Burden of non-communicable diseases attributable to high temperature in a changing climate from 1990 to 2019: a global analysis.

BACKGROUND: With global climate change, the health threats of ambient high temperature have received widespread attention. However, latest spatio-temporal patterns of the non-communicable diseases (NCDs) burden attributable to high temperature have not been systematically reported. We aimed to analyze vulnerable areas and populations based on a detailed profile for the NCDs burden attributable to high temperature globally. METHODS: We obtained data from the Global Burden of Diseases (GBD) Study (2019) to describe the temporal and spatial patterns of NCDs burden attributable to high temperature globally from 1990-2019. Then we analyzed the differences by region, sex, and socio-demographic index (SDI). Finally, the age­period­cohort (APC) model was utilized to explore the age, period, and cohort effects of NCDs mortality caused by high temperature. RESULTS: In 2019, the number of deaths and Disability-adjusted life years (DALYs) from high-temperature-related NCDs was about 150,000 and 3.4 million globally, of which about 70% were in South Asia and North Africa and Middle East, and the burden was higher in men. Among 204 countries and territories, the highest age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were observed in Oman and United Arab Emirates, respectively. The global burden showed an upward trend from 1990 to 2019, with an EAPC of 3.66 (95%CI: 3.14-4.18) for ASMR and 3.68 (95%CI: 3.16-4.21) for ASDR. Cardiovascular diseases were the main contributors to the global burden of high-temperature-related NCDs in 2019. The age and period effect in APC model showed an increasing trend globally. There was a significant negative correlation between SDI and both ASMR (r = -0.17) and ASDR (r = -0.20) from 1990 to 2019. CONCLUSION: There was an increasing trend of the global burden of high-temperature-related NCDs. The burden was likely to be higher in males and the elderly, as well as in countries and regions with less economically and socially developed and in tropical climates. Surveillance and prevention measures should be implemented with a focus on these vulnerable areas and susceptible populations.

Increasing emergency department visits for anaphylaxis in very early childhood: A canary in the coal mine.

AIM: The incidence of anaphylaxis is increasing globally in tandem with changing environmental and lifestyle factors. There is very limited data on very early childhood presentations. We aim to assess changes in rates, characteristics and management of infant anaphylaxis in a paediatric ED over a 15-year period. METHODS: We conducted a retrospective study of children <2 years of age who presented with verified anaphylaxis comparing cases in years 2003-2007 with those in 2013-2017. Standardised information was collected on demographics, clinical presentation, management and triggers. RESULTS: Manually confirmed anaphylaxis rates in <2 year olds increased from 3.6 to 6.2 per 104 population (OR 1.7, 95% CI: 1.3-2.7; p < 0.001) with the greatest increase in <1 year olds. Anaphylaxis severity increased between 2003-2007 and 2013-2017 (OR 2.3, 95% CI: 1.2-4.3; p = 0.018). Failure to administer adrenaline was reduced in 2013-2017 (p = 0.007). Food was the leading anaphylaxis trigger (97.85%). CONCLUSION: This is the first study to suggest an increase in the incidence and severity of ED anaphylaxis presentations in children aged <2 years. Increased awareness of specific characteristics in this age group is required to facilitate timely recognition and optimal management. Further large-scale studies are warranted to understand underlying environmental drivers and find prevention strategies to reduce the burden of disease.

The health and economic burden associated with sugar-sweetened beverage consumption in Trinidad and Tobago.

