Domínios analisados na avaliação da resiliência em indivíduos com doenças cardiovasculares crônicas: revisão de escopo / Domains analyzed in the assessment of resilience in individuals with chronic cardiovascular diseases: a scoping review / Dominios analizados en la evaluación de la resiliencia en individuos con enfermedades cardiovasculares crónicas: revisión de escopo

OBJETIVO: Mapear as evidências científicas sobre os instrumentos utilizados na avaliação da resiliência em indivíduos adultos com doenças cardiovasculares crônicas e explorar seus domínios. MÉTODO: Revisão de escopo para responder à questão: Quais os instrumentos ou questionários utilizados para avaliação da resiliência em indivíduos adultos com doenças cardiovasculares crônicas? Foi realizada pesquisa nas bases de dados LILACS, Scopus, Web of Science, Pubmed, CINAHL e literatura cinzenta. Os estudos foram adicionados ao gerenciador Mendeley e a seleção realizada por dois revisores independentes (Kappa=0.86). RESULTADOS: Foram identificados 164 estudos e incluídos 14, sendo utilizados seis instrumentos para avaliação da resiliência. A avaliação da resiliência ocorreu em indivíduos com cardiopatia isquêmica, infarto do miocárdio, acidente vascular cerebral e insuficiência cardíaca. CONCLUSÃO: Os instrumentos não são adaptados para uso em indivíduos com doenças cardiovasculares crônicas. Faz-se necessária a formulação de instrumentos específicos que contemplem domínios individuais, mas que considerem o contexto social deste indivíduo.

OBJECTIVE: To map the scientific evidence on the instruments used to assess resilience in adult individuals with chronic cardiovascular disease, and explore their domains. METHOD: A scoping review to meet the question: What are the instruments or questionnaires used to assess resilience in adult individuals with chronic cardiovascular disease? The search was conducted in LILACS, Scopus, Web of Science, Pubmed, CINAHL databases and the grey literature. Studies were uploaded to Mendeley and the selection was performed by two independent reviewers (Kappa=0.86). RESULTS: A total of 164 studies were identified and 14 were included; six instruments were used to assess resilience. The resilience assessment occurred in individuals with ischemic heart disease, myocardial infarction, stroke, and heart failure. CONCLUSION: The instruments were not adapted for use in individuals with chronic cardiovascular diseases. The development of specific instruments that include individual domains and consider the social context of these individuals is necessary.

OBJETIVO: Mapear la evidencia científica sobre los instrumentos utilizados para evaluar la resiliencia en adultos con enfermedades cardiovasculares crónicas y explorar sus dominios. MÉTODO: Revisión de escopo para responder a la pregunta: ¿Que instrumentos o cuestionarios se utilizan para evaluar la resiliencia en personas adultas con enfermedades cardiovasculares crónicas? Se realizó una búsqueda en las bases de datos LILACS, Scopus, Web of Science, Pubmed, CINAHL y literatura gris. Los estudios fueron agregados al medidor Mendeley y la selección fue realizada por dos revisores independientes (Kappa=0.86). RESULTADOS: Se identificaron 164 estudios y se incluyeron 14, utilizando seis instrumentos para evaluar la resiliencia. La evaluación de la resiliencia se llevó a cabo en personas con cardiopatía isquémica, infarto del miocardio, accidente vascular cerebral e insuficiencia cardíaca. CONCLUSIÓN: Los instrumentos no están adaptados para su uso en personas con enfermedades cardiovasculares crónicas. Es necesario formular instrumentos específicos que contemplen dominios individuales, pero que consideren el contexto social de este individuo.

Economic and humanistic burden associated with noncommunicable diseases among adults with depression and anxiety in the United States.

