Dissertations / Theses: 'Chronic Non Communicable Diseases'

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Murphy, Georgina Anne Veronica. "Chronic non-communicable diseases and risk factors in rural Uganda." Thesis, University of Cambridge, 2014. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.707995.

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Elwell-Sutton, Timothy Mark. "Inequality, inequity and the rise of non-communicable disease inChina." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hub.hku.hk/bib/B5016272X.

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Background: Rapid economic growth in mainland China has been accompanied in recent years by rising levels of inequality and a growing burden of non-communicable disease (NCD), though little is known at present about the relations between these forces. This thesis makes use of data from a large sample of older men and women in Guangzhou, one of China’s most developed cities, to examine the relations between inequality, inequity and non-communicable disease. Objectives: This thesis addresses two research questions: what is the relationship between inequality/inequity and non-communicable disease in China; and what are the implications of this relationship for health policy in China. These two questions lead to two working hypotheses: first, that inequalities may be both a cause and consequence of NCDs in China, potentially creating a vicious cycle which reinforces inequality and inequity; and second, that reducing dependence on out of pocket payments as a source of healthcare finance may help to prevent the continuation of the inequality-NCD cycle. Methods: I used data from the Guangzhou Biobank Cohort Study (GBCS), including 30,499 men and women aged 50 or over from Guangzhou and multi-variable regression methods to examine associations of socioeconomic position at four life stages (childhood, early adulthood, late adulthood and current) with several health outcomes: self-rated health, chronic obstructive pulmonary disease, metabolic syndrome and markers of immunological inflammation (white blood cells, granulocytes and lymphocytes). These analyses related to the hypothesis that inequalities may be a cause of non-communicable disease in China. I also examined whether inequity may be a consequence of non-communicable disease by measuring whether horizontal inequity (deviation from the principle of equal access to healthcare for equal need) was greater for treatment of NCDs than for general healthcare. I tested this using both concentration index methods and multi-variable regression models. For comparative purposes, I conducted these analyses in data from three settings: Guangzhou, Hong Kong and Scotland (UK). Results: I found that socioeconomic deprivation across the life course was associated with poorer self-rated health, higher risk of COPD, higher white cell and granulocyte cell counts and (in women only) higher risk metabolic syndrome and higher lymphocyte cell counts. I also found evidence of pro-rich inequity in utilisation of treatment for three major non-communicable conditions (hypertension, hyperglycaemia and dyslipidaemia) in Guangzhou, whilst there was no evidence of inequity in general healthcare utilisation (doctor consultations and hospital admissions) or treatment of gastric ulcer. Conclusion: My findings gave qualified support for the idea that socioeconomic inequalities may contribute to some, though not all, non-communicable diseases in China. Moreover, the mechanisms which link socioeconomic inequality to NCDs in China remain unclear. My results also supported the suggestion that a rising burden of non-communicable disease may contribute to greater pro-rich inequity in healthcare utilisation, especially for conditions which are chronic and asymptomatic. As rates of NCDs continue to rise in China and other developing countries, policies to prevent and treat common NCDs may be improved by a clearer understanding of how inequality is related to non-communicable disease.
published_or_final_version
Community Medicine
Doctoral
Doctor of Philosophy

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Maimela, Eric. "Development of an integrated, evidence-based management model for chronic non-communicable diseases and their risk factors, in a rural area of Limpopo Province, South Africa." Thesis, University of Limpopo, 2016. http://hdl.handle.net/10386/1732.

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Thesis(Ph.D.(Medical Science)) -- University of Limpopo, 2016
Background: Chronic disease management (CDM) is an approach to health care that keeps people as healthy as possible through the prevention, early detection and management of chronic diseases. This approach offers holistic and comprehensive care, with a focus on rehabilitation, to achieve the highest level of independence possible for individuals.The aim of this study was to develop an integrated, evidence-based model for the management of chronic non-communicable diseases in a rural community of the Limpopo Province, South Africa. Methods: The study was conducted at Dikgale Health and Demographic Surveillance System (HDSS) site is situated in Capricorn District of Limpopo Province in South Africa. This study followed mixed methods methodology with an aim on integrating quantitative and qualitative data collection and analysis in a single study to develop an intervention program in a form of model to improve management of chronic diseases in a rural area. Therefore, this included literature review and WHO STEPwise approach to surveillance of NCD risk factors for quantitative techniques and focus group discussions, semi-structures interviews and quality circles for qualitative techniques. In the surveillance of NCD risk factors standardised international protocols were used to assess behavioural risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity) and physical characteristics (weight, height, waist and hip circumferences, and blood pressure). A purposive sampling method was used for qualitative research to determine knowledge, experience and barriers to chronic disease management in respect of patients, nurses, community health workers (CHWs), traditional health practitioners (THPs) and managers of chronic disease programmes. Data were analysed using STATA 12 for Windows, INVIVO and Excel Spreadsheets. Results: The study revealed that epidemiological transition is occurring in Dikgale HDSS. This rural area already demonstrates a high burden of risk factors for non-communicable diseases, especially smoking, alcohol consumption, low fruit and vegetable intake, physical inactivity, overweight and obesity, hypertension and dyslipidaemia, which can lead to cardiovascular diseases. The barriers mostly mentioned by the nurses, patients with chronic disease, CHWs and THPs include lack of knowledge of NCDs, shortages of medication and shortages of nurses in the clinics which cause patients to stay for long periods of time in a clinic. Lack of training on the management of chronic diseases, supervision by the district and provincial health managers, together with poor dissemination of guidelines, were contributing factors to lack of knowledge of NCDs management among nurses and CHWs. THPs revealed that cultural insensitivity on the part of nurses (disrespect) makes them unwilling to collaborate with the nurses in health service delivery. x The model developed in this study which was the main aim of the study describes four interacting system components which are health care providers, health care system, community partners and patients with their families. The main feature of this model is the integration of services from nurses, CHWs and THPs including a well-established clinical information system for health care providers to have better informed patient care. The developed model also has an intervention such as establishment of community ambassadors. Conclusion: Substantially high levels of the various risk factors for NCDs among adults in the Dikgale HDSS suggest an urgent need for adopting healthy life style modifications and the development of an integrated chronic care model. This highlights the need for health interventions that are aimed at controling risk factors at the population level in order to slow the progress of the coming non-communicable disease epidemic. Our study highlights the need for health interventions that aim to control risk factors at the population level, the need for availability of NCD-trained nurses, functional equipment and medication and a need to improve the link with traditional healers and integrate their services in order to facilitate early detection and management of chronic diseases in the community. The developed model will serve as a contribution to the improvement of NCD management in rural areas. Lastly, concerted action is needed to strengthen the delivery of essential health services in a health care system based on this model which will be tasked to organize health care in the rural area to improve management and prevention of chronic illnesses. Support systems in a form of supervisory visits to clinics, provision of medical equipments and training of health care providers should be provided. Contribution from community partners in a form of better leadership to mobilise and coordinate resources for chronic care is emphasized in the model. This productive interaction will be supported by the district and provincial Health Departments through re-organization of health services to give traditional leaders a role to take part in leadership to improve community participation.
Medical Science Department, University of Limpopo in South Africa,International Health Unit, and Antwerp University

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Nojilana, Beatrice. "Policy approaches to prevent chronic non-communicable diseases: The role of population-based data." University of the Western Cape, 2018. http://hdl.handle.net/11394/6886.

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Philosophiae Doctor - PhD
Background: Non-communicable diseases (NCDs) continue to rise in South Africa, accounting for 43% of total deaths in 2012. Smoking and a diet high in salt are among the major modifiable risk factors for NCDs that can be addressed through cost-effective policy interventions in the form of regulation or legislation and active multisectoral engagement. Population-based prevalence and mortality data are necessary for monitoring and evaluation such interventions. South Africa has developed a National Strategic Plan for NCDs but there is limited evaluation of NCD policies. Furthermore, there is a need to explore the availability of population-based data and the role that it can play to monitor interventions. Aim: The overall aim of the thesis is to assess the implementation of policies for reducing risk factors for chronic NCDs in South Africa, and to explore the role of population-based data in supporting environmental and policy approaches to prevent NCDs. The thesis will also examine whether there are differences in urban and rural settings in the implementation of tobacco control and salt reduction regulation as well as the barriers to implement the National Strategic Plan for prevention of NCDs. Methods: Multiple methods of data collection were used. A desk review of policies to address NCDs in South Africa was undertaken and semi-structured interviews with the NCD policymakers and managers in two provinces (the Eastern Cape and Western Cape) were undertaken, to explore challenges and successes of implementation of the NSP. The Cross-sectional baseline questionnaire and quantified food frequency data from the PURE study were used to determine the prevalence of smoking and the intakes of sodium and potassium in a selected urban and a rural community. Data collected using a validated community audit tool was used to assess the physical environment related to tobacco as well as questionnaire data from face-to-face interviews about perceptions about tobacco use in the urban and rural communities. Trends in mortality from tobacco related and high salt consumption related conditions together with prevalence data from national health surveys were reviewed to assess the health impact.

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Ward, Sarah. "Chronic Conditions of US-Bound Cuban Refugees: October 2008-September 2011." Digital Archive @ GSU, 2012. http://digitalarchive.gsu.edu/iph_theses/225.

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Background: Historically, most refugees have originated from countries with high rates of infectious diseases. However, non-communicable diseases are becoming increasingly more common in refugee populations resettling in the United States. Purpose: Examine the prevalence of selected chronic conditions among newly arriving adult Cuban refugees and compare the results to the prevalence of the same chronic conditions among the other top five incoming refugee populations: Burmese, Bhutanese, Iranians, Iraqis, and Somalis Methods: Data used in this study were derived from the Department of State’s Medical History and Physical Examination Worksheet and included all adult (≥20 years) Cuban, Burmese, Bhutanese, Iranian, Iraqi, and Somali refugees identified through the Center’s for Disease Control and Prevention Electronic Disease Notification Center, and who entered the United States during October 2008-September 2011. Data were analyzed using SPSS version 19.0. Descriptive statistics, chi-square analysis, and logistic regressions were performed to assess the prevalence of chronic conditions, check for associations between country of origin and outcome of interest, and to estimate the relative risk for Cubans compared to the remaining top five incoming refugee populations. Results: A total of 99,920 adults were included in the study. The largest population was Iraqi (27.6%), followed by Bhutanese (26.2%), Burmese (24.4%), Iranian (8.6%), Cuban (7.9%), and Somali (5.3%). All outcomes of interest were significantly associated with country of origin. Cubans were at a greater risk for asthma but were not the greatest at-risk population for the remaining outcomes of interest. Conclusion: The prevalence of non-communicable diseases was higher among the incoming refuges than has been traditionally assumed. These findings point to the need for a better understanding of the health status of refugee populations and the development of culturally appropriate health programs that include education on prevention and treatment of chronic conditions.

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Masokwane, Patrick Maburu Dintle. "Prevalence of non-AIDS defining conditions and their associations with virologic treatment failure among adult patients on anti-retroviral treatment in Botswana." University of the Western Cape, 2016. http://hdl.handle.net/11394/5247.

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Magister Public Health - MPH
Background: The recognition of HIV/AIDS as a chronic life-long condition globally in recent years has demanded a different perception and an alignment to its association with other chronic diseases. Both HIV and other chronic non-communicable diseases are significant causes of morbidity and mortality. Their combined DALY contributions for Botswana would be significant if research and strategies in controlling these conditions are not put in place. Natural aging and specific HIV-related accelerated aging of patients who are on antiretroviral treatment means that age-related diseases will adversely affect this population. Princess Marina Hospital Infectious Diseases Care Clinic has been in operation since 2002. The clinic has initiated over 16 000 patients on anti-retroviral treatment (ART) since 2002. The current study estimated the prevalence of non-AIDS defining conditions (NADCs) in the attendees of the clinic in 2013. The majority of patients that attended the clinic had been on treatment for over three years with some patients more than ten years. These ART experienced patients were more likely to be susceptible to chronic non-communicable diseases, including non-AIDS defining conditions. The nomenclature used in classification of NADCs in the current study was appropriate for resource-limited settings; because the study setting offered HIV treatment under resources constraints. Aim: The current study characterised non-AIDS defining conditions, and determined their associations with virologic treatment failure in a cohort of patients that were enrolled at Princess Marina Hospital antiretroviral clinic in Gaborone, Botswana. Methods: A retrospective cross sectional study of records of patients who attended the Princess Marina Infectious Diseases Care Clinic in 2013. Stratified random sampling of a total of 228 patients’ records was achieved from a total population of 5,781 records. Data was transcribed into a Microsoft Excel Spreadsheet and then exported to Epi-Info statistical software for analysis. Results: Eighty (35%) cases of NADCs were reported/diagnosed in the study sample; with 27% (n=62) of the patients having at least one condition, 6.7% (n=17) two conditions, and 0.4% (n=1) three conditions. The top prevalent conditions were hypertension (n= 40), hyperlipidaemia (n=7) and lipodystrophy (n=7). The prevalence of NADCs on the various categories of patients compared with the total sample population was as follows: active patients (prevalence ratio= 0.70), transferred out patients (prevalence ratio = 1.24), patients who died (prevalence ratio=2.04) and patients who were lost to follow-up (prevalence ratio =2.86). The prevalence of NADCs was significantly associated with increasing age (p<0.001); having social problems (p=0.028); having been on treatment for over three years (p=0.007); an outcome of death (p = 0.03) and being lost to follow-up (p=0.007). The study showed that being controlled on second line or salvage regimen (p=0.014) and the presence of adherence problems in the past was associated with virologic failure (p=0.008). There was no association of presence of NADCs to virologic failure. Conclusions: There was significant morbidity of non-AIDS defining conditions in the Princess Marina Infectious Diseases Care Clinic shown by a prevalence of NADCs in the clinic of 35% in 2013.The significant associations of the presence of NADCs and virologic failure with outcomes of death and loss to follow-up illustrate the adverse effects that NADCs are having, and calls for strategies to address multi-morbidities in HIV patients on antiretroviral treatment.

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Maseko, Mbali. "Chronic non-communicable diseases (ncds), absenteeism and workplace wellness initiatives at a consumer goods company in South Africa." University of Western Cape, 2019. http://hdl.handle.net/11394/7636.

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Master of Public Health - MPH
Non-communicable diseases (NCDs) are the leading causes of deaths worldwide and are shown to be responsible for approximately 71% of deaths globally. NCDs mainly affect individuals of working age, resulting in high sick leave absences and loss of productivity in the working environment. This presents a major barrier to economic growth, particularly in low- and middle-income countries where the impact is greatest. Among the interventions identified in the South African Strategic Plan for the control of NCDs, is the implementation of wellness initiatives (i.e. diet and exercise interventions) in the workplace. This has been to improve overall productivity and decrease absenteeism. This study was therefore aimed at investigating the effect that participating in workplace wellness initiatives targeted at employees, particularly those that are overweight, hypertensive and diabetic at Nestlé, had on the number of working days lost due to sick leave from NCDs.

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Cepuch, Christina. "Availability of essential medicines for chronic disease vs. communicable disease in Kenya as an indicator of age-related inequities in access." Thesis, University of Western Cape, 2012. http://hdl.handle.net/11394/3306.

