regression analysis) were used.Results. The prevalence of combined pathology of NCDs was determined on the exampleof hospitalized patients. The importance of taking into account the age and results ofthe primary screening in the formation of the COPD risk group and the possibility ofsupplementing it with an assessment of the risk of fatal complications of cardiovasculardiseases on the SCORE scale is proved. Features of prevalence and combination ofrisk factors (RF) and the major NCDs among the economically active population arerevealed. It was found that with the same targeted preventive consultation of patients byPHC and specialized medical care doctors, the effectiveness of interventions significantlyincreases. The key to the high effectiveness of prevention is proved to be coordinatedcooperation between medical professionals at different levels of medical care and patientand their families.Conclusions. The proposed model of multi-factor prevention of major NCDs is based ona patient-oriented approach, taking into account the combined RF and major NCDs. Theprinciple of an integrated approach and the complexity of interventions is ensured bylayering all types of prevention provided by PHC in cooperation with specialized medicalcare and the public health service.

Stewardship of noncommunicable diseases in Iran: a qualitative study

PurposeNoncommunicable diseases (NCDs) count for over 80% of premature death worldwide. More than 76% of the total burden of diseases in Iran is devoted to NCDs. In line with the World Health Organization action plan, Iran has developed its national action plan that led to establishment of the National Committee for Prevention and Control of NCDs (INCDC), whose aim is 30% mortality reduction attributed to NCDs by 2030. The stewardship of health system is the cornerstone of performing and sustaining meaningful actions toward prevention and control of NCDs. The literature is tiny on how to materialize the stewardship and governance of health system. The purpose of this article is to report the findings of a national study that aimed to identity functions and subfunctions of stewardship of NCDs and its related risk factors in Iran.Design/methodology/approachThis is a qualitative study. The authors conducted interviews with 18 purposefully selected interviewees until the authors reached saturation. Thematic content analysis was used for analysis and MAXQDA 10 was employed for data management. The difficulty of coordinating with interviewers and health policymakers in the field slowed the process of research progress.FindingsThe authors identified seven themes and categorized them as main functions for appropriate stewardship of NCDs in Iran, including intelligence generation; strategic framework; evidence-based policies/decisions; system design; resource allocation/development; capacity-building and enforcement/alignment; and categorized them as important.Practical implicationsThe seven themes presented as stewardship functions include concepts and practical examples of the experiences and performance of leading countries in the field of NCDs control that can help policymakers and health managers for better descion-making.Originality/valueIran adopted its national action plan in 2015 and WHO selected Iran as a fast-track country in 2017. The study confirmed that to achieve the global targets, appropriate and contextual stewardship for any specific setting is fundamental. Iran needs to improve its stewardship for prevention and control of NCDs and implement its national action plan. Therefore, the functions and policies outlined in this article for the proper performance of NCDs can improve more meaningful practices in this area in Iran and many other countries.