BACKGROUND: In Trinidad and Tobago, non-communicable diseases (NCDs) are the leading cause of death. Unhealthy diet is one modifiable NCD risk factor, which contributes to the NCD burden. The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of NCDs. AIM: The aim of this paper is to estimate the burden of disease and economic costs associated with the consumption of SSBs in Trinidad and Tobago as evidence to support the implementation of health and fiscal policies on SSB consumption. METHODS: The results of this study were obtained through the use of a mathematical model which used a comparative risk assessment approach to estimate the health and economic burden associated with SSB intake, by sex and age. RESULTS: Estimates for one year showed that SSB consumption was associated with approximately 15,000 cases of overweight and obesity in adults and 11,700 cases in children, 28% of all the cases of diabetes and overall, an estimated 387 deaths and 9000 years of healthy life were lost due to premature death and disability. Approximately US$23.1 million was spent in the public healthcare system to treat diseases associated with consumption of sugary beverages. CONCLUSIONS: The consumption of SSBs is associated with increases in diseases, deaths and rising healthcare costs in Trinidad and Tobago. It is hoped that the results of this study will provide an added rationale and impetus for the implementation of policies to reduce the consumption of SSBs.

'Obesities': Position statement on a complex disease entity with multifaceted drivers.

Academic medicine fosters research that moves from discovery to translation, at the same time as promoting education of the next generation of professionals. In the field of obesity, the supposed integration of knowledge, discovery and translation research to clinical care is being particularly hampered. The classification of obesity based on the body mass index does not account for several subtypes of obesity. The lack of a universally shared definition of "obesities" makes it impossible to establish the real burden of the different obesity phenotypes. The individual's genotype, adipotype, enterotype and microbiota interplays with macronutrient intake, appetite, metabolism and thermogenesis. Further investigations based on the concept of differently diagnosed "obesities" are required.

Population health trends analysis and burden of disease profile observed in Sierra Leone from 1990 to 2017.

BACKGROUND: Sierra Leone, in West Africa, is one of the poorest developing countries in the world. Sierra Leone has experienced several recent challenges namely, a civil war from 1991 to 2002, a massive Ebola outbreak from 2014 to 2016, followed by floods and landslides in 2017.In this study, we quantified the burden of disease in Sierra Leone over a 27-year period, from 1990 to 2017. METHODOLOGY: In this descriptive study, we analysed secondary data from the Institute of Health Metrics and Evaluation, Global Burden of Disease (GBD) study. We quantified patterns of burden of disease, injuries, and risk factors in Sierra Leone. We report GBD data and metrics including mortality rates, years of life lost and risk factors for all ages and both sexes from 1990 to 2017. RESULTS: From 1990 to 2017, trends of mortality rates for all ages and sexes have declined in Sierra Leone although mortality rates remain some of the highest when compared to other developing countries. The burden of communicable, maternal, neonatal, and nutritional (CMNN) diseases are greater than the burden of non-communicable diseases (NCDs) due to the prevalence of endemic diseases in Sierra Leone. The most important CMNNs associated with premature mortality included respiratory infections, neglected tropical diseases, malaria, and HIV-Aids. Life expectancy has increased from 37 to 52 years. CONCLUSION: Sierra Leone's health status is gradually improving following the civil war and Ebola outbreak. Sierra Leone has a double burden of disease with CMNNs leading and NCDs progressively increasing. Despite these challenges, Sierra Leone has promising initiatives and programs pursuing the Universal Health Coverage 2030 Sustainable Developmental Goals Agenda. There is need for accountability of available resources, clear rules and expected roles for non-governmental organisations to ensure a level playing field for all actors to rebuild the health system.

A qualitative exploratory study of selected physicians' perceptions of the management of non-communicable diseases at a referral hospital in Zimbabwe.