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Magister Public Health - MPH
Background: A growing concern about possible age-related inequities in health care access has emerged in the increasing debate on the challenges of population ageing and health in sub-Saharan Africa. Older persons may experience systematic exclusion from health services. Viewed as one of the poorest, most marginalized groups in SSA societies, older people are deemed to lack access to even basic, adequate health care. There is an assumption, furthermore, that older persons have less access to required health services than do younger age-groups. This suggests an element of age-related inequity. One possible indicator of age-related inequity may be found through measuring the relative availability of essential medicines for chronic non-communicable diseases (NCD), relative to the availability of medicines for communicable diseases (CD). Aim and objectives: The aim of the study was to compare the availability of essential medicines for NCD and CD in Kenya, as an indicator of age-related inequities in access to health care in Kenya. The three study objectives were as follows, in public and mission facilities in Kenya: 1. To assess the availability of medicines for the following CD: diarrhoea, HIV, malaria, pneumonia and other infections 2. To assess the availability of medicines for the following NCD common in older populations: arthritis, diabetes, glaucoma, gout, heart disease, hypertension and Parkinson’s disease 3. To compare the availability of medicines for CD and NCD and draw conclusions on possible age-related inequities in access. Study design: Using an adapted version of the HAI / WHO methodology, a cross sectional descriptive survey of medicines availability was conducted. HAI and WHO collaboratively developed a standardized and validated methodology for comprehensively measuring medicines availability, as well as prices, affordability and price components. The survey manual, launched in 2003 and revised in 2008, is available to the public. The methodology involves collecting data on the availability and price of medicines found in a sample of health facilities across sectors of interest within national health systems. If the specific medicine, dose and form being surveyed is available on the day of the survey, then the medicine is documented as being available. Methods: Random sampling was carried out in six of Kenya’s eight provinces, targetting ten facilities per province. Data on availability of the targeted medicines was collected by trained data collectors on pilot-tested data collection forms adapted from the standardized WHO / HAI methodology. The list of medicines included sixteen for communicable diseases to treat infections such as diarrhoea, HIV, malaria, and pneumonia and twelve medicines used to treat non-communicable diseases such as diabetes, arthritis, hypertension, gout, glaucoma, stroke and Parkinson’s disease. Availability of medicines was noted by physical observation by a data collector, and calculated as the percentage of facilities where a medicine was found on the day of data collection. The availability of brands and generics was not distinguished and were combined to establish availability of each medicine. Overall availability of all CD and NCD medicines was compared, and within each category between rural and urban areas and between mission and public facilities. The Ministry of Health was informed of the survey and provided the data collectors with an MOH endorsement letter. The names of facilities participating in the study were recorded on the data collection forms, but not reported. No data on individual patients was collected, and no patients were interviewed for this survey. Data were entered into an Excel file and exported to and analyzed with SPSS. Results: A total of 56 facilities were surveyed: 49 in the public sector and 7 in the mission sector, giving a facility response rate of 93%. Thirty facilities were located in rural settings and 26 were in urban settings. More CD medicines were available than medicines for NCD. Of a total of 896 individual observations of CD medicines, 632 (70.5%) were recorded as available on the day of visit, compared to 306 (45.5%) of 672 possible individual observations of NCD medicines. These differences were highly significant statistically (chi-square=98.8, p<0.001). Furthermore, comparison of availability between urban and rural areas showed statistically significant differences for NCD medicines (40.6% vs. 51.3%, p=0.007), but not CD medicines (72.5% vs. 68.3%, p=0.190). There were no significant differences in availability of medicines in mission compared to public facilities. Conclusions: This study reveals the low relative availability of medicines for NCDs in Kenya’s public and mission sector. Medicines for NCDs were less available in rural vs. urban facilities, but there was no rural vs. urban difference in medicines for CDs. While more research should be carried out to understand the reasons behind these findings, immediate attention to the supply and financing of medicines for NCDs is urgently needed. The relatively lower availability of medicines for NCDs than for CDs may be an indicator of age-related inequities in access to health care in Kenya and calls for more investigations on equity and access to health for older people in Kenya.

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Lebina, Limakatso. "Fidelity and costs of implementing the integrated chronic disease management model in South Africa." Doctoral thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33758.

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Background: The health systems in many low-middle income countries are faced with an increasing number of patients with non-communicable diseases within a high prevalence of infectious diseases. Integrated chronic disease management programs have been recommended as one of the approaches to improve efficiency, quality of care and clinical outcomes at primary healthcare level. The South African Department of Health has implemented the Integrated Chronic Disease Management (ICDM) Model in Primary Health care (PHC) clinics since 2011. Some of the expected outcomes on implementing the ICDM model have not been achieved, and there is a dearth of studies assessing implementation outcomes of chronic care models, especially in low-middle income countries. This thesis aims to assess the degree of fidelity, moderating factors of fidelity and costs associated with the implementation of the ICDM model in South African PHC clinics. Methods: The study was a cross-sectional study design using mixed methods and following the process evaluation conceptual framework. A total of sixteen PHC clinics in the Dr. Kenneth Kaunda (DKK) health district of the North West Province as well as the West Rand (WR) health district of the Gauteng Province, that were ICDM pilot sites were included in the study. The degree of fidelity in the implementation of the ICDM model was evaluated using a fidelity criterion from the four major components of the ICDM model as follows: facility reorganization, clinical supportive management, assisted self-support and strengthening of the support systems. In addition, the implementation fidelity framework was utilized to guide the assessment of ICDM model fidelity moderating factors. The data on fidelity moderating factors were obtained by interviewing 30 purposively selected healthcare workers. The abbreviated Denison Organizational Culture (DOC) survey was administered to 90 healthcare workers to assess the impact of three cultural traits (involvement, consistency and adaptability) on fidelity. Cost data from the provider's perspective were collected in 2019. The costs of implementing the ICDM model current activities for three (facility reorganization, clinical supportive management and assisted self-management) components and additional costs of implementing with enhanced fidelity were estimated. Costs data was collected from budget reviews, interviews with management teams, and other published data. Descriptive statistics were used to describe participants and clinics. Fidelity scores were summarized using medians and proportions and compared by facilities and health districts. Qualitative data were analysed thematically. Pearson correlation coefficient was utilized to assess the association between fidelity and culture. The annual ICDM model implementation costs per PHC clinic and patient per visit were presented in 2019 US dollars. Results: The 16 PHC clinics had comparable patient caseload, and a median of 2430 (IQR: 1685-2942) patients older than 20 years received healthcare services in these clinics over six months. The overall implementation fidelity of the ICDM model median score was 79% (125/158, IQR: 117-132); WR was 80% (126/158, IQR: 123-132) while DKK was 74% (117/158, IQR: 106-130), p=0.1409. The highest clinic fidelity score was 86% (136/158), while the lowest was 66% (104/158). The fidelity scores for the four components of the ICDM model were very similar. A patient flow analysis indicated long (2-5 hours) waiting times and that acute and chronic care services were combined onto one stream. Interviews with healthcare workers revealed that the moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). Participants also indicated that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure and adequate staff, and balanced patient caseloads. The overall mean score for the DOC was 3.63 (SD = 0.58), the involvement cultural trait had the highest (3.71; SD = 0.72) mean score, followed by adaptability (3.62; SD = 0.56), and consistency (3.56; SD = 0.63). Although there were no statistically significant differences in cultural scores between PHC clinics, culture scores for all three traits were significantly higher in WR (involvement 3.39 vs 3.84, p= 0.011; adaptability 3.40 vs 3.73, p= 0.007; consistency 3.34 vs 3.68, p= 0.034). The mean annual cost of implementing the ICDM model was $148 446.00 (SD: $65 125.00) per clinic, and 84% ($124 345.00) was for current costs while additional costs for higher fidelity accounted for were 16% ($24 102.00). The mean cost per patient per visit was $6.00 (SD:$0.77). Conclusion: There was some variability of fidelity scores on the components of the ICDM model by PHC clinics, and there are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors influencing implementation fidelity of the ICDM model. Organizational culture needs to be purposefully influenced to enhance adaptability and consistency cultural traits of clinics to enhance the ICDM model's principles of coordinated, integrated, patient-centred care. Small additional costs are required to implement the ICDM model with higher fidelity. Recommendations: Interventions to enhance the fidelity of chronic care models should be tailored to specific activities that have low degree of adherence to the guidelines. Addressing some of the moderating factors like training and mentoring of staff members, role clarification and supply chain management could contribute to enhanced fidelity. Organizational culture enhancements to ensure that the prevailing culture is aligned with the planned quality advancements is recommended prior to the implementation of new innovative interventions. Further research on the cost-effectiveness of the ICDM model in middle-income countries is recommended.

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Andrijauskas, Kornelijus. "Tęstinė (nuolatinė) lėtinių neinfekcinių ligų profilaktika kaimo bendruomenėje." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2006. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2006~D_20060227_134704-47831.

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INTRODUCTION Chronic non-communicable diseases (CND) become the reason of 50 percent of deaths in the welfare societies. The World Health Organisation (WHO) has indicated that in the 2025 CND, especially cardiovascular diseases will remain the most important health problem in Europe and in the world [The World health Report, 1998]. The mortality rates from IHD, as well as overall mortality in Lithuania, increased since 1995, a tendency for decrease during the last decade has been observed. According to the Lithuanian Statistics, the mortality rate from IHD in 2001 was 628.2/100000 inhabitants per year [Lithuanian Ministry of Health, 2004]. It decreased almost by quarter as compared to 1995; nevertheless, the mortality rates from IHD in Lithuania exceed the average (mean) of the European Union countries nearly by two fold [WHO Data Base, 2003]. The investigations in the world, as well as in Lithuania have shown that the risk factors (RF) of the CND are common for all the CND [V.Grabauskas, 1995, IU.Haq, 1999]. In Lithuania the epidemiological research on CND has been performed in the context of the international integrated preventive program on non-communicable diseases (CINDI) [J.Petkevičienė, 1994, J.Klumbienė, 1999]. Therefore, the role of the family doctor in the primary prevention of CND, especially the ischemic heart disease (IHD), becomes very important in a certain community. The investigation in Lithuanian have shown that every second 35-64 year old man or woman... [to full text]

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Tsolekile, Lungiswa Primrose. "Development of an integrated model of care for use by community health workers working with chronic non-communicable diseases in Khayelitsha, South Africa." University of the Western Cape, 2018. http://hdl.handle.net/11394/6903.

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Philosophiae Doctor - PhD
Non-communicable diseases (NCD) continue to be a public health concern globally and contribute to the burden of disease. The formal health system in developing countries lacks the capacity to deal with these NCD as it is overburdened by communicable diseases. Thus, community health workers (CHWs) have been suggested as a solution for alleviating the burden for primary health facilities, by extending NCD care to the community. This thesis aims to develop an integrated model of care for CHWs working with patients with non-communicable diseases by describing and exploring current CHW roles, knowledge and practices in relation to community-based NCD care. The specific objectives for this study included 1) the exploration of the NCD roles of generalist CHWs in the context of a limited resource urban setting; 2) determining the NCD-related knowledge of CHWs, and factors influencing this in a limited resource urban setting and 3) a comparison of actual and envisaged roles in the management and prevention of NCD using the integrated chronic diseases management model (ICDM) as a benchmark, and propose key competencies and systems support for NCD functions of CHWs in South Africa Mixed methods were used to achieve the objectives of this study. First, a qualitative enquiry was conducted using observations to respond to the first objective. A quantitative cross-sectional design was then used to achieve the second objective, and a questionnaire was used to interview CHWs. A comparison of findings from both the quantitative and qualitative studies with policy guidelines was undertaken to address the third objective.

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Wang, Qun [Verfasser]. "Health Seeking Behavior and Out-of-Pocket Expenditure on Chronic Non-communicable Diseases in Sub-Saharan Africa : The Case of Rural Malawi / Qun Wang." Frankfurt a.M. : Peter Lang GmbH, Internationaler Verlag der Wissenschaften, 2018. http://d-nb.info/1161046992/34.

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Pitale, Gauri Anilkumar. "Anna He Purnabramha: Deorukhe Women’s Agency in the Making of Bodies, Cuisines, and Culture in Maharashtra, India." OpenSIUC, 2017. https://opensiuc.lib.siu.edu/dissertations/1455.

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The world is changing. India is changing. Food is changing. Bodies are changing. What does this mean for the women of Maharashtra, India? Globalization and modernity manifest in new and interesting ways the world over. As people establish networks of global commodity, capital, and human circulation, anthropologists raise pertinent concerns. While some are apprehensive about cultural loss and western cultural imperialism, others make a case for the rise of glocalization. While some espouse the positives of a free market economy, others are critical of the nutrition transition in developing countries and what this means for the health of the people undergoing this transition. The site of this study is the region of Konkan in Maharashtra, India. India is undergoing fast paced culture change since liberalizing its economy in the year 1991. I focus on the experiences of present day rural and urban Deorukhe Brahmin women (mothers and their daughters), who belong to an endogamous upper caste group that claims to be indigenous to Konkan. Generally, rural Indian regions are modernizing more slowly than urban areas. This study looks at how women are active agents in the changes that are taking place in their bodies, diet, and gender identities. A biocultural study, this dissertation takes into consideration anthropometric data and ethnographic data to comprehend the manner in which women, who are the gastronomic decision makers at the household level, are responding to the increasing influx of non-traditional foods. My study focuses on the moral implications of changing dietary practices and the appearance of chronic non-communicable diseases on the notions of the self. By discussing the manner in which Indian women practice their agency, using traditional gender roles, I aim to demonstrate how these women adjoin that which is thought to index the global and the local to shape a new India.

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Williams, Samantha. "The unmet psychosocial and supportive care needs of young adults who have a parent with a non-communicable disease." Thesis, University of Wolverhampton, 2012. http://hdl.handle.net/2436/297631.

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Aims: Unmet needs have mainly been investigated with formal and informal adult caregivers and ill individuals within psycho-oncology; findings indicate unmet needs are associated with negative affective state and caregiver burden. Research relating to adolescent children’s experiences of unmet needs during parental illness has, in the main, been based upon parental reports or professional opinion, yet research suggests that parental reports can downplay the effects and it is important to ask the adolescent child for their opinion. Adolescence is a transitional time in development; this may make the illness experience and subsequent needs vary from those of formal and informal adult caregivers. This thesis pragmatically investigates adolescent children’s firsthand accounts of unmet psychosocial and supportive care needs when they have a parent with a non-communicable disease. Methods: Systematic Review: To inform the direction of the thesis and capture all relevant published literature, a comparative systematic review was carried on adolescent’s experiences of unmet needs when they have a parent with a NCD, cancer or psychological problem. The review was conducted using standardized procedures and guidance from the Cochrane collaboration. Interpretative Phenomenological Analysis: Qualitative methodology was used to investigate seven adolescent’s experiences of unmet psychosocial and supportive care needs in relation to having a parent with a NCD. Participants were recruited through institutions of further and higher education. Quantitative Research: Pearson’s correlation and multiple regressions were used to test associations between unmet needs, depression, stress, anxiety and quality of life, and to determine the applicability of the revised version of the Offspring Cancer Needs Inventory (OCNI) for individuals who have a parent with a NCD. One hundred and seven adolescent children completed the revised version of the OCNI, the DASS-21 (depression, anxiety, and stress) and AC-QoL (Adult carers’ quality of life) scales. Findings: Systematic Review: In the review 1479 papers were considered. Seven met the inclusion criteria, of these five papers related to cancer, one to chronic illness and one to psychological problems. Results suggest that adolescents had informational, supportive and recreational needs, and did not want to worry parents by asking them questions. The lack of hits and the disparity between illness groups is problematic in making comparisons and drawing definitive conclusions. Interpretative Phenomenological Analysis: Four interdependent themes emerged from the data, two relating to interpersonal needs (Information Needs and Support Needs), and two relating to intrapersonal needs (Need for 4 Acknowledgement and Need to be Them-Self), each had their own number of sub-themes. Adolescent’s had a variety of needs that could be partially met through honest and accurate information, interpersonal support and acknowledgment of their caring role within the family. The interdependence of the needs indicated that the fulfilment of one need has the potential of meeting other needs. Unmet needs were comparable to those of adolescent children who have a parent with cancer; as such it was deemed that the new version of the OCNI would be suitable for use with individuals who had a parent with a NCD. Quantitative Research: Ninety-Three percent of adolescents reported at least one unmet need. Analysis suggests that the unmet needs variables were co-dependent and correlated with depression, stress, anxiety, and quality of life. Certain unmet need variables predicted stress, anxiety, depression, and quality of life. Conclusion: The findings of this thesis indicate that adolescent children who have a parent with a NCD have a variety of unmet needs, and that these are associated with affective state and well-being. It is suggested that counselling psychologists are well placed to provide psychological and needs based interventions based upon the findings within this thesis. More research is required in this area to determine cause and effect; owing to counselling psychologists working with the lifespan they would be well placed to further the knowledge in this area.