Aims: This study estimated the economic and humanistic burden associated with chronic non-communicable diseases (NCCDs) among adults with comorbid major depressive and/or any anxiety disorders (MDD and/or AAD).Materials and methods: A retrospective analysis was conducted using the Medical Expenditure Panel Survey data (2010-2015). The analytic cohort included adults (≥18 years) with MDD only (C1), AAD only (C2), or both (C3). The presence of either of 6 NCCDs (cardiovascular diseases [CVD], pulmonary disorders [PD], pain, high cholesterol, diabetes, and obesity) were assessed. Study outcomes included healthcare costs, activity limitations, and quality of life. Multivariate regressions were conducted in each of the 3 cohorts to evaluate the association between the presence of NCCDs and outcomes.Results: The analytic sample included 9,160,465 patients: C1 (4,391,738), C2 (3,648,436), C3 (1,120,292). Pain (59%) was the most common condition, followed by CVD (55%), high cholesterol (50%), obesity (42%), PD (17%), and diabetes (14%). Mean annual healthcare costs were the greatest for C3 ($14,317), followed by C1 ($10,490) and C2 ($7,906). For C1, CVD was associated with the highest increment in annual costs ($3,966) followed by pain ($3,617). For C2, diabetes was associated with the highest incremental annual costs ($4,281) followed by PD ($2,997). For C3, cost trends were similar to those seen in C2. NCCDs resulted in a significant decrease in physical quality of life across all cohorts. Pain was associated with a significantly higher likelihood of self-reported physical, social, cognitive, and activity limitations compared to those without pain.Conclusions: 60% of patients with MDD and/or AAD had at least one additional NCCD, which significantly increased the economic and humanistic burden. These findings are important for payers and clinicians in making treatment decisions. These results underscore the need for development of multi-pronged interventions which aim to improve quality of life and reduce activity limitations among patients with mental health disorders and NCCDs.

Global patterns in price elasticities of sugar-sweetened beverage intake and potential effectiveness of tax policy: a cross-sectional study of 164 countries by sex, age and global-income decile.

OBJECTIVE: To quantify global relationships between sugar-sweetened beverage (SSB) intake and prices and examine the potential effectiveness of tax policy. DESIGN: SSB intake data by country, age and sex from the Global Dietary Database were combined with gross domestic product and price data from the World Bank. Intake responsiveness to income and prices was estimated accounting for national income, age and sex differences. SETTING: 164 countries. POPULATION: Full adult population in each country. MAIN OUTCOME MEASURES: A consumer demand modelling framework was used to estimate the relationship between SSB intake and prices and derive own-price elasticities (measures of percentage changes in intake from a 1% price change) globally by age and sex. We simulated how a 20% tax would impact SSB intake globally. Tax policy outcomes were examined across countries by global income decile for representative age and sex subgroups. RESULTS: Own-price responsiveness was highest in lowest income countries, ranging from -0.70 (p<0.100) for women, age 50, to -1.91 (p<0.001) for men, age 80. In the highest income countries, responsiveness was as high as -0.49 (p<0.001) (men, age 20), but was mostly insignificant for older adults. Overall, elasticities were strongest (more negative) at the youngest and oldest age groups, and mostly insignificant for middle-aged adults, particularly in middle-income and high-income countries. Sex differences were mostly negligible. Potential intake reductions from a 20% tax in lowest income countries ranged from 14.5% (95% CI: 29.5%, -0.4%) in women, 35 ≤ age < 60, to 24.9% (44.4%, 5.3%) in men, age ≥60. Intake reductions decreased with country income overall, and were mostly insignificant for middle-aged adults. CONCLUSIONS: These findings estimate the global price-responsiveness of SSB intake by age and sex, informing ongoing policy discussions on potential effects of taxes.

Are Nigerian Women Pro-Active about Noncommunicable Disease Prevention? A Quantitative Survey.