INTRODUCTION: Non-communicable diseases (NCDs) have recently become a global public health burden and a leading cause of premature death, mainly in low- and middle-income countries (LMICs). The aim of the study was to explore physicians' perceptions on the availability and quality of clinical care for the management of NCDs. METHODS: This was a qualitative exploratory study meant to obtain expert perceptions on clinical care delivery for NCDs in one Zimbabwean central hospital setting. Data was collected from participants who consented and was analyzed using Stata version 13. A four-point Likert scale was used to categorize different levels of perceived satisfaction. FINDINGS: Twenty-three doctors participated in the study: four female doctors and nineteen males. Nineteen of the doctors were general practitioners, whilst four were specialists. The findings indicated that both categories perceived some shortfalls in clinical care for NCDs. Moreover, the perceptions of general practitioners and specialists were not significantly different. Participants perceived cancer care to be lagging far behind the other three NCDs under study. Care of cardiovascular diseases (CVDs) and diabetes showed mixed perceptions amongst participants, with positive perceptions almost equaling negative perceptions. Furthermore, hypertension was perceived to be clinically cared for better than the other NCDs under consideration. Reasons for the gaps in NCD clinical care were attributed by 33% of the participants to financial challenges; a further 27% to patient behavioral challenges; and 21% to communication challenges. CONCLUSIONS: The article concludes that care delivery for the selected NCDs under study at CCH need to be improved. Furthermore, it is crucial to diagnose NCDs before patients show clinical symptoms. This helps disease prognosis to yield better care results. The evaluation of doctors' perceptions indicates the need to improve NCD care at the institution in order to control NCD co-morbidities that may increase mortality.

'Trend in premature mortality from four major NCDs in Nanjing, China, 2007-2018'.

BACKGROUND: This study aims to analyze the trends of premature mortality caused from four major non-communicable diseases (NCDs), namely cardiovascular disease (CVD), cancer, chronic respiratory diseases, and diabetes in Nanjing between 2007 and 2018 and project the ability to achieve the "Healthy China 2030" reduction target. METHODS: Mortality data of four major NCDs for the period 2007-2018 were extracted from the Death Information Registration and Management System of Chinese Center for Disease Control and Prevention. Population data for Nanjing were provided by the Nanjing Bureau of Public Security. The premature mortality was calculated using the life table method. Joinpoint regression model was used to estimate the average annual percent changes (AAPC) in mortality trends. RESULTS: From 2007 to 2018, the premature mortality from four major NCDs combined in Nanjing decreased from 15.5 to 9.5%, with the AAPC value at - 4.3% (95% CI [- 5.2% to - 3.4%]). Overall, it can potentially achieve the target, with a relative reduction 28.6%. The premature mortality from cancer, CVD, chronic respiratory diseases and diabetes all decreased, with AAPC values at - 4.2, - 5.0%, - 5.9% and - 1.6% respectively. A relative reduction of 40.6 and 41.2% in females and in rural areas, but only 21.0 and 12.8% in males and in urban areas were projected. CONCLUSION: An integrated approach should be taken focusing on the modifiable risk factors across different sectors and disciplines in Nanjing. The prevention and treatment of cancers, diabetes, male and rural areas NCDs should be enhanced.

Assessment and prioritization of the WHO "best buys" and other recommended interventions for the prevention and control of non-communicable diseases in Iran.

BACKGROUND: The WHO's "best buys" and other recommended interventions are a menu of policy options and cost-effective interventions for the prevention and control of major noncommunicable diseases (NCDs). The menu has six objectives, implementing which by member states is expected to promote the achievement of the nine NCD targets by 2025. In line with their context, countries can select from the menu of best buys and other recommended interventions. Iran adopted its national action plan on NCDs, 2015, including global as well as some specific goals and targets. This study had two objectives: analyzing the gaps to reach the national targets on NCDs; and prioritizing the best buys and other recommended interventions based on multi-criteria decision-making (MCDA) method for the context of Iran. METHODS: This is a mixed-methods study. We used qualitative textual evidence (documentary content analysis) and MCDA for prioritization of interventions based on five criteria, including a number of people to be potentially affected by the intervention, cost-effectiveness of the intervention, attributable burden (DALY per 100,000), hospitalization and variations among income levels. Data related to five criteria for each intervention were extracted from national studies and relevant international organizations. The weight of each criterion determines based on the opinions of national experts. RESULTS: Out of 105 actions and interventions recommended by WHO, only 12 of them were not on the national agenda in Iran, while the six missed interventions were related to objective number 4. Only one of the best buys Group's interventions was not targeted (vaccination against human papillomavirus, two doses of 9-13-year-old girls), for which arrangements are being made for the implementation. Encouraging and educating healthy dietary habits and increasing public awareness about the side effects of smoking and exposure to second-hand smoke, e.g., through mass media campaigns, are among the interventions in need of serious prioritization. The priority of interventions was independently calculated in the area of risk factors and clinical preventive interventions. CONCLUSION: Due to limited resources, low and middle-income countries (LMICs) need to identify and prioritize more cost-effective and more equitable interventions to combat the NCD epidemic. Based on our findings, we advocate more investment in the mass and social media campaigns to promote a healthy diet, avoid tobacco use, as well as the inclusion of some effective clinical preventive interventions into the national action plan, along the long pathway to tackle NCDs and ultimately reach sustainable health development in Iran. The use of the MCDA approach assisted us in formulating a simultaneous use of efficiency and equity, and other indices for prioritizing the interventions.