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Yurivilca, Santolalla Vda De Diaz Sara Del Carmen. "NUTRIMIND: Asesoría y coaching nutricional en el distrito de San Juan de Lurigancho." Master's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2020. http://hdl.handle.net/10757/653123.

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El presente trabajo es una oportunidad de negocio que brinda asistencia y coaching nutricional a la población del distrito de San Juan de Lurigancho que es el más poblado de Lima con un sector industrial y comercial desarrollado, lo que hace de SJL un excelente lugar para el presente emprendimiento. Este servicio está dirigido a personas preocupadas por su apariencia física y/o que presentan sobrepeso y obesidad la cual puede desencadenar más adelante en enfermedades no transmisibles como diabetes, hipertensión arterial, enfermedades cardiovasculares, etc. Para el desarrollo de este proyecto se realizó un estudio de mercado que permiten realizar una eficiente segmentación de mercado. Obteniendo como resultado que los encuestados requerían y necesitaban este tipo de servicio. La empresa tendrá el nombre de NUTRIMIND S.A.C., brindará a nuestros clientes: consulta nutricional presencial y coaching nutricional vía online completando el servicio con talleres nutricionales y de mindfulness organizacionales. Todo ello para que nuestro cliente se sienta comprometido en lograr su objetivo de salud y tome conciencia de la importancia de esta. La implementación de este negocio requiere una inversión inicial de S/.25915.2 soles que será cubierta por el aporte de capital propio. Consecuentemente el estudio se presenta como un plan de negocios viable y rentable. Obteniéndose una TIR de 83% y un VAN de 69 738.36. Este negocio permitirá el emprendimiento y a la misma vez generar empleo a más profesionales de la salud debido a que sus resultados son favorables.
The present work is a business opportunity that provides nutritional assistance and coaching to the population of the district of San Juan de Lurigancho that is the most populated of Lima with an industrial and commercial sector developed which makes SJL an excellent place for the present venture. This service is aimed at people concerned about their physical appearance and/or who are overweight and obese which can later trigger in noncommunicable diseases such as diabetes, high blood pressure, cardiovascular disease, etc. For the development of this project a market study was carried out that allow efficient segmentation of the market. Getting as a result that respondents required and needed this type of service. The company will be named NUTRIMIND S.A.C., will provide our clients: face-to-face nutritional consultation and nutritional coaching via online completing the service with nutritional workshops and organizational mindfulness. All this so that our client feels committed to achieving their health goal and become aware of the importance of it. The implementation of this business requires an initial investment of S/.25915.2 soles that will be covered by the contribution of own capital. Consequently, the study is presented as a viable and profitable business plan. Obtaining an 83% TIR and a VAN of 69 738.36. This business will allow entrepreneurship and at the same time generate employment for more health professionals because their results are favorable.
Tesis

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Stephani, Victor [Verfasser], Reinhard [Akademischer Betreuer] Busse, Rüdiger [Akademischer Betreuer] Zarnekow, Reinhard [Gutachter] Busse, and Rüdiger [Gutachter] Zarnekow. "Combating chronic diseases in Africa : the efficacy, the need and the implementation of mobile phone-based health interventions against non-communicable diseases in Sub-Saharan Africa / Victor Stephani ; Gutachter: Reinhard Busse, Rüdiger Zarnekow ; Reinhard Busse, Rüdiger Zarnekow." Berlin : Technische Universität Berlin, 2019. http://d-nb.info/1193571111/34.

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Campos, Mônica Chiodi Toscano de. "Adaptação transcultural e validação do World Health Organization Health and Work Performance Questionnaire para enfermeiros brasileiros." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-27022012-093012/.

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O Brasil tem experimentado transformações na composição etária e no perfil epidemiológico da população, com alterações relevantes no quadro de morbi-mortalidade. Diante deste contexto, aumenta o interesse dos estudiosos sobre as conseqüências sociais e econômicas das doenças crônicas não transmissíveis e a busca por novos métodos para analisar o perfil dessas doenças e formas de alocar, com eficiência, os recursos em saúde visando à promoção da saúde da população. Os objetivos deste estudo, de delineamento metodológico, foram traduzir, adaptar culturalmente para o Brasil o instrumento Health and Work Performance Questionnaire (HPQ) e avaliar as propriedades psicométricas da versão brasileira em enfermeiros. O HPQ é um instrumento adotado pela Organização Mundial da Saúde que permite a coleta de informações sobre condições crônicas de saúde e avaliar o impacto destas condições no desempenho do trabalho, pela análise do absenteísmo, presenteísmo e a ocorrência de acidentes de trabalho. O processo de adaptação seguiu o Protocolo de Tradução da Organização Mundial da Saúde. Os dados para a avaliação das propriedades psicométricas foram coletados no período de julho a agosto de 2011, em um hospital público e de ensino do interior do Estado de São Paulo, por meio da aplicação da versão adaptada do HPQ, denominada \"Questionário Saúde e Desempenho no Trabalho\" (HPQ Brasil), em 100 enfermeiros.. As propriedades psicométricas analisadas foram: a validade de face e conteúdo (grupo de especialistas), a confiabilidade pelo Alfa de Cronbach e a estabilidade por teste-reteste. O nível de significância adotado foi de 0,05. Os resultados demonstraram que a amostra estudada foi composta por enfermeiros que possuíam as seguintes características; 89% sujeitos do sexo feminino, com média de idade de 33,9 anos, 51% solteiros e 67% com formação de pós graduação. Na avaliação das propriedades psicométricas, a consistência interna da versão adaptada do HPQ, alfa de cronbach foi de 0,94 para a seção A e 0,86 para a seção B do instrumento. Na análise das concordâncias da estabilidade teste-reteste, as concordâncias foram positivas e estastisticamente significantes. Desta forma, a versão adaptada do HPQ mostrou-se valida e confiável na amostra estudada. O HPQ - Brasil poderá ser usado para acompanhar a prevalência de problemas de saúde entre trabalhadores, as taxas de tratamento destes problemas e os seus efeitos no desempenho no trabalho, além de oferecer as instituições de saúde informações fundamentais para o planejamento de programas de melhoria da saúde e da produtividade dos trabalhadores e de redução dos custos com as Doenças Crônicas Não-Trasmissíveis aspectos que denotam a relevância do estudo ora apresentado.
Brazil has undergone a process of transition with changes in age composition and epidemiological profile of its population which has caused a significant impact on morbidity and mortality. In light of that there is a growing interest among experts in social and economic consequences of chronic noncommunicable diseases (NCDs) and new approaches to assess the profile of these diseases and to effectively allocate resources for health promotion. This study aimed to translate into Brazilian Portuguese and culturally adapt the World Health Organization (WHO) Health and Work Performance Questionnaire (HPQ) and evaluate its psychometric properties among Brazilian nurses. The HPQ was developed by the WHO and can measure the impact of chronic illnesses on work performance through the analysis of absenteeism, presenteeism and work-related injuries. The adaptation process followed the WHO Translation Protocol. The psychometric properties of the Brazilian version of the questionnaire (Health and Work Performance Questionnaire, HPQ-Brazil) were evaluated in a sample of 100 nurses from a public teaching hospital in the state of São Paulo, southeastern Brazil, between July and August 2011. The psychometric properties analyzed included face validity and content validity (expert group), reliability by Cronbach\'s alpha, and test-retest stability. A 5% level of significance was set. The study sample comprised nurses with the following characteristics: 89% were female, mean age 33.9 years; 51% were single and 67% had graduate training. The internal consistency of the adapted version of HPQ using Cronbach\'s alpha was 0.94 for the instrument\'s section A and 0.86 for section B. There were statistically significant positive concordances in the analysis of test-retest stability. Thus, the adapted version of the HPQ proved valid and reliable in the sample studied. The HPQ-Brazil can be used to assess the prevalence of health conditions and treatment rates and their impact on work performance among workers. In addition it can provide input for planning strategies to improve worker\'s health and productivity and reduce NCD-related costs.

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Adegborioye, Abiodun. "In vitro evaluation of antimicrobial and antioxidant activities of olea europaea subsp. africana and euryops brevipapposus used by Cala community folkloric medicine for the management of infections associated with chronic non-communicable diseases." Thesis, University of Fort Hare, 2016. http://hdl.handle.net/10353/4869.

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Chronic non-communicable diseses are a global public health challenge that continuously threatens the development and health of humans. Risk factors such as unbalanced diet-the high consumption of processed food or food from animal origin are responsible for NCDs. NCDs result in weakened immune system, making the host susceptible to opportunistic infections. Thus, the NCDs burden is most times chronic and multiple with the illness and suffering of the affected person numerous. The lack of cure for NCDs, the high cost of drugs, their high side-effects, and the emergence of multiple drug resistance has given rise to the investigation of other sources for therapeutic cure such as medicinal plants. The ethanol, n-hexane and ethyl acetate extracts of Olea europaea were analysed for their antioxidant and antimicrobial activities. The essential oil was also analysed for their chemical constituents. The n-hexane extracts of O. europaea exhibited no inhibition against all of the microorganisms tested, while the ethyl acetate and ethanol extracts exhibited inhibition, with minimum inhibitory concentration values between 0.625 mg/ml to 1.25 mg/ml. The ethanol leaf and ethyl acetate stem extracts exhibited significant activity in the inhibition of 2, 2-azinobis-(3-ethylbenzothiazolin - 6-sulfonic acid diammonium salt (ABTS) free radical, the n-hexane leaf extract had the overall significant lipid peroxidation inhibition activity, while in the inhibition of 2, 2- diphenyl-1-picrylhydrazyl radical (DPPH), the ethanol and ethyl acetate leaf extracts had strong activity. Nonanal, phytol, α-Pinene, α-Phellandrene, spatulenol and farnesol were some of chemical components identified after the GC-MS analysis of O. europaea oil. In the final part of the dissertation, Euryops brevipapposus essential oil was assessed for the antioxidant activities using free radical scavenging assays. In addition to this, the antimicrobial activities were assessed and the chemical composition was analysed using GC-MS. The essential oil demonstrated significant antioxidant activity against 2, 2-diphenyl-2-picryl-hydrazyl free radical (DPPH), 2, 2′-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) and lipid peroxides with IC50 value of 0.0000000671 mg/ml, 1.05 mg/ml, and 1.170 mg/ml respectively. The essential oil also showed significant activity against all microorganisms tested with minimum inhibitory concentration (MIC) values between 0.055 mg/ml to 0.5 mg/ml. α-pinene, α- Phellandrene, germacrene D, β-pinene, trans- β.-Ocimene, bicyclogermacrene and β -Phellandrene were some of the chemical compounds identified in E. brevipapposus oil. The study has shown that E. brevipapposus and O. europaea are abundant in phytochemical compounds which were thought to be the root cause for the activities demonstrated. Therefore, these therapeutic properties observed validate and elucidate the traditional usage of the both plants in the treatment /management of diseases.

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Shiyab, Amy S. "Knowledge and Perception of Nutritional Genomics Among Registered Dietitian Nutritionists." Kent State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=kent1563187321042113.

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Paris, Ludivine. "Etude de l'intérêt des outils numériques pour évaluer et promouvoir l'activité physique chez des patients atteints de maladies chroniques." Thesis, Université Clermont Auvergne‎ (2017-2020), 2018. http://www.theses.fr/2018CLFAC017/document.

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Les maladies chroniques non transmissibles sont la première cause de mortalité évitable dans le monde. L’origine de ces maladies est multifactorielle. L’inactivité physique (IP) et la sédentarité sont progressivement devenues des facteurs de risque majeurs de ces maladies. L’activité physique (AP) régulière permet d’améliorer la santé et de prévenir les risques de comorbidités et de mortalité. L’arrivée massive des Technologies de l’Information et de la Communication (TIC) offre de nouveaux outils de promotion de l’AP. L’objectif de ces travaux est d’évaluer le potentiel des TIC en tant que support d’accompagnement en AP auprès de patients atteints d’une maladie chronique. Ainsi, le premier travail avait pour objectif de déterminer les connaissances, usages et intérêts des patients vis-à-vis de l’utilisation des TIC dans le parcours de soins et pour l’AP. Dans une deuxième étude, nous avons étudié l’effet d’un réentrainement supervisé de trois mois et d’un podomètre sur les intentions et les motivations vis-à-vis de l’AP, la perception de l’état de santé et le niveau d’AP et de sédentarité de sujets porteurs de pathologies chroniques. Enfin, la troisième étude portait sur l’impact d’un atelier d’information en AP Adaptée (APA) couplé à l’utilisation d’un dispositif numérique d’accompagnement personnalisé pendant un an, comparé à celui d’une brochure d’information et d’exemples d’exercices en APA, sur l’atteinte des recommandations en AP chez des patients. Ces travaux montrent que les patients atteints de maladie chronique utilisent les TIC, mais qu’ils ont des connaissances technologiques partielles. Ils sont moyennement favorables à l’utilisation de ces outils dans le domaine de la santé et de l’AP. Les patients ont besoin d’être rassurés et formés à l’utilisation de ces nouveaux outils. La prise en charge thérapeutique par l’AP est efficace pour instaurer le changement comportemental chez les patients mais ne permet pas de le maintenir sur le long terme. La remise d’un podomètre ne suffit pas à les remotiver pour pratiquer l’AP. Les résultats préliminaires de la troisième étude obtenus sur un sous–échantillon des patients indiquent qu’un atelier en APA suivi d’un accompagnement personnalisé par un dispositif numérique ou que la remise d’une brochure de conseils et d’exemples d’exercices pourrait augmenter la quantité d’AP déclarée à 12 mois. L’analyse en intention de traiter reste à faire pour confirmer ces résultats. La prise en charge thérapeutique par l’AP est efficace pour instaurer le changement comportemental, à condition que le patient soit prêt et motivé. Souvent elle ne suffit pas pour maintenir ce changement sur le long terme, révélant la nécessité d’un accompagnement personnalisé en AP, qui peut prendre plusieurs formes suivant les besoins des patients (sessions d’AP individuelles ou en groupe, dispositif numérique, brochure)
Non communicable chronic diseases are the first cause of avoidable death in the world. The origin of these diseases is multifactorial. Physical inactivity and sedentary behavior are gradually becoming major risk factors. Regular Physical Activity (PA) allows improving health and preventing the risks of comorbidity and mortality. Massive development of Information and Communication Technologies (ICT) offers new tools of PA promotion. The aim of these works is to assess the ICT as a mean to support patients with chronic diseases in their PA practice. Thus, the first study aimed to determine patients’ knowledge, use and interest towards ICT applied to health and PA fields. In a second study, we studied the impact of a 3-months supervised PA program associated with a pedometer on the intentions and motivations towards PA, perceived health and active and sedentary behaviors. Finally, the third study was a one-year intervention comparing the effect of an Adapted Physical Activity (APA) workshop associated with a personalized digital system with that a guideline and examples in APA on the achievements of the PA recommendations. These works showed that patients with chronic diseases used the ICT, but they had partial technological knowledge. They were moderately in favour of the ICT use in health and the PA fields. The patients needed to be reassured and trained in the use of these new tools. Patients care by PA resulted in a significant change in behavior but did not allow maintaining it in the long term. The pedometer was not sufficient to increase PA practice. Preliminary results of the third study indicated that an APA workshop followed by a personalized digital system use or a guidelines and exercises book could increase reported PA level 12 months after the study beginning. The intent-to-treat analysis will be performed later to confirm these results.Patients care by PA is effective to provoke behavioral changes if the patient is ready and motivated by health benefits. Often this initial care is not sufficient to keep 150 min-by week PA in the long term, revealing the need to continue the patients’ accompanying. Several forms could be considered depending on patients’ needs (individual or group sessions, digital device, guideline)

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Gonçalves, Francisca Aurina. "Desenvolvimento, reprodutibilidade e validação de um instrumento para quantificar em gramas o consumo de açúcar de amostra da população adulta em Porto Alegre/RS." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2011. http://hdl.handle.net/10183/52697.