BACKGROUND: Noncommunicable diseases (NCDs) continue to cause significant morbidity and mortality worldwide with incidence increasing rapidly in developing countries. Poor utilization of preventive healthcare services contributes to this high burden. OBJECTIVE: To assess the knowledge and utilization of preventive healthcare services among women in Lagos, Nigeria. METHODS: This was a cross-sectional descriptive study carried out at Mainland Local Government Area (LGA) between May and July 2014. Respondents were selected using the multistage sampling method. A pretested, interviewer-administered questionnaire was used to obtain information. Data were analyzed using Epi info software version 7. Summary and inferential statistics were done and the level of significance was set at <5% (p < 0.05). FINDINGS: Awareness of specified NCDs among the 322 respondents was 82.61% and of preventive healthcare services for the NCDs was 65.22%. Virtually all (99.05%) of the respondents had poor knowledge of these preventive services. Utilization rates were equally poor. Most common screening/tests done were Blood Pressure measurement (78.18%), Self breast examination (69.96%) and blood sugar test (58.33%). Much lower utilization rates were recorded for lipid profile (37.57%), Pap smear (26.11%), Visual Inspection with Acetic Acid (VIA) (19.72%), Human Papilloma Virus (HPV) immunization (16.55%) and mammography (14.72%). CONCLUSIONS: Respondents were aware of specified NCDs and preventive healthcare services. They considered routine medical check-up important, however they had poor knowledge of the preventive health services for NCDs and hardly utilized them. Women should be given detailed information on the preventive healthcare services to improve their knowledge and utilization so as to reduce the NCD burden.

Household coping strategies after an adult noncommunicable disease death in Bangladesh.

When facing adverse health from noncommunicable disease (NCD), households adopt coping strategies that may further enforce poverty traps. This study looks at coping after an adult NCD death in rural Bangladesh. Compared with similar households without NCD deaths, households with NCD deaths were more likely to reduce basic expenditure and to have decreased social safety net transfers. Household composition changes showed that there was demographic coping for prime age deaths through the addition of more women. The evidence for coping responses from NCDs in low- and middle-income countries may inform policy options such as social protection to address health-related impoverishment.

Patients' attendance patterns to different healthcare settings and perceptions of stakeholders regarding screening for chronic, non-communicable diseases in high street dental practices and community pharmacy: a cross-sectional study.

OBJECTIVE: Non-communicable diseases (NCDs) impose a significant health and economic burden. This study aimed to assess the differential attendance patterns of public to different healthcare professionals and gauge the opinions of key stakeholders towards screening of NCDs by allied healthcare professionals. DESIGN: Questionnaires were designed piloted and subsequently completed by key stakeholders. The results were analysed descriptively. SETTING: Public questionnaires were undertaken in a West Midlands transport station and Public Markets. High street dental and community pharmacy settings were selected via local clinical and research networks. Healthcare professionals were identified using professional networks and were emailed a web link to an online survey. PARTICIPANTS: 1371 members of the public, 1548 patients and 222 healthcare professionals (doctors general practitioner (GP), dentists general dental practitioner (GDP) and pharmacists) completed the questionnaires. OUTCOME MEASURES: The outcome was to compare attendance patterns at GDP and GP practices to determine whether different populations were more likely to access different healthcare professionals, this included determining when patients were last screened for NCDs by their GP. Additionally, the willingness of patients to undergo the required intervention and the opinions of stakeholders regarding the concept of screening for the specified NCDs in general dental and community pharmacy settings were also explored. RESULTS: 12% of patients who reported seeing a GDP biannually reported that they had not had contact with a GP in the last year. Over 61% of the public reported attending a GDP biannually, of this group 48% reported having never had a check-up at the GP. All stakeholders surveyed were in broad support of the concept of allied health professionals undertaking screening for specific general health conditions. CONCLUSIONS: This study has established that allied healthcare professionals may have access to different cohorts of the population to GPs. If GDPs and pharmacists have access to patients who are not using healthcare services elsewhere, they may be ideally placed to risk assess, and where appropriate offer preventative advice and test for NCDs.

The economic impact of non-communicable diseases among households in South Asia and their coping strategy: A systematic review.