[IMPROVEMENT OF ORGANIZATIONAL APPROACHES TO REGULAR MEDICAL CHECKUP SERVICE IN THE METROPOLITAN HEALTHCARE SYSTEM].

An adequate response to the challenges people face in the context of continuing urbanization, increasing life expectancy and, at the same time, falling birth rates, is to maximize the containment of chronic non-communicable diseases (NCDs) by high level of healthcare organization and medical services provided to the patients with such pathologies. Global economic losses caused by NCDs result in disability and early mortality among working population as well as in significant treatment costs increasing with the advancement of the disease. That is why outpatient care for NCD patients which includes behaviour factors monitoring is an urgent task for the world and Russian healthcare. In this regard, the goal of this study is to find organizational solutions to improve regular medical checkup service for NCD patients in the metropolitan healthcare system, relying on the data provided by medical organizations in the form of statistical observations. Thus, the results of correlation analysis have revealed a connection between the increased number of individuals in the second and third health groups and individuals scheduled for a regular medical checkup at the end of the year and its absence between the clinical examination results and the number of firstly diagnosed patients. It is also reported that the number of diseases registered for a regular medical checkup at the end of the reporting period (year) has increased, so patients with polymorbid conditions are supposed to prevail among the others on these days and require a special approach to their management. Taking into account the results obtained, possible ways for optimizing the organizational model of a regular medical checkup are the following: special hours (days) for such patients admission, permanent cooperation of a doctor (local general practitioner, GP, family doctor) and a health worker with a secondary medical education (to deal with organizational issues), etc.

Exploring patient experiences with and attitudes towards hypertension at a private hospital in Uganda: a qualitative study.

BACKGROUND: Hypertension is the leading risk factor for mortality worldwide and is more common in sub-Saharan Africa than any other region. Work to date confirms that a lack of human and material resources for healthcare access contributes to this gap. The ways in which patients' knowledge and attitudes toward hypertension determine their engagement with and adherence to available care, however, remains unclear. METHODS: We conducted an exploratory, qualitative descriptive study to assess awareness, knowledge, and attitudes towards hypertension and its management at a large private hospital in Kampala. We interviewed 64 participants (29 with hypertension and 34 without, 1 excluded) in English. General thematic analysis using the Integrated Conceptual Health Literacy Model was used to iteratively generate themes and categories. RESULTS: We identified three main themes: Timing of Hypertension Diagnosis, Aiming for Health Literacy, and the Influence of Knowledge on Behavior. Most participants with hypertension learned of their condition incidentally, speaking to the lack of awareness of hypertension as an asymptomatic condition. Drove nearly all participants to desire more information. However, many struggled to translate knowledge into self-management behaviors due to incomplete information and conflicting desires of participants regarding lifestyle and treatment. CONCLUSIONS: Internal patient factors had a substantial impact on adherence, calling attention to the need for educational interventions. Systemic barriers such as cost still existed even for those with insurance and need to be recognized by treating providers.