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Evidências indicam a relação entre o consumo excessivo de açúcar pela população mundial e o desenvolvimento de doenças crônicas como cárie, obesidade, diabetes e câncer. Para verificar a relação entre dieta e processo saúde-doença, estudos epidemiológicos utilizam instrumentos válidos, reprodutíveis e confiáveis, sendo o mais utilizado o questionário de frequência alimentar (QFA). Este estudo tratou de desenvolver, reproduzir e validar um instrumento de pesquisa (QFA-açúcar) que permita quantificar em gramas o consumo de açúcar em amostra da população adulta de Porto Alegre/RS. Para a determinação da lista de alimentos e do modelo de registro do QFA-açúcar, foi realizada a abordagem de pesquisa qualitativa denominada grupo focal, baseada na adaptação do QFA desenvolvido para a população adolescente, adulta e idosa de Porto Alegre (QFA-Porto Alegre). A quantificação do açúcar dos alimentos seguiu o método físico-químico de análise de alimentos de Fehling, ou a leitura da tabela de composição de alimentos do Departamento de Agricultura dos Estados Unidos (USDA). O QFA-açúcar foi avaliado por juízes com experiência na elaboração e aplicação de QFA. O resultado final desta etapa apresenta o QFA-açúcar com 94 itens. Para testar a reprodutibilidade e medir a validade do QFA-açúcar, foi empregada a abordagem quantitativa de pesquisa, utilizando uma amostra de 81 indivíduos, residentes em Porto Alegre, com idade entre 18 e 60 anos, selecionada através da amostragem por estágios múltiplos. O estudo aconteceu de julho a novembro de 2011 e os participantes responderam dois inquéritos recordatórios de 24 horas e 2 QFA-açúcar, num intervalo de 15 a 30 dias. A reprodutibilidade foi testada através do coeficiente de correlação intraclasse por ponto e por intervalo de 95% de confiança, por meio do teste das diferenças das médias pareadas (t-student) e pelo coeficiente alfa de Cronbach. A validade foi medida através dos coeficientes de correlação de Pearson e Spearman brutos e deatenuados e da classificação dos indivíduos segundo suas distribuições em quartos de consumo de sacarose de cada método. Os resultados apontaram que, para a reprodutibilidade, o teste t-student indicou que não há diferença significativa entre os dois questionários (p>0,01). O valor obtido para o coeficiente de alfa de Cronbach foi 0,903. Quanto à validade, diversamente do QFA-açúcar2, o teste t pareado entre o QFA-açúcar1 e a média dos dois IR24h mostrou diferença estatisticamente significativa para a ingestão de sacarose (p<0,05). Os coeficientes de correlação de Pearson e Spearman deatenuados para o QFA-açúcar 1 foram de 0,18 e 0,21 e para o QFA-açúcar2 de 0,36 e 0,44. A concordância exata média entre os QFA-açúcar1 e 2 foi de 30,25% e o percentual médio de indivíduos classificados em quartos adjacentes foi 61,11%. Concluindo, o QFA-açúcar possui relevâncias e limitações, contudo pode ser aprimorado. Mostrou reprodutibilidade e validade satisfatórias e poderá ser utilizado em estudos epidemiológicos para investigar a associação entre consumo de açúcar, doenças crônicas não-transmissíveis e cárie na população adulta de Porto Alegre.
Evidence indicates the relationship between excessive consumption of sugar by the population and the development of non communicable chronic diseases such as caries, obesity, diabetes and cancer. To investigate the relationship between diet and health-disease process, epidemiological studies use valid and reproducible instruments, and the most widely used is the Food Frequency Questionnaire (FFQ). The objective of this study was to develop, reproduce and validate a survey instrument (FFQ-sugar) to quantify in grams the sugar consumption in a sample of the adult population from Porto Alegre / RS. To determine the list of foods and the model's log of the FFQ-sugar, was carried out a qualitative research approach called focus group. It was based on the adaptation of the FFQ developed for adolescents, adults and elderly from Porto Alegre (FFQ-Porto Alegre). The food sugar quantification followed the Fehling method of food physical-chemical analysis or the reading of the food composition table from the American United States Department of Agriculture (USDA). The FFQ-sugar was evaluated by judges with experience in FFQ developing and implementing. The final result of this step shows the FFQ sugar with 94 items. To test the reproducibility and to measure the validity of the FFQ-sugar, was used the quantitative research approach. A sample of 81 individuals living in Porto Alegre, from 18 and 60 years of age were selected by multistage sampling. The study happened from July to November of 2011. The participants answered two 24-hour dietary recall questionnaire and two FFQ-sugar, in a interval of 15 to 30 days. The reproducibility was tested by the intra-class correlation coefficient by point and 95% confidence interval, through the test of paired differences of means (student-t test) and by the Cronbach's alpha. The validity was measured by the brute and de-attenuated correlation coefficients of Pearson and Spearman and by the classification of the individuals according to their distributions in sucrose consumption quartile of each method. The results showed that, for the reproducibility, the student-t test indicated that there is no significant difference between the two questionnaires (p> 0,01). The value of the coefficient of Cronbach's alpha was 0.903. As for validity, unlike the FFQ-açúcar2, the student-t test between the FFQ-açúcar1 and the two IR24h average demonstrated statistically significant difference for sucrose intake (p <0,05). The de-attenuated correlation coefficients of Pearson and Spearman for the FFQ-sugar1 were 0,18 and 0,21 and for the FFQ-sugar2 were 0,36 and 0,44. The exact average concordance between the FFQ- sugar 1 and 2 was 30,25% and the the average percentage of individuals classified in adjacent quartiles was 61,11%. The FFQ-sugar has relevance and limitations, but can be improved. It showed reasonable reproducibility and validity. As such, it may be used in epidemiological studies to investigate the association between sugar consumption, non communicable chronic diseases and dental caries in the adult population from Porto Alegre.

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Vanelli, Chislene Pereira. "Hipertensão arterial: estudo da base de dados do Centro Hiperdia de Juiz de Fora e avaliação da rede de atenção vinculada a este programa." Universidade Federal de Juiz de Fora, 2014. https://repositorio.ufjf.br/jspui/handle/ufjf/514.

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FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais
Introdução: As doenças crônicas não transmissíveis estão associadas a grande morbimortalidade e a elevados custos financeiros para o sistema público de saúde. Dentre estas doenças, destaca-se a hipertensão arterial sistêmica (HAS), uma doença de alta prevalência e que se associa frequentemente com complicações metabólicas, renais e, sobretudo cardiovasculares. Diante dessa realidade, foi implantado o Programa Hiperdia Minas no Estado de Minas Gerais, visando garantir o acesso à assistência especializada aos indivíduos com hipertensão arterial sistêmica, diabetes mellitus e doença renal crônica. O presente estudo foi dividido em duas etapas, as quais tiveram por objetivo descrever o perfil sociodemográfico e clínico dos usuários, além da caracterização das equipes das unidades de saúde avaliadas. Metodologia: O estudo descreveu e analisou a base de dados do Centro HIPERDIA Minas de Juiz de Fora e também as unidades de atenção primária a saúde (UAPS) que encaminharam usuários a este Centro. Foram incluídos no estudo 943 usuários encaminhados e atendidos para controle da HAS. Foram entrevistados os profissionais de saúde de 14 UAPS da cidade de Juiz de Fora, selecionadas pelo número de encaminhamentos ao Centro HIPERDIA. Resultados: A média de idade dos indivíduos foi 58,8±13,1 anos, sendo 61,3% do gênero feminino. Apenas 20,7% dos usuários chegaram ao Centro HIPERDIA com HAS em estágio 3. Do total de usuários avaliados, 78,6% apresentava excesso de peso. Hipertrigliceridemia, hipercolesterolemia e elevação do colesterol LDL estiveram presentes em 45,0, 49,6 e 66,5%, respectivamente. Além disso, 49,9% apresentaram taxa de filtração glomerular estimada < 60 mL/min, 15,3% dos usuários apresentavam coronariopatia, 76,1% disfunção diastólica de ventrículo esquerdo e 34,8% alto risco cardiovascular. A pressão arterial esteve elevada em 72,5% dos hipertensos por ocasião da admissão no Centro HIPERDIA Minas de Juiz de Fora. UAPS com equipes incompletas foram relatadas por 53,8% dos supervisores. Não foram realizadas “Referência” e “Contra referência” de atendimento de usuários entre a atenção básica e os outros níveis de complexidade em 61,5% das unidades. Em 84,6% das UAPS, a coordenação não analisou os relatórios emitidos pelo sistema de informações do Hiperdia. Conclusões: Observou-se elevada prevalência de dislipidemia, doença cardiovascular e redução na taxa de filtração glomerular. Encaminhamentos inadequados, mau controle da hipertensão arterial e a elevada prevalência de lesões de órgãos alvo sugerem a fragmentação no sistema de atenção à saúde e a ineficiência de interlocução entre os diferentes níveis da rede de atenção à saúde.
Introduction: The chronic non-communicable diseases are associated to large morbimortality and to elevated financial costs for the public health system. Amongst these diseases, highlights the systemic arterial hypertension (SAH), a disease of high prevalence which is frequently associated to metabolic, renal and, mostly, cardiovascular complications. Facing this reality, the Hiperdia Minas Program was implemented in the state of Minas Gerais, aiming at guaranteeing the access to specialized care for the individuals with systemic arterial hypertension, diabetes mellitus and chronic kidney disease. This study was divided into two stages, which aimed to describe the sociodemographic and clinical profile of users, and the characterization of teams of health units evaluated. Methodology: This study described and analyzed the database of the HIPERDIA Minas center of Juiz de Fora and also the primary healthcare unities (UAPS) which forwarded users to this Center. 943 users who were forwarded and attended for the control of SAH were included. The health professionals of 14 UAPS in the city of Juiz de Fora, selected by the number of forwarding to the HIPERDIA Center, were interviewed. Results: the individual age average was 58.8±13.1 years old, being 61.3% females. Only 20.7% of the users arrived to the HIPERDIA Center presenting stage 3 HAS. Out of all the evaluated users, 78.6% were overweight. Hypertriglyceridemia, hypercholesterolemia and elevated LDL cholesterol were present in 45.0, 49.6 and 66.5%, respectively. In addition, 49.9% had estimated glomerular filtration rate <60 mL/min, 15.3% of users had coronary artery disease, 76.1% diastolic dysfunction of the left ventricle and 34.8% high cardiovascular risk. Blood pressure was elevated in 72.5% of hypertensive on admission in HIPERDIA Minas center of Juiz de Fora. UAPS with incomplete teams were reported by 53.8% of supervisors. User attendance “Reference” and “Counter reference” between basic care and other attendance complexity levels were not performed in 61.5% of the units. In 84.6% of the UAPS, the coordination didn’t analyze the reports emitted by the Hiperdia information system. Conclusions: A high prevalence of dyslipidemia, cardiovascular disease and reduced in the glomerular filtration rate were observed. Inadequate forwarding, poor control of arterial hypertension and high prevalence of lesions of targeted organs suggest the fragmentation of the health care system and the inefficiency of dialog between the different levels of the health care network.

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Orbolato, Rafael [UNESP]. "Epidemiologia da atividade física entre pacientes atendidos na atenção básica do SUS: coorte de 18 meses." Universidade Estadual Paulista (UNESP), 2018. http://hdl.handle.net/11449/153150.

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O Sistema Único de Saúde (SUS) é a principal fonte de serviços de saúde da população brasileira, onde aproximadamente 71,1% da população utilizam seus serviços. As Doenças Crônicas Não Transmissíveis (DCNTs) exercem um impacto expressivo na morbidade e mortalidade da população. A Atividade Física (AF) é um importante recurso para promoção da saúde, controle da obesidade e principalmente para a prevenção de DCNTs. Objetivo: Investigar as mudanças na prática de AF e tempo de televisão em usuários do SUS durante um período de 18 meses e o impacto do gênero e tempo nessas variáveis, assim como relacionar se a prática de AF, ou a falta dela, influência nos gastos com saúde no SUS. Métodos: Foram avaliados 198 participantes (58 homens e 140 mulheres) durante um segmento de 18 meses, as avaliações ocorreram a cada seis meses. O Nível de AF foi mensurado através do questionário de Baecke, foram realizadas medidas antropométricas e hemodinâmicas (peso, estatura, IMC, circunferência de cintura, pressão arterial), a composição corporal foi analisada pela impedância bioelétrica, foram questionados também a respeito da condição econômica e gastos com saúde. Resultados: Foi verificado que homens apresentaram maiores escores em todas as variáveis de AF de deslocamentos (caminhada [p-valor 0,013], ciclismo [p-valor 0,001] e locomoção [p-valor 0,007]) quando comparados às mulheres, mas para comportamento sedentário não houve diferença significativa. Esses resultados ratificam as consistentes diferenças na prática de AF entre homens e mulheres, as quais são suportadas por fatores socioculturais. Pessoas que acumularam maior prática de ciclismo apresentaram menores valores para IMC (p-valor= 0,03), gordura corporal (p-valor= 0,001), onde o ciclismo explicou 2,4% e 8,6% dessas mudanças, respectivamente. Custos com saúde e maior prática de ciclismo foram negativamente relacionados, onde o ciclismo foi responsável por reduzir 2% de todos custos acumulados durante o período. Conclusão: Homens são usualmente mais ativos que mulheres em diferentes comportamentos relacionados à prática de atividade física e a prática de ciclismo impactou positivamente na redução dos custos com saúde na atenção primária e indicadores de adiposidade.
The Unified Health System (SUS) is the main source of health services for the Brazilian population, where approximately 71.1% of the population use their services. The Chronic Non-communicable Diseases (DCNTs) have a significant impact on the morbidity and mortality of the population. The Physical Activity (AF) is an important resource for health promotion, control of obesity and especially for the prevention of DCNTs. Objective: To investigate changes in physical activity and sedentary behavior in users of the Brazilian National Health System during 18 months and the impact of gender and time on such variables, as well to relate whether the practice of AF, or the lack of it, influence health expenditures in the SUS. Methods: 198 participants (58 men and 140 women) were assessed. Physical activity level was assessed using the Baecke questionnaire, anthropometrical and hemodynamic measures (weight, stature, BMI, waist circumference, blood pressure) were performed, body composition was analyzed by bioelectrical impedance, were also questioned about the economic condition and health expenditures. Results: It was verified that men presented higher scores in all physical activity variables (walking [p-value 0.013], cycling [p-value 0.001] and locomotion [p-value 0.007]) when compared to women, but for sedentary behavior there was no significant difference between genders, which are supported by sociocultural factors. People who accumulated more cycling had lower values for BMI (p-value = 0.03), body fat (p-value = 0.001) where cycling explained for 2.4% and 8.6% of these changes, respectively. Costs with health and greater cycling were negatively related, where cycling was responsible for reducing 2% of all costs accumulated during the period. Conclusion: Men are usually more active than women in different domains of physical activity and changes through the time are similar between genders and cycling practice had a positive impact on the reduction of health care costs in primary care and adiposity indicators.