BACKGROUND: Out of pocket payment (OOPP), is the major health financing mechanism in South Asia region. With the rising burden of non-communicable diseases (NCDs), the region is facing a high financial burden. However, the extent and nature of economic impact caused by treatment and management of NCDs at the household level is yet unknown. METHOD: We conducted a systematic review using Medline and Embase databases. Only peer-reviewed quantitative studies published between January 2000 to December 2016 assessing OOPP or catastrophic health expenditure or impoverishment or financial coping strategy due to at least one of the four major NCDs-cardiovascular diseases(CVDs), diabetes, cancer, chronic respiratory disease in South Asia region was included in the review. The review is registered in PROSPERO no: CRD42017059345. RESULTS: A total of 21 studies (of 2693 records identified) met the inclusion criteria. The economic impact was most frequently studied in CVDs and in terms of OOPP. The studies collectively indicated high OOPP, higher likelihood of catastrophic expenditure and impoverishment for inpatient care for these major NCDs which was visible in all income levels. Borrowing and selling off assets were the most common forms of coping strategies adopted and varied inconsistently between urban and rural households. The true extent of the economic impact, however, remains difficult to determine due to methodological heterogeneity regarding outcomes reported and measures employed for calculation of OOPP, catastrophic expenditure, and impoverishment across these four major NCDs and between nations. CONCLUSION: The economic impact due to treatment and management of CVDs, diabetes, cancer and chronic respiratory diseases among households in South Asia seems dire. Given the lack of sufficient evidence the review stresses the need for further research in the region to develop evidence-informed nationally tailored prepayment mechanisms covering NCDs to reduce economic vulnerability and standardization of tools measuring the economic impact for generating comparable estimates.

Traditional Chinese Practice, A Promising Integrative Intervention for Chronic Non-Infectious Disease Management.

The number of people with chronic diseases rises rapidly in recent years worldwide. Except for drug medication, mind-body exercises are indispensable for chronic disease management. Traditional Chinese practice (TCP), as an integrative intervention, is known as an effective means to keep in good health and fitness, as well as help regulate emotion. This paper introduces the domestic and overseas studies on effectiveness of TCP for chronic diseases, and explores the key action links from three aspects, including functional training of multiple-joint guided by consciousness, relieving psychological risk factors, improving respiratory and digestive function, blood and lymph circulation through respiratory training, and regulation of nerve, metabolic, and immune system. Finally, the authors discussed how to integrate TCP in the chronic disease management, and put forward that the practice methods and evaluation standard should be assessed academically.

Social influences on adolescents' dietary behavior in Catalonia, Spain: A qualitative multiple-cases study from the perspective of social capital.

Adolescence has been referred to as the last best chance to prevent adult non-communicable diseases. Gaining further evidence on the psychosocial determinants of health behaviors, particularly the impact of peers, social networks and media on diet, is necessary to develop appropriate preventive strategies. Based on a multiple-cases study, our aim was to discuss the social influences on adolescents' dietary behavior from a social capital perspective. Participants were reached through four high-schools in different Catalan rural-urban and socioeconomic contexts. Our results confirm the different layout of social capital in the community, school, peers and family. In our sample, family and peers are the most influent sources of social capital in relation to dietary behaviors, inducing both protective and damaging effects.

Moving the Agenda on Noncommunicable Diseases: Policy Implications of Mobile Phone Surveys in Low and Middle-Income Countries.

The growing burden of noncommunicable diseases (NCDs), for example, cardiovascular diseases and chronic respiratory diseases, in low- and middle-income countries (LMICs) presents special challenges for policy makers, due to resource constraints and lack of timely data for decision-making. Concurrently, the increasing ubiquity of mobile phones in LMICs presents possibilities for rapid collection of population-based data to inform the policy process. The objective of this paper is to highlight potential benefits of mobile phone surveys (MPS) for developing, implementing, and evaluating NCD prevention and control policies. To achieve this aim, we first provide a brief overview of major global commitments to NCD prevention and control, and subsequently explore how countries can translate these commitments into policy action at the national level. Using the policy cycle as our frame of reference, we highlight potential benefits of MPS which include (1) potential cost-effectiveness of using MPS to inform NCD policy actions compared with using traditional household surveys; (2) timeliness of assessments to feed into policy and planning cycles; (3) tracking progress of interventions, hence assessment of reach, coverage, and distribution; (4) better targeting of interventions, for example, to high-risk groups; (5) timely course correction for suboptimal or non-effective interventions; (6) assessing fairness in financial contribution and financial risk protection for those affected by NCDs in the spirit of universal health coverage (UHC); and (7) monitoring progress in reducing catastrophic medical expenditure due to chronic health conditions in general, and NCDs in particular. We conclude that MPS have potential to become a powerful data collection tool to inform policies that address public health challenges such as NCDs. Additional forthcoming assessments of MPS in LMICs will inform opportunities to maximize this technology.