The association between biopsychosocial factors and disability in a national health survey in South Africa.

The association between psychosocial factors and disability is less clear. This study investigated the biological and psychosocial (employment and psychological distress) factors associated with level of disability in an adult sample in South Africa. Data were analysed from a cross-sectional survey among adults aged 18-64 (n = 4974). Multiple linear regression was used to investigate the associations of the selected variables with disability. The mean percentage score on the WHODAS scale of disability was 5.31% (95% CI: 4.74-5.88). Age (p < 0.001) and race (p = 0.0002) were significantly associated with disability, and history of stroke (ß = 7.19, 95% CI: 3.19-11.20) and heart-related conditions (ß = 2.08, 95% CI: [0.23-3.93) showed positive associations. Of the psychosocial variables, psychological distress (ß = 10.49 [8.63-12.35]) showed a strong positive association while employment (-1.62 [-2.36 to -0.88]) showed a negative association with disability. The association between demographic factors, medical conditions and increased disability confirms the findings in the literature. The finding that psychological distress is associated with increased disability has not been frequently reported. This study highlights specific psychosocial targets that may be usefully addressed by health policies and interventions in order to improve disability management.

Non-communicable diseases and related risk behaviors among men and women living with HIV in Cambodia: findings from a cross-sectional study.

BACKGROUND: There is a growing concern for an increasing burden of non-communicable diseases (NCDs) in people living with HIV. This concern is evident especially in developing countries where dietary and lifestyle risk factors associated with NCDs are becoming more prominent. This study explored the prevalence of diabetes mellitus, hypertension, and hyperlipidemia and related risk factors in men and women living with HIV in Cambodia. METHODS: This cross-sectional study was conducted among 510 adult people living with HIV randomly selected from one city and four provinces in Cambodia. A structured questionnaire was used to collect data on socio-demographic characteristics, health behaviors, medical history, and antiretroviral therapy (ART). Anthropometric and biological measurements were performed. Descriptive statistics were used to calculate proportions and means of the measured variables. An independent Student's t-test was used for continuous variables. Chi square test or Fisher's exact test was used for categorical variables to explore gender differences. RESULTS: Prevalence of diabetes mellitus, hypertension, and hyperlipidemia was 9.4, 15.1, and 33.7%, respectively. The prevalence of hyperlipidemia was significantly higher among men compared to women. Mean systolic and diastolic blood pressures were also significantly higher among men. Regarding risk factors, 17.3% of participants were overweight, and 4.1% were obese. Tobacco and alcohol use was common, particularly among men. Fruit and vegetable consumption was considerably low among both men and women. Physical activity levels were also low. About 40% of participants reported having a job that involved mostly sitting or standing; 46.3% reported engaging in moderate activities; and 11.8% reported engaging in vigorous activities during leisure time. A significantly higher proportion of men compared to women engaged in vigorous activities both at work and during leisure time. CONCLUSIONS: The prevalence of diabetes mellitus, hypertension, and hyperlipidemia among men and women living with HIV in Cambodia is considerably high. Related risk factors were also common. Given the comorbidity of NCDs and HIV, policy and programmatic interventions are required, including integration of NCD screening into HIV programs. Distinctions in the levels of diseases and in health behaviors between men and women suggest that interventions need to be tailor-made and gender-specific, targeting their respective diseases and behaviors.

Diabetes care in a complex humanitarian emergency setting: a qualitative evaluation.