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MacDonald, Tara. "Ignoring a Silent Killer: Obesity & Food Security in the Caribbean (Case Study: Barbados)." Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/23229.

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Obesity and obesity-related diseases – such as type 2 diabetes – have become the most crucial indicators of population health in the 21st century. Formerly understood as ‘diseases of affluence’, obesity is now prevalent in the Global South posing serious risk to socioeconomic development. This is particularly true for rapidly developing countries where nutrition transitions are most apparent. There are many factors which impact on risk of obesity (e.g. gender, culture, environment, socioeconomic status, biological determinants). The problem is further aggravated within small island developing states where food security is exacerbated by factors associated with globalization and development. The thesis examines the surge of obesity and type 2 diabetes within Caribbean populations, using Barbados as a case study. A holistic approach was applied using an ecological health model. Moving away from the lifestyle model, the theoretical framework underpinning included sub-theories (e.g. social constructivism, feminism, post-colonial theory, concepts of memory and trauma).

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Lemos, Andréa dos Reis. "Análise da comunicação de marketing no varejo de alimentos no Município de São Paulo." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/89/89131/tde-20122011-092310/.

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Uma das conseqüências da transição nutricional é a elevação da prevalência de obesidade na população mundial. Entre os fatores ambientais determinantes da escolha alimentar, destaca-se a influência dos meios de comunicação. O objetivo do estudo foi construir e aplicar um questionário para análise da comunicação de marketing no varejo de alimentos do município de São Paulo. Amostra propositiva de 52 setores censitários do município de São Paulo foi selecionada conforme níveis de IDH e densidade de indicadores ambientais para análise do marketing no varejo de alimentos para consumo imediato e domiciliar. A pesquisa identificou maior número de estabelecimentos de varejo de alimentos para consumo imediato (472) do que para consumo domiciliar (305). O volume de mensagens nos pontos-de-venda foi consideravelmente maior para alimentos industrializados (484) do que alimentos in natura (275). Registrou-se propaganda de alimentos em maior número de varejos de alimento para consumo imediato (47%) do que consumo domiciliar (20%). Identificou-se associação positiva entre renda e IDH em relação ao volume de propagandas de alimentos in natura que abordavam o conteúdo \"saúde\". Houve associação negativa entre renda e volume de propagandas para alimentos industrializados em \"economia\" e \"saúde\". O volume total de propagandas em estabelecimentos de alimentos para consumo domiciliar apresentou correlação negativa com IDH, enquanto no varejo de alimentos para consumo imediato houve correlação negativa com renda. Os resultados do presente trabalho apontam para a necessidade de maior esforço de pesquisa no que tange à propaganda de alimentos nos equipamentos de varejo de alimentos. O fortalecimento de ações de monitoramento de propagandas de alimentos nos equipamentos varejistas possibilitaria maior conformidade das mensagens das propagandas em relação à legislação de alimentos, em benefício da saúde do consumidor.
The nutrition transition presents as consequence an increase in obesity prevalence among worldwide population. Among environmental factors determining food choices of individuals, it is possible to point out the influence of mass media communication. The objective of the study is to structure and apply a questionnaire for the study of marketing communication in food retail at the city of Sao Paulo. 52 census sectors from Sao Paulo city were selected for data collection, according HDI and environmental variables, in order to allow the analysis on marketing communication on retail of food for immediate or household consumption. Results indicate that there are more retail stores of food for immediate consumption (472) than household consumption in Sao Paulo city. Volume of advertisement in food retail stores was considerably higher for processed foods (484) than in natura (275). Food advertisement was registered in higher number of retail stores of food for immediate consumption (47%) than in retail stores of food for household consumption (20%). There was a positive association between income and HDI in relation to the volume of advertisement for in natura foods approaching the \"health\" content. A negative association between income and volume of advertisement for processed foods was identified in relation to \"economy\" and \"health\" contents. The total volume of advertisement in retail stores of food for household consumption presented negative correlation in relation to HDI, while retail of food for immediate consumption had negative correlation in relation to income. Results obtained in the study indicate the need for joint efforts in research towards food advertisement in food retail stores. Strengthening of monitoring action in food advertisement located in retail stores may assure higher accomplishment food regulation patterns in relation to the messages published, benefiting the consumers\' health.

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Zulu, Tryphine. "Socioeconomic inequalities in non-communicable diseases in South Africa." Doctoral thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31799.

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Non-communicable diseases (NCDs) have reached epidemic proportions globally and in South Africa. This thesis is situated within the health equity framework. The aim is to assess the extent of wealth related inequalities in NCDs and to assess the impact of the social determinants of health in mediating these inequalities. Data from the first South African National Health and Examination Survey (SANHANES-1) and wave 4 of the South African National Income Dynamics Study (NIDS) were used. The methods used include the concentration curve, concentration index and decomposition analysis to assess the drivers of socioeconomic inequality in NCDs and some causes of NCDs including smoking, obesity, high blood pressure; use of screening services and effective coverage for hypertension management. The prevalence of smokers is 18.7%, the population average BMI is 26.38 kg/m2, and the prevalence of hypertension is 29.7%. The distribution of these risk factors is pro-wealthy with concentration indices ranging from 0.048 for hypertension, 0.057 for smoking prevalence to 0.115 for obesity. While these risk factors are prevalent amongst the wealthy, the outcomes are worse amongst the poor. The concentration index for expenditure on cigarettes is strongly pro-poor, (-0.130) compared to the prowealthy smoking prevalence. The hypertensive poor suffer more severe hypertension with a concentration index of -0.054 for depth and -0.079 for severity, respectively. Obesity affects the wealthiest the most. However, the overweight adults who are poor tend to suffer more severe obesity as shown by a relatively smaller concentration index of depth (0.015) and severity (0.033) respectively. The overall utilisation of screening services is below 50% for eligible respondents. The two wealthiest quintiles benefit disproportionately more than they should, given their share of the population. This is particularly true for diabetes and cholesterol with a concentration index of 0.27 for cholesterol, 0.129 for diabetes and 0.052 for hypertension. Adults that do not take up screening services are predominantly the black race group, poor, rural, male, unemployed and uninsured. Only 23% of those with hypertension are diagnosed, on treatment and are controlled. Wealth-related variables such as education, wealth, health insurance coverage and province of residence drive most of the observed pro-wealthy inequalities in this thesis. Wealthier adults benefit to a larger extent from the care cascade, compared to the poor. Therefore, until there is a substantial increase in early diagnosis and effective treatment, high levels of mortality from NCDs will persist in South Africa. And until the poor are prioritised through radical policy change in all economic sectors, the observed inequalities will continue.

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Tang, Shenglan, John Ehiri, and Qian Long. "China's biggest, most neglected health challenge: non-communicable diseases." BioMed Central, 2013. http://hdl.handle.net/10150/610162.

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BACKGROUND:Over the past two decades, international health policies focusing on the fight against the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis (TB), malaria, and those diseases that address maternal and child health problems, among others, have skewed disease control priorities in China and other Asian countries. Although these are important health problems, an epidemic of chronic, non-communicable diseases (NCDs) in China has accounted for a much greater burden of disease due to the ongoing rapid socioeconomic and demographic transition.DISCUSSION:Although NCDs currently account for more than 80% of the overall disease burden in China, they remain very low on the nation's disease control priorities, attracting marginal investment from central and local governments. This leaves the majority of patients with chronic conditions without effective treatment. International organizations and national governments have recognized the devastating social and economic consequences caused by NCDs in low- and middle-income countries, including China. Yet, few donor-funded projects that address NCDs have been implemented in these countries over the past decade. Due to a lack of strong support from international organizations and national governments for fighting against NCDs, affected persons in China, especially the poor and those who live in rural and less developed regions, continue to have limited access to the needed care. Costs associated with frequent health facility visits and regular treatment have become a major factor in medical impoverishment in China. This article argues that although China's ongoing health system reform would provide a unique opportunity to tackle current public health problems, it may not be sufficient to address the emerging threat of NCDs unless targeted steps are taken to assure that adequate financial and human resources are mapped for effective control and management of NCDs in the country.SUMMARY:The Chinese government needs to develop a domestically-driven and evidence-based disease control policy and funding priorities that respond appropriately to the country's current epidemiological transition, and rapid sociodemographic and lifestyle changes.

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Intrusi, Valentina. "Managing Challenges of Non Communicable Diseases during Pregnancy: An Innovative Approach." Master's thesis, Alma Mater Studiorum - Università di Bologna, 2018. http://amslaurea.unibo.it/15675/.

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Le sfide lanciate dalle malattie non trasmissibili sono accolte da tecnologie sempre più all'avanguardia. Nonostante questo, ancora oggi gestire e monitorare gravidanze a rischio rimane un problema. La simulazione di condizioni come quella data dal diabete gestazionale, può aiutare a capire quali sono i principali fattori che influenzano l'andamento della malattia in modo da poterne evitare l'insorgenza e, in questo modo, migliorare la salute di madri e generazioni future. Questa tesi ha come obietto lo studio e il miglioramento di un sistema Agent-Based pensato per il trattamento del diabete di tipo 1 e la modellazione di una sua estensione per il diabete gestazionale. Al termine della tesi è stato migliorato il sistema rendendolo più fedele ai cambiamenti fisiologici che avvengono durante il metabolismo del glucosio e la modellazione della placenta e relativamente delle modifiche che apporta all'intero sistema getta le basi per nuovi sviluppi legati al trattamento di malattie durante il periodo di gestazione.

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Aleluia, Ítalo Ricardo Santos. "Avaliação da coordenação do cuidado no âmbito da Atenção Primária à Saúde: um estudo de caso." Instituto de Saúde Coletiva, 2014. http://repositorio.ufba.br/ri/handle/ri/16337.

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A crescente prevalência das condições crônicas no cenário epidemiológico brasileiro exige transformações na organização dos serviços de saúde que viabilizem melhorias na integração e continuidade do cuidado. A Atenção Primária à Saúde (APS) assumiu papel prioritário para integrar cuidados, serviços e informações, e tem como atributo fundamental a coordenação do cuidado. Embora o processo de coordenar o cuidado seja colocado como atributo fundamental da APS, cumprir essa função ainda é uma tarefa de difícil operacionalização em diversos municípios brasileiros. Esse estudo teve como objetivo avaliar a coordenação do cuidado no âmbito da APS em um município do Estado da Bahia. Trata-se de um estudo de caso único, com dois níveis de análise, em duas equipes de Saúde da Família. Considerou-se com fontes primárias de evidência as informações registradas no diário de campo do pesquisador, dados obtidos mediante entrevistas semiestruturadas com profissionais, gestores e usuários da APS e, como fontes secundárias, o banco de dados do PMAQ-AB, a análise dos documentos da Secretaria Municipal de Saúde e das equipes de APS. Para avaliar a coordenação do cuidado, foram selecionadas condições traçadoras (a hipertensão e o diabetes) e elaborou-se uma imagem objetivo, com vistas a analisar comparativamente as equipes e estimar em que medida os critérios da coordenação do cuidado, adotados nesse estudo, têm sido cumpridos (ou não) por ambas. Adotou-se como categorias de análise o planejamento da assistência, a padronização de condutas, o referenciamento, a comunicação e o monitoramento do usuário. Os resultados evidenciaram que a coordenação do cuidado não tem sido cumprida por ambas as equipes, e que houve maior dificuldade para o cumprimento dos critérios relativos à padronização de condutas e à comunicação entre profissionais e serviços de saúde. A falta de protocolos assistenciais, a ausência de critérios para estratificação de riscos e o desconhecimento dos demais profissionais da rede, pelos profissionais da APS, dificultaram o compartilhamento de saberes e responsabilidades na construção de planos de cuidados. A ausência de registros informatizados e o descuido com os registros manuais da atenção prestada, certamente comprometeram a qualidade e a continuidade das informações assistenciais. A falta de tecnologias telecomunicativas e os problemas de articulação entre os serviços da rede colaboraram para a baixa comunicabilidade entre os níveis de atenção. Por fim, a ausência de sistemas informatizados, a desorganização e a insuficiência na oferta de exames e consultas restringiram o referenciamento vertical dos usuários, com baixa capacidade das equipes gerenciarem as filas de espera e monitorarem os fluxos e contrafluxos assistenciais. Considera-se de suma importância a implantação de sistemas informatizados e de tecnologias de telecomunicação; a criação e adoção de protocolos assistenciais, de estratégias de capacitação profissional, de avaliação e monitoramento regular dos serviços, que possam refletir sobre a capacidade das equipes de APS coordenarem o cuidado ao usuário. Reitera-se a importância de novas pesquisas que investiguem outros casos da microrregião, com eixos investigativos centrados na coordenação do cuidado e que considerem as relações e os conflitos do processo de trabalho entre os serviços e os profissionais dos três níveis de atenção.

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Pastakia, Sonak D. "Developing self-sustainable models of care for non-communicable diseases in Kenya." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/91742/.