The Development of an Interactive Voice Response Survey for Noncommunicable Disease Risk Factor Estimation: Technical Assessment and Cognitive Testing.

BACKGROUND: The rise in mobile phone ownership in low- and middle-income countries (LMICs) presents an opportunity to transform existing data collection and surveillance methods. Administering surveys via interactive voice response (IVR) technology-a mobile phone survey (MPS) method-has potential to expand the current surveillance coverage and data collection, but formative work to contextualize the survey for LMIC deployment is needed. OBJECTIVE: The primary objectives of this study were to (1) cognitively test and identify challenging questions in a noncommunicable disease (NCD) risk factor questionnaire administered via an IVR platform and (2) assess the usability of the IVR platform. METHODS: We conducted two rounds of pilot testing the IVR survey in Baltimore, MD. Participants were included in the study if they identified as being from an LMIC. The first round included individual interviews to cognitively test the participant's understanding of the questions. In the second round, participants unique from those in round 1 were placed in focus groups and were asked to comment on the usability of the IVR platform. RESULTS: A total of 12 participants from LMICs were cognitively tested in round 1 to assess their understanding and comprehension of questions in an IVR-administered survey. Overall, the participants found that the majority of the questions were easy to understand and did not have difficulty recording most answers. The most frequent recommendation was to use country-specific examples and units of measurement. In round 2, a separate set of 12 participants assessed the usability of the IVR platform. Overall, participants felt that the length of the survey was appropriate (average: 18 min and 31 s), but the majority reported fatigue in answering questions that had a similar question structure. Almost all participants commented that they thought an IVR survey would lead to more honest, accurate responses than face-to-face questionnaires, especially for sensitive topics. CONCLUSIONS: Overall, the participants indicated a clear comprehension of the IVR-administered questionnaire and that the IVR platform was user-friendly. Formative research and cognitive testing of the questionnaire is needed for further adaptation before deploying in an LMIC.

Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations.

The co-occurrence of health burdens in transitioning populations, particularly in specific socioeconomic and cultural contexts, calls for conceptual frameworks to improve understanding of risk factors, so as to better design and implement prevention and intervention programmes to address comorbidities. The concept of a syndemic, developed by medical anthropologists, provides such a framework for preventing and treating comorbidities. The term syndemic refers to synergistic health problems that affect the health of a population within the context of persistent social and economic inequalities. Until now, syndemic theory has been applied to comorbid health problems in poor immigrant communities in high-income countries with limited translation, and in low-income or middle-income countries. In this Series paper, we examine the application of syndemic theory to comorbidities and multimorbidities in low-income and middle-income countries. We employ diabetes as an exemplar and discuss its comorbidity with HIV in Kenya, tuberculosis in India, and depression in South Africa. Using a model of syndemics that addresses transactional pathophysiology, socioeconomic conditions, health system structures, and cultural context, we illustrate the different syndemics across these countries and the potential benefit of syndemic care to patients. We conclude with recommendations for research and systems of care to address syndemics in low-income and middle-income country settings.

Magnitude and scope of non-communicable disease-related disability: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of the review will be to identify, assess and synthesize the evidence that examines the magnitude and scope of disability including impairments, activity limitations and participation restrictions associated with four main non-communicable diseases (NCDs): cardiovascular diseases (CVDs), cancers, diabetes and chronic respiratory diseases.To systematically examine the magnitude of disability associated with CVDs, cancers, diabetes and chronic lung diseases, the questions that this review will specifically address are:To systematically examine the scope of disability associated with CVDs, cancers, diabetes and chronic respiratory diseases, the questions that this review will address are.