BACKGROUND: Evidence is urgently needed from complex emergency settings to support efforts to respond to the increasing burden of diabetes mellitus (DM). We conducted a qualitative study of a new model of DM health care (Integrated Diabetic Clinic within an Outpatient Department [IDC-OPD]) implemented by Médecins Sans Frontières (MSF) in Mweso Hospital in eastern Democratic Republic of Congo (DRC). We aimed to explore patient and provider perspectives on the model in order to identify factors that may support or impede it. METHODS: We used focus group discussions (FGDs; two discussions, each with eight participants) and individual semi-structured qualitative interviews (seven patients and 10 staff) to explore experience of and perspectives on the IDC-OPD. Participants were recruited purposively to represent a range of DM disease severity and staff functions respectively, and to ensure the age and gender distribution was representative of the population of DM patients registered in the clinic. Data were coded in NVivo10© and analysed using an inductive thematic approach. RESULTS: There appears to be little awareness surrounding DM in patient communities, resulting in delays presenting to hospital. Patients describe their first reactions to symptoms as fear and confusion, often assuming symptoms are of another disease (e.g. HIV/AIDS). They often express disbelief that they could have DM (e.g. stating DM is a 'rich man's disease') and lack acceptance that there is no cure. Patients experienced difficulty travelling to appointments, exacerbated by flare-ups in the conflict. Providing psycho-social and sensitisation activities in a group setting appears to offer an opportunity for patients to support each other in their effort to adhere to drug treatment and follow-up appointments. All patients reported great difficulty in adhering to the recommended diet, which was viewed as unaffordable and unavailable, and fear that this would be the biggest obstacle to maintaining their drug treatment (as treatment must be taken with food). CONCLUSION: Our findings emphasize the importance of community awareness of DM and the value of treatment support, including psychosocial and educational support to DM patients and their families, and culturally sensitive, low-cost dietary advice, to ensuring the adoption and maintenance of DM treatment.

Assessing the impact of general practitioner team service on perceived quality of care among patients with non-communicable diseases in China: a natural experimental study.

OBJECTIVE: China issued the national primary care policy of promoting general practitioner (GP) team service in 2011. We conducted this study to assess the impact of the GP team service on quality of primary care as perceived by patients with non-communicable diseases (NCDs). DESIGN: Natural experimental study. SETTING: This study was conducted in Shanghai, where the policy was effectively implemented, and Kunming, where the policy was not implemented. PARTICIPANTS: In both cities, NCD patients were interviewed with primary care assessment tool (PCAT) after their clinical consultations in their community health centers. INTERVENTION: The implementation of GP team service policy. MAIN OUTCOME MEASURES: Multiple linear regressions were employed to compare PCAT scores between the two rounds of the surveys in each city. Difference-in-difference (DID) analysis was used to identify the changes between two cities over time. RESULTS: A total of 663 and 587 patients in Shanghai, and 400 and 441 patients in Kunming were surveyed in 2011 and 2013, respectively. The DID analysis showed that the total primary care quality scores improved in Shanghai compared with Kunming between 2011 and 2013 (ß = 1.30, 95% CI: 0.74, 1.87). In Shanghai, care quality in 2013 improved significantly for the total score and the six components when compared with those in 2011. No significant changes were observed in Kunming in the same period. CONCLUSION: Primary care policies that promote long-term provider-patient relationships, coordinated service with hospitals and capitation payment for the GP team may contribute to the improvement of care quality in Shanghai.

Facilitators and barriers of adopting healthy lifestyle in rural China: a qualitative analysis through social capital perspectives.

Non-communicable diseases (NCDs) are the major public health concerns in China. However, little has been known yet about the background social factors that influence lifestyles as possible NCD risk factors. This qualitative study aimed to explore facilitators and barriers of adopting healthy lifestyles among residents in a rural community of China. Three age-stratified focus group discussions (FGDs) were conducted in Fangshan district of Beijing in 2013. A FGD guide was designed to elicit the participants' perception and experience regarding their lifestyles. The audio-records were transcribed, and data were qualitatively analyzed through thematic approach. Through social capital framework with bonding, bridging, and linking classifications, we identified the following facilitators and barriers to adopt healthy lifestyles. (1) Facilitators: mutual support from family/friends and motivation to participate in regular exercises (bonding); cooperative relationships with community health workers (bridging); and nationwide high level of healthy lifestyle awareness (linking). (2) Barriers: negative influence from family/friends, insufficient support from family/friends, peer pressure and tolerance towards unhealthy lifestyles (bonding); insufficient support from health professionals (bridging); and inequity in allocation of public resources (linking). This study revealed that bonding, bridging and linking social capital would work as facilitators and barriers to adopt healthy lifestyles among rural residents in China.