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Background (Kenya) Sub-Saharan Africa (SSA) is in the midst of experiencing an unprecedented increase in non-communicable diseases (NCD), specifically diabetes and hypertension. This shift has required public sector health systems, which have historically focused on managing acute diseases, to redesign their services to appropriately serve chronic disease needs. Issue Addressed In order to provide a description of our efforts to bring up comprehensive services for NCDs in rural Kenya within this thesis, I have specifically selected publications which target different aspects of the healthcare system. This includes our efforts related to clinical training for pharmacists, screening for NCDs, medication supply chains, remote phone-based care services, and care delivery based in the community. Prior to the implementation of the programs mentioned in these domains, access to these services was largely not available in western Kenya. Furthermore, the publication of our research from this western Kenyan cohort is designed to supplant the relatively limited research which emanates from rural sub-Saharan Africa. Research Questions For each of these selected publications, we defined a set of primary and, in some cases, secondary research questions focused on identifying the contextualized attributes of service delivery in this setting while also assessing the impact. For the first publication on training for clinical pharmacists, we assessed the impact of Kenyan Bachelor of Pharmacy interns and North American Doctor of Pharmacy interns while providing clinical care in an inpatient setting in Kenya. Our primary research question assessed whether there was a significant difference in the number of clinical interventions documented by interns from the two countries. In the second paper, we shifted our focus to outpatient care and wanted to address the uptake of different strategies of screening for diabetes and hypertension. Our primary research question assessed whether there were any significant differences in follow-up at the public sector clinic after screening positive via home-based screening (community health volunteer provides screening at your home) versus community-based screening (a community wide event is established where people voluntarily show up to receive screening) in a rural setting. In the third paper, we sought to continue to improve aspects of outpatient care by describing our model for improving access to medications. Our primary research question focused on descriptively assessing the change in availability of essential medications before and after implementation of this model. In the fourth paper, we described and assessed our model for providing intensive diabetes follow-up remotely. Our primary research question focused on whether patients experienced statistically significant improvements in blood glucose control after participating in this service for six months. In the fifth paper, we brought together various elements of our prior activities to design and evaluate the community-based model of care called BIGPIC - Bridging Income Generation through grouP Integrated Care. The primary research question for this investigation was to identify the frequency with which patients who screened positive for diabetes or hypertension linked to care. Secondary research questions compared the linkage frequency observed with this model compared to a historical control, along with a descriptive assessment of the loss to follow up, and an assessment of whether this model led to statistically significant reductions in blood pressure after 1 year of implementation. Short Summary of the Individual Papers with Results Linking Them Together Within our assessment of pharmacy training, we found that the Kenyan pharmacy interns provided statistically significantly more clinical interventions per day than their North American counterparts. This result highlighted the potential for Kenyan pharmacy providers to provide clinical services which were largely unavailable in western Kenya prior to this research. Despite the lack of the clinically focused Doctor of Pharmacy curriculum in Kenya, Kenyan pharmacy interns within the Bachelors in Pharmacy program were able to make an average of 16.7 consultations per day with the medical team compared to 12.0 per day for the North Americans. In the second paper we shifted our focus to the outpatient setting and were surprised to find that there weren’t any statistically significant differences in follow-up between home-based versus community-based screening for NCDs. This highlighted the reluctance of rural patients to travel to public sector facilities for care regardless of the screening method utilized. This realization led us to simultaneously focus on improving the reliability of services available in public sector while also trying to implement solutions to facilitate the provision of remote services for care. Within our efforts to improve medication access in paper 3, we were able to demonstrate how our revolving fund pharmacy model was able to improve access to medications from < 40% to > 90%. In paper 4, we were able to implement a self-monitored blood glucose program and demonstrate a dramatic improvement in the blood sugars of patients enrolled in the self-monitored blood glucose program with a statistically significant 31.6% absolute decline in HbA1c. The culmination of these efforts and learnings is described in paper 5, where we implemented the BIGPIC care delivery model which resulted in a statistically significant improvement in linkage to care for screened patients, a retention in care frequency of 70.3%, and a statistically significant mean decline in the systolic blood pressure of 21mmHg (95% CI 13.9-28.4, P < 0.01).

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Angkurawaranon, C. "Urbanization and internal migration as risk factors for non-communicable diseases in Thailand." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2015. http://researchonline.lshtm.ac.uk/2267958/.

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Urbanization, which is driven mainly by the expansion of cities and urban migration, is considered one of the key drivers of non-communicable diseases (NCDs) in developing countries. This research aims to investigate the patterns and associations between different levels of urban exposures and NCD risk factors, NCD morbidity and NCD mortality in Thailand, to better understand the mechanisms underlying the link between urbanization and NCD in Thailand. Using several study designs and analytical techniques, the research described in this thesis found that the process of migration and living in an urban environment were associated with lower social trust and higher levels of emotional problems. Urban environments were also associated with behavioural and physiological risk factors for NCDs, including smoking, heavy alcohol consumption, inadequate physical activity, inadequate fruit/vegetable consumption, high BMI, and high blood pressure. Both early life urban exposure and accumulation of urban exposure throughout life potentially play a role in these increases in behavioural and physiological risk factors for NCDs. Early life urban exposure was also found to be associated with an increased risk of developing obesity in adulthood. Increased psychosocial, behavioural and physiological risk factors associated with living in an urban environment may not translate directly into increased prevalence of biological risk factors for NCDs (such as high cholesterol), the development of NCDs, or into NCD-related mortality. It is likely that biological risk factors for NCDs, as well as NCD incidence and mortality are more amendable to change from the positive influences of urbanization through higher socioeconomic status and potential access to better health care.

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Viali, Satupaitea Public Health &amp Community Medicine Faculty of Medicine UNSW. "Trends and development of non-communicable diseases and risk factors in Samoa over 24 years." Awarded By:University of New South Wales. Public Health & Community Medicine, 2009. http://handle.unsw.edu.au/1959.4/40404.

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Abstract inserted as part of Final MPH Thesis: Non-Communicable Diseases like diabetes, cardiovascular diseases, cancers and others, have become the major cause of premature death, morbidity and disability in many Pacific countries including Samoa. These are linked by common preventable risk factors like obesity, hypertension, smoking, unhealthy diets and physical inactivity. OBJECTIVES: To determine the trends and development of Non-Communicable diseases and its risk factors in Samoa over the last 24 years using the recently developed diagnostic criteria. RESEARCH DESIGN AND METHODS: This research thesis combines 3 large surveys that were done in 1978, 1991, and 2002, looking at the trends in the prevalence of diabetes, and the prevalence of the NCD risk factors such as blood pressure, obesity, cholesterol and smoking. The 3 survey samples were selected randomly from around similar regions (Urban Upolu, Rural Upolu, and Rural Savaii) of Samoa in 1978, 1991 and 2002, with a total of 5973 individuals (1978 survey = 1467; 1991 survey = 1778; 2002 survey = 2728) available for the thesis analysis. The 1978 and 1991 data sets were secured from Professor P Zimmet, and the 2002 STEPs survey data set was secured from the Samoa Ministry of Health. The 3 surveys methodologies, survey procedures, questionnaires and anthropometric measurements were similar though the diagnostic criteria used to measure obesity slightly differ between the surveys. The blood pressure measurements were similar though the diastolic blood pressure measure in 1978 was higher. The 1978 and 1991 surveys used fasting venous blood sampling to measure fasting plasma glucose, and cholesterol levels at the laboratory. OGTT was also used in 1978 and 1991, but not 2002. The 2002 survey used capillary sampling to measure fasting glucose using a glucometer, and cholesterol level using a cholesterol meter. The combined data was then cleaned, standardized and matched with each survey, to make analysis easier. The recent diagnostic criteria were then applied to all the surveys to diagnose diabetes (1999 WHO Diabetes Criteria), hypertension (WHO 1999, JNC-VII 2003, NHF 1999 Hypertension Criteria), obesity (BMI ≥30 kg/m??), and hypercholesterolaemia. The prevalences using the recent diagnostic criteria were then mapped out. RESULTS: The overall age-standardized prevalence of type 2 diabetes (known or previously unknown) utilizing the current 1999 WHO diagnostic criteria for men and women ≥20 years of age has increased from 5.4% (males 4.8%, females 5.9%) in 1978, to 12.0% (males 10.9%, females 13.5%) in 1991, and to 20.1% (males 17.2%, females 22.2%) in 2002. Among the individuals with diabetes in the 3 surveys, more than 60% had previously undiagnosed diabetes. Compared with the 1978 survey, the diabetes prevalence in 2002 represents a 4-fold increase over the 24 year period. This has occurred along with increasing obesity, urbanization and modernization, aging, cultural changes, and changes in physical activity. There is a high prevalence of non-communicable disease risk factors. The age-standardized prevalence of hypertension defined by the WHO 1999 and JNC-VII 2003 criteria was 47.2% in 1978, 22.5% in 1991, and 24.0% in 2002. The high prevalence of hypertension in 1978 was due to the method used for recording diastolic blood pressure. Hypertension was more common in the urban regions than rural regions in 1978 and 1991 while in 2002, there was no statistical difference between the rates of hypertension between the different regions due to the rise in the prevalence rate of hypertension in rural regions. There is a high prevalence of overweight and obesity in Samoa. Using the WHO classification for BMI, there was an increase in obesity (BMI ≥ 30kg/m??) prevalence in Samoa in the last decade, increasing steeply from 34.9% in 1978 to 51.3% in 1991, and slowing down to an increase to 57.4% in 2002. The prevalence of obesity is significantly higher in females compared with their male counterparts. The overweight prevalence (BMI 25-29.9kg/m??) was 34% in 1978, 31% in 1991 and 29% in 2002. The prevalence of obesity has increased by 65% from 1978 to 2002 with an increase of 47% from 1978 to 1991, and 12% from 1991 to 2002. Prevalence of obesity is increasing with age and is more of a problem in women than men. It is higher in the urban regions but there has been a faster rise in obesity prevalence in rural regions from 1978 to 2002 as the rural regions become urbanized. The prevalence of hypercholesterolaemia (total cholesterol ≥ 5.2 mmol/l) was 30.5% in 1978, and this increased to 51.1% in 1991. There was a marked decline of hypercholesterolaemia in 2002 (14.4%), which may be due to differences in the method of measurement. Although smoking prevalence remains high in Samoa it declined significantly from 42.4% 1978 to 35.3% 1991 but remained essentially steady at 38% in 2002. There was a significant gender difference in smoking with about 60% of men and 20% of women smoking regularly. CONCLUSION: Samoa is experiencing an increasing problem with Non-Communicable diseases like diabetes and some of its risk factors. Diabetes prevalence has dramatically increased by 4-fold in the last 24 years. The prevalence of hypertension has stabilized around 23% though there was a decrease from 1978. The prevalence of obesity has also increased. Smoking prevalence has slightly increased from 1991 to 2002 with a significant number of the population smoking. Hypercholesterolaemia is more common in 1991 with an apparent decrease in 2002. These findings have important implications for public health efforts and policy developments to contain the epidemic of Non-Communicable diseases in Samoa.

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Tsolekile, Lungiswa. "Urbanization and lifestyle changes related to non-communicable diseases: An exploration of experiences of urban residents who have relocated from the rural areas to Khayelitsha, an urban township in Cape Town." Thesis, University of the Western Cape, 2007. http://hdl.handle.net/11394/2073.

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Magister Public Health - MPH
The prevalence of non-communicable diseases such as hypertension and diabetes including obesity has increased among the black population over the past few years. The increase in these diseases has been associated with increased urbanization and lifestyle changes. No studies have documented the experiences of people who have migrated to urban areas. Aim: To describe the type of lifestyle changes, reasons for the lifestyle changes and the barriers to adopting a healthy lifestyle among people who have migrated from rural areas to urban areas in the past 5 years and reside in Khayelitsha. Objectives: (1) To identify people who have moved from rural to urban areas in the past 2-5 years; (2) To explore reasons for moving to the city; (3) To explore experiences of respondents on moving to the city; (4) To identify the types of lifestyle changes related to chronic diseases among respondents on arrival to the city; (5) To identify reasons for the lifestyle changes among respondents; (6) To identify coping strategies that have been adopted by respondents; (7) To identify barriers to healthy lifestyle among respondents; (8) To make recommendations for development of appropriate interventions that will enable migrating populations to adjust better to city life. Rural-urban migration (urbanization) was associated with factors such as seeking employment, better life and working opportunities. On arrival in the city migrants face a number of challenges such as inability to secure employment and accommodation. Faced with these challenges, migrants change their lifestyle including buying fatty foods, increasing frequency in food consumption and decreasing in physical activity. In the city factors such as poverty, environment including lack of infrastructure, and lack of knowledge about nutrition, social pressures and family preferences were identified as hindrances to a healthy lifestyle. Conclusion: This study identified various factors that influence the decision to migrate from rural areas. Lifestyle changes in an urban setting are due to socio-economic, environmental and individual factors. Perceived benefits of moving to urban areas can pose challenges to health and this may have negative health-outcomes.
South Africa

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Alkhalaf, Majid M. "Nutrition and body composition as risk factors of non-communicable diseases in Saudi Arabia." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8533/.

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Background: Saudi Arabia is an affluent nation faced with steep population increase (~75% in just over 10 years) and a young population (63% aged under 30) in the context of globalized dietary habits and food supply leading to increase the trend of consumption junk food use. However, there are no national dietary surveys to give more accurate details. With existing high prevalence of obesity, it is foreseeable that Saudi Arabia (SA) will face a significant increase in the burden of non-communicable diseases (NCDs) in a short space of time. Reducing the behavioural and environmental risk factors associated with NCDs (physical activity, alcohol overuse, exposure to tobacco smoke, and low nutritionally balanced diet including high salt and energy intake and low intake of fruit and vegetables) requires cross-community sectors, including health, education, agriculture, and planning. Early detection and intervention also require reliable and cost effective tools. The relationship between chronic high salt intake and CVDs has already been established. This thesis examines the relationship between body composition and nutrition, and NCDs using techniques from the full breadth of Human Nutrition Research. Methods: The first cross-sectional study focused on developing and validating a culture-specific FFQ for salt intake against 24-h urinary outputs and repeated 24-h dietary recall, to identify relationships between salt intake, socio-economic factors and blood pressure (BP); and explore dietary sources of salt intake. In the second study, a secondary analysis of integrated data from five Saudi National Surveys assessed the performance of different anthropometric measures (body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and waist to height ratio (WHtR)) and body composition indices (estimated skeletal muscle mass (SMM), the percentage of skeletal muscle mass to body weight (%SMM) and Skeletal Muscle Mass Index (SMI)) in predicting metabolic diseases. Saudi nationals only were included in the study. ROC analysis was used to explore the best predictor of metabolic diseases and develop new thresholds. To assess the agreement and misclassification of overweight and obesity using BMI and WC measurements, BMI in combination with WC measurements were used to classify participants as [High-Risk Adiposity by BMI and WC], [High-Risk Adiposity by BMI only], and [High Risk Adiposity by WC only] based on the action levels. Each anthropometric and muscle mass indices were categorised to deciles. Additionally calculated were age-adjusted odds ratios by applying logistic regression models of the different metabolic risk factors in case of an increase of one decile of the respective anthropometric and estimated SMM parameter. In the third study, a cross-sectional survey was developed using the Theory of Planned Behaviour to provide a holistic understanding of factors that may influence food choices and behaviours, and in particular, intentions of adopting a nutritionally-balanced diet. External variables including age, gender, socio-economic status, and being aware of health and nutrition policies and others were included into the model as they were potentially related to TPB constructs. Attitude toward behaviour, subjective norms, perceived behavioural control and knowledge as actual barriers to behaviour were assessed. Results: In the first study, the newly developed Saudi FFQ was found to be of moderate validity in ranking people based on their estimated salt intake, and performed as well as other salt FFQ developed for other nations. The Riyadh population used in this survey consumed 8.7 g salt per day (estimate), higher than the recommended level of salt ( > 5 g/d for salt). A minority (18%) met the recommended level. The main sources of salt were, surprisingly, vegetables and un-processed foods, and a positive relationship between income and salt intake was observed. Meanwhile, salt intake, defined by FFQ, was associated with systolic BP only (R=0.089, p=0.036), an association which disappeared when adjusted for age, WC and gender. The second study highlighted that a majority of Saudi adults could be categorized as overweight or obese (72%). Worryingly, short of half of those with a normal BMI (18.5–25) aged over 45 also had a large waist. Combining WC and BMI did not improve their value as predictors of metabolic diseases and WC was the best overall predictor of metabolic diseases while BMI was the poorest. This study suggests new cut-off points for WC in SA, in a context of metabolic diseases, ranging between 90 to 92 cm (women) and 94 to 99 cm (men). The newly developed WC cut-offs are higher than the cut-offs for Asian men and women (90 and 80 cm, respectively). The new WC cut-off for women is higher than the cut-off for Caucasian women (88 cm); and the WC cut-off for men is lower than the cut-offs for Caucasian men (102 cm). The obesity prevalence based on BMI and WC also increased proportionately with both SMM (kg) and SMI (kg/m2) increase while the obesity decreased proportionately with %SMM increase. SMI was a poor predictor of metabolic diseases while %SMM was the best, having the highest AUC levels. New (defined) cut-off points for %SMM for metabolic diseases were defined, ranging from 29 to 32% for men and 26 to 28% for women. The third study highlighted that very few SA adults have been exposed to national nutrition and health guidelines (18%). Awareness of these was the strongest predictor of attitude toward behaviour, social norms and knowledge of nutritionally-balanced diet whilst perceived social pressure to engage in behaviour toward a more nutritionally balanced diet (SN) was the strongest predictor of subjects’ intention. Conclusion: Study 1 added a new and unexpected source of salt intake including vegetables and unprocessed foods. These findings raise a concern regarding the encouragement to increase intake of vegetables without including advice regarding cooking advice, in light of the risk of higher salt intake in SA. It would be worthwhile to consider education strategies towards the use of alternative ingredients or dressings in salad and cooked vegetables. Study 2 added an evidence about the weakness of BMI and SMI in predicting metabolic diseases and misclassifying the population. The study suggests using WC and %SMM as alternative measures and adopting the newly developed cut-offs. Study 3 sheds the light on possible avenues for policies, health promotions and nutrition interventions to focus on Saudi adults, in order motivate the population to adopt nutritionally balanced diet by increasing population knowledge and awareness.