Case studies in nanny state name-calling: what can we learn?

The 'nanny state' has become a popular metaphor in debates about public health regulation. It fulfils a particular role in that debate: to caution government against taking action. This paper presents case studies of nanny state criticisms, using them to identify a series of contextual features that may assist in better understanding, evaluating and where appropriate, resisting the rhetorical force of nanny state criticisms. The case studies presented include Rush Limbaugh's reactions to Michelle Obama's efforts to encourage American food companies to market healthier food to children; Christopher Hitchens' critique of New York City Mayor Michael Bloomberg's public health policies; and the reaction of neoliberal think tanks to Australia's plain tobacco packaging legislation. These case studies do not provide a basis for making generalisations about the practice of 'nanny state name-calling'. Nor do they preclude debate about the appropriate limits of government action. However, in appropriate cases they may assist policy-makers and public health advocates to contest the framing of public health interventions as unwarranted incursions into the private lives of individuals. One important lesson from these case studies is that the principal concern of nanny state critics is not loss of freedom as such, but the role of the state. The nanny state critique is ultimately a call for the state to be agnostic about the health of citizens, allowing market forces to dominate. Although the nanny state critique is not new, it is a significant challenge to government efforts to address lifestyle-influenced risk factors for non-communicable diseases, including tobacco use, harmful use of alcohol, and unhealthy diet.

National Non-Communicable Diseases Conferences- A Platform to Inform Policies and Practices in Tanzania.

Background: Non-communicable diseases (NCDs) arise from diverse risk factors with differences in the contexts and variabilities in regions and countries. Addressing such a complex challenge requires local evidence. Tanzania has been convening stakeholders every year to disseminate and discuss scientific evidence, policies, and implementation gaps, to inform policy makers in NCDs responses. This paper documents these dissemination efforts and how they have influenced NCDs response and landscape in Tanzania and the region. Methods: Desk review was conducted through available MOH and conference organizers' documents. It had both quantitative and qualitative data. The review included reports of the four NCDs conferences, conference organization, and conduct processes. In addition, themes of the conferences, submitted abstracts, and presentations were reviewed. Narrative synthesis was conducted to address the objectives. Recommendations emanated from the conference and policy uptake were reviewed and discussed to determine the impact of the dissemination. Findings: Since 2019, four theme-specific conferences were organized. This report includes evidence from four conferences. The conferences convened researchers and scientists from research and training institutions, implementers, government agencies, and legislators in Tanzania and other countries within and outside Africa. Four hundred and thirty-five abstracts were presented covering 14 sub-themes on health system improvements, financing, governance, prevention intervention, and the role of innovation and technology. The conferences have had a positive effect on governments' response to NCDs, including health care financing, NCDs research agenda, and universal health coverage. Conclusion: The National NCDs conferences have provided suitable platforms where stakeholders can share, discuss, and recommend vital strategies for addressing the burden of NCDs through informing policies and practices. Ensuring the engagement of the right stakeholders, as well as the uptake and utilization of the recommendations from these platforms, remains crucial for addressing the observed epidemiological transition in Tanzania and other countries with similar contexts.

Is ChatGPT an Effective Tool for Providing Dietary Advice?