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Qarani, Sozan. "Investigation of the role of the non-integrin laminin receptor in the pathogenesis of bacterial meningitis." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/31739/.

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The human non-integrin laminin receptor (LamR) is a multifunctional protein which is localised to a number of sub-cellular locations. LamR is a component of the ribosome and has a number of intracellular functions; it also acts as an extracellular receptor for laminin, growth factors, pathogenic microorganisms, prion proteins, toxins and the anticarcinogen epigallocatechin gallate (ECGC). Although LamR is present in most cellular compartments, its overexpression in many types of cancer cells suggests a vital role for LamR in tumor-cell migration and invasion. There are two isoforms of laminin receptor: the monomeric 37-kDa laminin receptor precursor (37LRP) and the mature 67-kDa laminin receptor (67LR). Although the precise molecular nature of 67LR is unclear, accumulating evidence strongly suggest that 37LRP can undergo homo- and/or hetero-dimerization with Galectin-3 (Gal-3) to form mature 67LR. A recent study demonstrated that both homo- and heterodimer LamR forms are present on the cell surface, where they form distinct populations. Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) are major causes of bacterial meningitis. The contribution of LamR in traversal of the blood brain barrier (BBB) by neurotropic viruses is well established and interaction with LamR was recently found to be critical for initiation of bacterial contact with the blood brain barrier (BBB). These bacteria bind LamR via the surface protein adhesins: meningococcal PilQ and PorA; pneumococcal CbpA; and H. influenzae OmpP2. Further investigations showed that the fourth and second extracellular loops of meningococcal PorA and OmpP2 of H. influenzae, respectively, are responsible for LamR binding. The work presented here consists of two complementary projects in which a number of approaches were taken to characterise the ligand-binding domains of LamR. The first project aimed to identify sites on LamR that are critical for binding the ligands of bacterial meningeal pathogens. The second project aimed to identify residues that contribute to the stability of LamR homodimers and the heterodimer with Gal-3. Several mutations were introduced into full-length human LamR, either by deletion mutations within the C-terminal domain (CTD) of LamR using inverse polymerase chain reaction (IPCR), or by single-amino acid substitution in the N-terminal domain (NTD) of LamR using site-directed mutagenesis. Protocols for large-scale expression of full-length and truncated LamR proteins in human cells were developed, as well as non-denaturing purification protocols. We hypothesised that bacteria-binding domains could be located on both the NTD and CTD of LamR. In vivo examination using ELISA assays, in which the interaction of LamR and whole bacteria or purified recombinant PorA or PilQ were tested identified several novel sites on LamR that contributed significantly to binding of the bacterial ligands. These sites include amino acids 206-229 and 263-282, located within the CTD, and Tyrosine 156 in the NTD, each of which contributed to the binding of meningococcal PorA, and more specifically it’s fourth extracellular loop. Furthermore, three sites on LamR comprising amino acids 206-229 and 263-282 within the CTD and Tyrosine 139 in the NTD were shown to contribute to binding pneumococcal CbpA, OmpP2 and Loop two of OmpP2 of H. influenzae. These results indicate that the three neuroinvasive bacteria share the same binding sites on LamR. Bimolecular fluorescence complementation (BifC) coupled with flow cytometry and confocal microscopy revealed the vital contribution of amino acid residues Arginine 155, Tyrosine 156 and Lysine 166 (all within the NTD of LamR) for the homodimerization and heterodimerization of LamR with Gal-3. The dimerization of two meningococcal host receptors, LamR and Gal-3, may help to extend spectrum of their bacterial adhesins, which may act cooperatively or synergistically at different stages of infection. Information about the residues in LamR that contribute to the stabilization of LamR dimers has implications for the role of LamR dimers in the pathogenesis of bacterial meningitis. Identification of bacteria-binding domains on LamR is of particular interest for development of vaccines or therapeutic interventions that provide protection against the three major meningitis-causing bacteria. The aim of the current work was first to localise the domains of LamR responsible for binding with PorA and PilQ of N. meningitidis; CbpA and OmpP2 of S. pneumonia, and OmpP2 of H. influenzae. Also, previous studies have shown conspicuous homodimerisation of 37LRP and heterodimerisation with Gal-3. Our second aim was to identify of amino acid residues involved in 37LRP self-association and heterodimer formation with Gal-3. In current work, several regions of LamR were hypothesised to constitute the binding site for the bacterial ligands; these predictions were based on previous studies on LamR binding domains and the crystal structure of laminin receptor. Also, to investigate both homo and heterodimerisation of LamR, the involvement of several putative amino acid residues within 37LRP in LamR dimerisation was was hypothesised.

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Younus, Muhammad. "Risk factors for sporadic non-typhoidal Salmonella infections in Michigan children a population-based case-control study /." Diss., Connect to online resource - MSU authorized users, 2008.

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Júnior, João Marcos Penna. "Perfil epidemiológico dos pacientes incluídos no Sistema de Cadastramento e Acompanhamento de Hipertensos e Diabéticos, no município de Rio Claro, RJ." Universidade do Estado do Rio de Janeiro, 2013. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=6488.

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Introdução. As doenças cardiovasculares constituem a principal causa de morbimortalidade na população brasileira. Desta forma, o Ministério da Saúde apresentou o HiperDia, um sistema de cadastramento e acompanhamento de portadores de HAS e DM atendidos na rede ambulatorial do SUS. Objetivo. Descrever o perfil dos hipertensos e diabéticos cadastrados no sistema HiperDia das oito unidades básicas do município de Rio Claro/RJ, no período de janeiro a dezembro de 2012. Métodos. Os dados de óbitos foram obtidos a partir do Sistema de Informações de Mortalidade (SIM), e as populações estimadas pelo IBGE, foram também obtidas na página do MS. As demais informações foram coletadas por meio de uma planilha de dados agregados, elaborada a partir da própria ficha de cadastramento do HiperDia e distribuído às unidades. Resultados. Pôde-se observar que a grande maioria dos pacientes cadastrados no HiperDia era portadora de hipertensão (95%) e que mais de 1/5 (21%) dos pacientes tinham as duas doenças concomitantemente. Além disso, mais de 4/5 (82%) dos pacientes com DM também apresentou HAS. As mulheres cadastradas foram maioria em ambas as doenças, tendo sido 63,2% e 71%, para HAS e DM, respectivamente. No que diz respeito à idade, ambas as doenças tiveram ocorrência mais elevada em grupos etários mais velhos, embora a prevalência de DM pareça ter se mantido constante para aqueles com 60 anos de idade ou mais. O fator de risco mais relevante para as duas doenças foi o sedentarismo, referido por 76% e 69% daqueles com HAS e DM, respectivamente. Conclusão. Conclui-se sobre a necessidade de modificar a ficha de coleta de dados do HiperDia e de monitoramento mais assíduo dos pacientes. Sugestões de Saúde Pública. Sugere-se inclusão de informações na ficha de coleta de dados do HiperDia sobre os níveis de glicemia e amputação de extremidades dos membros inferiores depois de três anos matriculados no programa, no caso de DM, e informação sobre a manutenção de níveis de pressão arterial sob controle, no caso de HAS, além de informações mais detalhadas sobre os fatores de risco referidos.
Introduction. Cardiovascular disease is the leading cause of morbimortality in the Brazilian population. Recently, the Ministry of Health introduced Hiperdia, a system of registration and monitoring people living with Systemic Hypertension and Diabetes mellitus treated in the out patient facilities of the Public Health System, SUS hereafter. Main Goal. To describe the profile of hypertensive and diabetic patients enrolled in HiperDia treated in one of the eight basic units of the Rio Claro city, during the period between January and December 2012. Methods. The mortality data were obtained from Mortality Information System (SIM), and the population was estimated from the Brazilian Agency for Geography ans Statistics IBGE, both available at Brazilian Health Ministry (MS). Other data were collected from a consolidated data table distributed to all eight basic units and it was based on the registration form of HiperDia. Results. It was observed that the great majority of patients registered in HiperDia were living with hypertension (95%) and more than 1/5 (21%, precisely) had both diseases simultaneously. In addition, for those with Diabetes melittus, more than four fifths (82%) patients also had systemic hypertension. Women are the majority of the cases for both diseases, namely 63.2% for hypertension and 71 % for Diabetes melittus. Considering the age of the patient, both diseases had occurred more frequently among elders, although the prevalence of Diabetes melittus appears to have remained constant for those with 60 yrs and older. The most important risk factor for both diseases was sedentarism, as mentioned by 76 % and 69 % of those with hypertension and Dabetes melittus, respectively. Conclusions. It is needed to modify the form to collect data from HiperDia and also to increase the frequency of the monitoring of patients. Suggestions to Public Health Policies. It is suggested to include in the Hiperdia registration form, information about blood glucose levels and about the amputation of the lower extremities after three years for those enrolled in the program, in the case of Diabete mellitus. For the case of hypertension, information about the maintenance levels of the blood pressure control, and to add more detailed informations about the risk factors.

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Beneke, Jeanine. "Anthropometrical indicators of non-communicable diseases for a black South African population in transition / Jeanine Beneke." Thesis, North-West University, 2009. http://hdl.handle.net/10394/4333.

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Adeloye, Davies Olubunmi. "Estimating the burden of selected non-communicable diseases in Africa : a systematic review of the evidence." Thesis, University of Edinburgh, 2015. http://hdl.handle.net/1842/21090.

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Background The burden of non-communicable diseases (NCDs) is rapidly increasing globally, and particularly in Africa, where the health focus, until recently, has been on infectious diseases. The response to this growing burden of NCDs in Africa has been affected owing to a poor understanding of the burden of NCDs, and the relative lack of data and low level of research on NCDs in the continent. Recent estimates on the burden of NCDs in Africa have been mostly derived from modelling based on data from other countries imputed into African countries, and not usually based on data originating from Africa itself. In instances where few data were available, estimates have been characterized by extrapolation and over-modelling of the scarce data. It is therefore believed that underestimation of NCDs burden in many parts of Africa cannot be unexpected. With a gradual increase in average life expectancy across Africa, the region now experiencing the fastest rate of urbanization globally, and an increase adoption of unhealthy lifestyles, the burden of NCDs is expected to rise. This thesis will, therefore, be focussing on understanding the prevalence, and/or where there are available data, the incidence, of four major NCDs in Africa, which have contributed highly to the burden of NCDs, not only in Africa, but also globally. Methods I conducted a systematic search of the literature on three main databases (Medline, EMBASE and Global Health) for epidemiological studies on NCDs conducted in Africa. I retained and extracted data from original population-based (cohort or cross sectional), and/or health service records (hospital or registry-based studies) on prevalence and/or incidence rates of four major NCDs in Africa. These include: cardiovascular diseases (hypertension and stroke), diabetes, major cancer types (cervical, breast, prostate, ovary, oesophagus, bladder, Kaposi, liver, stomach, colorectal, lung and non-Hodgkin lymphoma), and chronic respiratory diseases (chronic obstructive pulmonary disease (COPD) and asthma). From extracted crude prevalence and incidence rates, a random effect meta-analysis was conducted and reported for each NCD. An epidemiological model was applied on all extracted data points. The fitted curve explaining the largest proportion of variance (best fit) from the model was further applied. The equation generated from the fitted curve was used to determine the prevalence and cases of the specific NCD in Africa at midpoints of the United Nations (UN) population 5-year age-group population estimates for Africa. Results From the literature search, studies on hypertension had the highest publication output at 7680, 92 of which were selected, spreading across 31 African countries. Cancer had 9762 publications and 39 were selected across 20 countries; diabetes had 3701 publications and 48 were selected across 28 countries; stroke had 1227 publications and 19 were selected across 10 countries; asthma had 790 publications and 45 were selected across 24 countries; and COPD had the lowest output with 243 publications and 13 were selected across 8 countries. From studies reporting prevalence rates, hypertension, with a total sample size of 197734, accounted for 130.2 million cases and a prevalence of 25.9% (23.5, 34.0) in Africa in 2010. This is followed by asthma, with a sample size of 187904, accounting for 58.2 million cases and a prevalence of 6.6% (2.4, 7.9); COPD, with a sample size of 24747, accounting for 26.3 million cases and a prevalence of 13.4% (9.4, 22.1); diabetes, with a sample size of 102517, accounting for 24.5 million cases and a prevalence of 4.0% (2.7, 6.4); and stroke, with a sample size of about 6.3 million, accounting for 1.94 million cases and a prevalence of 317.3 per 100000 population (314.0, 748.2). From studies reporting incidence rates, stroke accounted for 496 thousand new cases in Africa in 2010, with a prevalence of 81.3 per 100000 person years (13.2, 94.9). For the 12 cancer types reviewed, a total of 775 thousand new cases were estimated in Africa in 2010 from registry-based data covering a total population of about 33 million. Among women, cervical cancer and breast cancer had 129 thousand and 81 thousand new cases, with incidence rates of 28.2 (22.1, 34.3) and 17.7 (13.0, 22.4) per 100000 person years, respectively. Among men, prostate cancer and Kaposi sarcoma closely follows with 75 thousand and 74 thousand new cases, with incidence rates of 14.5 (10.9, 18.0) and 14.3 (11.9, 16.7) per 100000 person years, respectively. Conclusion This study suggests the prevalence rates of the four major NCDs reviewed (cardiovascular diseases (hypertension and stroke), diabetes, major cancer types, and chronic respiratory diseases (COPD and asthma) in Africa are high relative to global estimates. Due to the lack of data on many NCDs across the continent, there are still doubts on the true prevalence of these diseases relative to the current African population. There is need for improvement in health information system and overall data management, especially at country level in Africa. Governments of African nations, international organizations, experts and other stakeholders need to invest more on NCDs research, particularly mortality, risk factors, and health determinants to have evidenced-based facts on the drivers of this epidemic in the continent, and prompt better, effective and overall public health response to NCDs in Africa.

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Ilchmann, Hanna. "Consequences of early life adverse events on the development of non-communicable diseases in mouse models." Thesis, Toulouse, INPT, 2019. http://www.theses.fr/2019INPT0077.