The chatbot Chat Generative Pretrained Transformer (ChatGPT) is becoming increasingly popular among patients for searching health-related information. Prior studies have raised concerns regarding accuracy in offering nutritional advice. We investigated in November 2023 ChatGPT's potential as a tool for providing nutritional guidance in relation to different non-communicable diseases (NCDs). First, the dietary advice given by ChatGPT (version 3.5) for various NCDs was compared with guidelines; then, the chatbot's capacity to manage a complex case with several diseases was investigated. A panel of nutrition experts assessed ChatGPT's responses. Overall, ChatGPT offered clear advice, with appropriateness of responses ranging from 55.5% (sarcopenia) to 73.3% (NAFLD). Only two recommendations (one for obesity, one for non-alcoholic-fatty-liver disease) contradicted guidelines. A single suggestion for T2DM was found to be "unsupported", while many recommendations for various NCDs were deemed to be "not fully matched" to the guidelines despite not directly contradicting them. However, when the chatbot handled overlapping conditions, limitations emerged, resulting in some contradictory or inappropriate advice. In conclusion, although ChatGPT exhibited a reasonable accuracy in providing general dietary advice for NCDs, its efficacy decreased in complex situations necessitating customized strategies; therefore, the chatbot is currently unable to replace a healthcare professional's consultation.

Inequalities in cardiovascular disease among elderly Indians: A gender perspective analysis using LASI wave-I (2017-18).

BACKGROUND: While Cardiovascular disease (CVD) affects both men and women, emerging evidence suggests notable gender differentials in disease prevalence. This study aims to explore and analyse the gender differentials in CVD disease prevalence in India. METHODS: The present study utilizes data from first wave of the nationally representative survey "Longitudinal Ageing Study in India" (LASI, WAVE-I, 2017-18) with the eligible sample size of 31,464 individuals aged 60 years and above. Logistic regression analysis was used to understand risk of CVD by demographic characteristics. Factors contribution to gender differences in CVD prevalence was examined using a non-linear Fairlie decomposition. RESULTS: The prevalence of CVD was lower in men (31.06%) compared to women (38.85%). Women have a 33% higher likelihood of CVD compared to men (OR: 1.33; 95% CI: 1.25-1.42). Lack of education also confers a lower risk, more pronounced in women with no schooling (OR: 0.81; 95% CI: 0.7-0.94) compared to men (OR: 0.52; 95% CI: 0.47-0.58). Morbidity influences CVD presence more among women than men, with individuals suffering from three or more diseases having markedly increased odds (Men: OR: 3.89; 95% CI: 3.54-4.3, Women: OR: 6.97; 95% CI: 6.48-10.11). Smoking accounted increase in (20.52%) the gender gap while years of schooling dramatically lessened the gender gap (-46.30%). CONCLUSION: Result show gender differential in CVD prevalence and underlying risk factors, underscoring the need for gender-specific preventive strategies and interventions. Our findings highlight the importance of refined approach to cardiovascular health that considers the complex interplay of biological, social, and environmental determinants.

Characterizing Multimorbidity Prevalence and Adverse Outcomes in Ethnically and Culturally Diverse Sub-Populations in India: Gaps, Opportunities, and Future Directions.

India is a large middle-income country and has surpassed China in overall population, comprising 20% of the global population (over 1.43 billion people). India is experiencing a major demographic shift in its aging population. Chronic diseases are common among older adults and can be persistent over the life course, lead to the onset of disability, and be costly. Among older adults in India, the existence of multiple comorbid chronic conditions (i.e., multimorbidity) is rapidly growing and represents a burgeoning public health burden. Prior research identified greater rates of multimorbidity (e.g., overweight/obesity diabetes, hypertension, cardiovascular disease, stroke, and malignancies) in minority populations in the United States (U.S.); however, limited studies have attempted to characterize multimorbidity among older adult sub-populations residing in India. To address this gap, we conducted a narrative review of studies on multimorbidity using the data from the Longitudinal Aging Study of India (LASI), the largest nationally representative longitudinal survey study of adults in India. Our definition of multimorbidity was the presence of more than two conditions in the same person. Our findings, based on 15 reviewed studies, aim to (1) characterize the definition and measurement of multimorbidity and to ascertain its prevalence in ethnically and culturally diverse sub-populations in India; (2) identify adverse outcomes associated with multimorbidity in the Indian adult population; and (3) identify gaps, opportunities, and future directions.