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Le concept des origines développementales des maladies et de la santé (DOHaD) émet l’hypothèse d’une origine périnatale des maladies non-transmissibles (NCD). Le modèle de stress de séparation maternelle (MS) est largement utilisé chez le rongeur comme un paradigme d’événements adverses en période néonatale. Mon projet de doctorat, avait pour but d’étudier les effets à long-terme du MS sur les fonctions de barrière intestinale, le métabolisme, la réponse immunitaire, l’auto-immunité ainsi que sur le microbiote, chez des souris mâles et femelles sauvages âgées sous régime standard. Le but étant de fournir des données expérimentales soutenant le lien entre stress néonatal et développement de désordres métaboliques ou autoimmuns à l’âge adulte. Premièrement, le MS a induit une intolérance au glucose et une perte de la sensibilité à l’insuline associée à une dysbiose fécale chez des souris sauvages C3H/HeN âgées de 350 jours (PND350). Le MS diminuait les concentrations d’IgG fécales et augmentait les IgG anti-E. coli plasmatiques, représentant la réponse humorale contre le microbiote commensal. Le MS diminuait significativement la sécrétion d’IL-17 et IL-22 en réponse à une stimulation du TcR et augmentait la sécrétion de TNF en réponse à une stimulation LPS dans une culture de cellules de la lamina propria de l’intestin grêle (siLP). Les mêmes résultats ont été obtenus au niveau systémique (rate). Nous avons ainsi démontré pour la première fois que le stress néonatal est un facteur de risque pour le développement des désordres métaboliques chez la souris sauvage âgée sous régime standard. Nous avons écarté un rôle exclusif du microbiote dans l’intolérance au glucose induite par le MS avec des expérimentations de transfert de microbiote fécal. Deuxièmement, chez les femelles PND350 soumises au MS, on observait une augmentation de la sécrétion d’IL-17 et IL-22 en réponse à une stimulation du TcR, et de TNF avec ou sans stimulation au LPS par les cellules de la siLP. Nous observons en plus une inflammation systémique. Les souris MS ont développées une intolérance au glucose associée à une baisse de la sécrétion de l’insuline en réponse à un challenge au glucose. Le ratio de la surface des cellules sur la surface du pancréas était légèrement diminué chez les MS et la valeur de ce ratio corrélait positivement avec la sécrétion d’insuline induite par le glucose. En somme, le MS induit chez les souris femelles des effets à long terme sur l’immuno-métabolisme et l’homéostasie du pancréas. Nous avons comparé les mesures de perméabilité intestinale in vivo (gavage) et ex vivo (chambres de Ussing) avec du FITC-Dextran 4 kDa dans un modèle de diabète de type 1 (NOD - souris non-obese diabetic). De façon inattendue, les résultats diffèraient en fonction des méthodes et cette différence n’était pas due à un défaut de la fonction rénale induite par le diabète. Par contre, nous observions un allongement de l’intestin grêle chez les souris diabétiques qui corrélait positivement avec la perméabilité intestinale in vivo. Le diabète ne modifiait pas le transit intestinal, l’humidité des fèces et l’apparence histologique de l’intestin. En somme, nos résultats soulignent l’importance de distinguer la perméabilité intestinale, exprimée en cm/s, et la notion d’exposition systémique aux antigènes luminaux. Mon travail de thèse montre que les événements adverses néonataux sont un facteur de risque pour les NCD. De façon intéressant, nos observations sur les souris âgées sont similaires aux observations épidémiologiques. En effet, nos résultats préliminaires suggèrent que les souris MS femelles développent des désordres métaboliques avec des caractéristiques auto-immunes; alors que les mâles développent des désordres métaboliques plus classiques : résistance à l’insuline. Mon travail sur le modèle MS souligne l’importance de la vie néo-natale dans l’établissement de l’homéostasie et conforte le concept de DOHaD
The concept of Developmental Origins of Health and Disease (DOHaD) highlights the importance of early life period and raises the hypothesis that Non Communicable Diseases (NCD) could find their origins in perinatal environment. Neonatal maternal separation (MS) is a stress model widely used in rodents as a paradigm of early life adverse events. In my PhD project, I aimed to investigate in aging male and female wild-type mice under normal diet the long-term effects of neonatal MS on intestinal barrier function, metabolism, immunity, auto-immunity, as well as on microbiota. My work aimed to provide experimental data to support a link between early life stress and development of metabolic or autoimmune disorders with aging. In our first study, MS led to glucose intolerance and loss of insulin sensitivity associated with fecal dysbiosis in Post Natal Day (PND) 350 wild-type C3H/HeN male mice fed a standard diet. Fecal IgG concentrations were decreased in MS mice compared to control mice, whereas anti-E. coli IgG, representing humoral response toward commensal microbiota, were significantly increased in plasma of MS mice. MS significantly decreased IL-17 and IL-22 secretion in response to TcR stimulation in small intestine lamina propria (siLP) culture. Besides, TNF secretion in response to LPS-stimulation was slightly increased. The same results were obtained at systemic level (spleen). For the first time, we demonstrated that early life stress alone is a risk factor for metabolic disorders development in aging wild type mice under normal diet. The result of this project gave us the opportunity to question the role of microbiota in MS-induced glucose intolerance. Fecal microbiota transfer of MS mice microbiota was not sufficient to induce glucose intolerance. In our second study in PND350 female, MS increased IL-17 and IL-22 by siLP cells in response to TcR stimulation. TNF secretion with and without LPS stimulation was also increased by MS. Additionally, we observed systemic low-grade inflammation. MS mice developed glucose intolerance associated with decreased insulin secretion in response to glucose stimulus. Ratio of -cell surface to pancreas surface was slightly decreased in MS mice compared to control. This ratio positively correlated with insulin secretion induced by glucose. Taken together, the results of our study showed that MS in wild type female mice under normal diet leaves a long-lasting imprinting on immune-metabolism and pancreas homeostasis. We compared in vivo and ex vivo intestinal permeability measurements in a model of type 1 diabetes (NOD – non-obese diabetic mice). Intestinal permeability was assessed in vivo by gavage and ex vivo in Ussing chambers with the marker FITC-Dextran 4 kDa. Surprisingly, the results of both methods were divergent. The difference between in vivo and ex vivo measurements could not be explained by altered renal excretion. Curiously, diabetic NOD mice had significantly longer small intestine than non-diabetic NOD mice and small intestine length positively correlated with intestinal permeability in vivo. However, there were no difference in intestinal transit time, feces humidity and histological appearance. Altogether, our results highlighted the importance to distinguish intestinal permeability, which is expressed as cm/s, and the notion of systemic exposition to luminal antigen. My PhD project shows that early life adverse events are a risk factor for NCD. Interestingly, our observations in aging mice are similar to epidemiological observations. Indeed, preliminary results suggested that female MS mice develop metabolic disorders with autoimmune characteristics but male MS mice develop classical metabolic disorders with insulin resistance. My work in MS model highlights the importance of early life in the establishment of homeostasis and comforts the concept of DOHaD

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Mostert, Karien. "The prevalence of certain risk factors of non-communicable diseases in a rural community : a physiotherapeutic perspective /." Access to E-Thesis, 2001. http://upetd.up.ac.za/thesis/available/etd-08152005-122415/.

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Mbangani, Roselyn. "Exploring the knowledge, attitudes, perceptions and practices of teachers around obesity and nutrition related non-communicable diseases." University of the Western Cape, 2018. http://hdl.handle.net/11394/6905.

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Magister Scientiae (Nutrition Management) - MSc(NM)
Introduction: Non-communicable diseases (NCDs) are among the leading causes of premature death in South Africa. As is the case with many countries in transition, in South Africa the burden of pre-NCDs such as overweight and obesity is increasing. The aim of this mixed method study was to gain an understanding on the knowledge, attitudes, practices and perceptions and related factors of primary and secondary school teachers in Limpopo Province of South Africa regarding nutrition related non-communicable diseases (NR-NCDs). Methodology: A mixed method approach, parallel convergent study design was used to collect both qualitative and quantitative data from a group of randomly selected public school teachers in Rakwadu Circuit, Limpopo, with due consideration of the ethical issues involved. For the quantitative inquiry, a previously validated structured questionnaire was adapted to collect data from 114 teachers, while 2 Focus Group Discussions (FGDs) were conducted by the researcher to collect the qualitative data. Information collected included teachers‟ dietary practices, physical activity levels and their knowledge, attitudes and perceptions towards nutrition related non-communicable diseases. Each of these variables had a number of questions which were scored and a mean score for each participant was obtained. Anthropometric measurements collected included Body Mass Index (BMI) and waist circumference (WC).

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Kruger, Clarissa. "Non-tuberculous mycobacteria in tuberculosis epidemic settings in South Africa." Thesis, Cape Peninsula University of Technology, 2007. http://hdl.handle.net/20.500.11838/1489.

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Thesis (MTech (Biomedical Technology))--Cape Peninsula University of Technology, 2007. .
Non-tuberculous mycobacteria (NTM) are often isolated from Human Immunodeficiency Virus (HIV) infected individuals, but there is very little information documented about the prevalence of NTM in community settings. An increase in NTM infection is also noted in HIV-negative people. Although it is as yet unknown whether the organisms cause desease in HIV-negative individuals or whether they are merely commensal organisms, their affect on HIV-positive individuals is unquestionable.

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Manuga, Tshilidzi. "The relationship between food environment, obesity and NCD status among adults aged 30-70 years in Langa and Mount Frere, South Africa." University of Western Cape, 2019. http://hdl.handle.net/11394/7637.

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Master of Public Health - MPH
Non-Communicable Diseases (NCDs) are some of the leading causes of death worldwide. Obesity results from the interactions between biology, behaviour, and environment. The current obesity epidemic is largely driven by environmental rather than biological factors, through its influence on social norms regarding food choices and lifestyle behaviours. The number of people dying from diabetes and hypertension keeps increasing because of the current obesity trend.

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Kapapa, Musambo Mutinta. "Health promotion for non-communicable diseases: Perceptions of physiotherapy and general practitioners in the southern province of Zambia." University of the Western Cape, 2018. http://hdl.handle.net/11394/6575.

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Magister Scientiae (Physiotherapy) - MSc(Physio)
The increasing spread of non-communicable diseases (NCDs), especially in the lowand middle-income countries calls for a more holistic and cost-effective measure to reduce its impact on society. One of the methods advocated for achieving this is health promotion. The Zambian government has called for a shift from curative to preventive management of diseases, including NCDs. Therefore, health professionals are being called upon to redirect their health care management approaches towards preventative care, incorporating health promotion. The study aimed at examining the knowledge, attitudes, practices and perceptions of physiotherapy practitioners and general medical practitioners in Zambia regarding their role in health promotion for NCDs in the hospitals of the Southern Province, Zambia. A sequential explanatory mixed method approach was employed. The quantitative results revealed 98% knowledge of general medical practitioners compared to the 90.6% of the physiotherapists. For attitude, physiotherapists possessed a more positive attitude with 86% while general medical practitioners possessed 80%. Lastly, the study revealed that physiotherapists practise health promotion more than the general medical practitioners, with a 96.2% and 67.7% respectively. The logistic regression showed no significance between the knowledge and attitude scores of the two groups of health practitioners. However, the practice scores revealed that physiotherapists are four times more like to incorporate health promotion compared to the general medical doctors. Both types of health practitioners were of the view that health promotion is the way forward towards the fight against NCDs. However, a number of challenges were echoed that prevent the implementation of a holistic approach management in their practice. Most of the challenges prevalent in these hospitals are policy-based, hence the need for policy makers to intervene for the fight against NCDs.

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Mfolozi, Odwa. "Non-communicable diseases and economic outcomes in South Africa: a cohort study for the period of 2008-2018." Master's thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31679.

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Background: The total number of people living with non-communicable diseases in South Africa currently is unknown even though non-communicable diseases (NCDs) was accountable for 60% of the top ten causes of death in South Africa for the year 2015. In 2016, according to Stats SA, noncommunicable diseases were accountable for 57.4% of all deaths in South Africa. In 2011 they were accountable for 23% of years of life lost and 33% of disability adjusted life years. Government total expenditure is also unknown but it is estimated at more than one billion rands per annum for low to middle income countries such as South Africa. NCDs negatively impact the labour market by decreasing labour productivity, increasing employee turnover and early retraction from the labour market. This further decreases individual and household income especially for the urban poor who carry the heaviest non-communicable disease burden in South Africa and contributes to the medical poverty trap as well as, worsening income inequality in South Africa. Objective: This dissertation investigates the association between non-communicable diseases and labour market participation (LFP) and the effect it has on household income (HHI). Methods: Using the longitudinal data from the National Income Dynamics Study (NIDS) with information on labour force participation, household income and diseases such as high blood pressure, diabetes, cancer, chronic lung disease, heart problems, stroke, arthritis; were used for analysis. The analysis used the 2008 (wave1), 2012 (wave 3) and 2016 (wave 5) data sets from the NIDS. The analysis is restricted to the population aged 18 years to 65years. The Study examines these associations using logistic and linear regression models for NCDs exposed households and non NCDs exposed households, comparing the two for differences and the effect observed on labour force participation and household Income. The control variables include location, age, race, gender, marital status and level of education. The NCDs are treated as exposure variables with labour Force Participation (LFP) and House Hold Income (HHI) being outcome variables. The study is guided by a conceptual framework that views the household as a unitary function. Lastly, the Policy Brief summarises the issues at hand, the findings and concludes with policy recommendations. Results: LFP: Based on the regression results, as a group NCDs show a negative relationship with labour force participation as a non-significant decrease but individually it depends on the type of NCD an individual is exposed to. Cancer, stroke and heart attacks are negatively associated with labour force participation. Asthma, diabetes and hypertension are positively associated with labour force participation. When an individual suffers from one NCD the relationship/association depends on the type of NCD, If and when an individual is burdened by a second or third NCD (Co-morbidities) the relationship with LFP tends to be positive (an increase in LFP). HHI: Counterintuitively as a group NCDs is associated positively with household income; a significant increase of 15% at 5 % level of significance. However, individually, hypertension, cancer, asthma, heart problems and stroke have a negative relationship (a decrease) with household income except Diabetes. Objectively there is insufficient evidence to conclude that NCDs decrease household income via decreasing labour force participation indirectly contributing to poverty in South Africa, as majority of household income comes from wages and remittances. Individually almost all NCDs (with Cancer and Hypertension having significant results) decrease household income but as a group increase household income. This requires further investigation into the NCD burdened household dynamics in South Africa. Conclusion: Therefore, as recommended by the WHO; individual specific interventions will be more effective than population-based interventions to alleviate the ripple effects of the non-communicable disease burden in low to middle income countries (LMIC). Universal Health Care and up scaled prioritisation at Primary Health Care level is needed as NCDs accounted for half the global burden of disease but only received 2% of international donations compared to human immune-deficiency virus (HIV/AIDS) that accounted for 4% of the global burden of disease receiving 29% of international donations and grants.

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Leung, Lai-king. "Are health-education programmes effective in improving knowledge of and compliance with non-pharmacological measures against mosquito-borne disease?" Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40721073.

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Sumilo, Dana. "Biological and non-biological factors in the spatio-temporal changes of tick-borne encephalitis (TBE) in the Baltic States." Thesis, University of Oxford, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.670189.

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Kien, Vu Duy. "Inequalities in non-communicable diseases in urban Hanoi, Vietnam : health care utilization, expenditure and responsiveness of commune health stations." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-126045.

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Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality among adults in Vietnam. Little is known about the magnitude of socioeconomic inequalities in NCDs and other NCD-related factors in urban areas, in particular among the poor living in slum areas. Understanding these disparities are essential in contributing to the knowledge, needed to reduce inequalities and close the related health gaps burdening the disadvantaged populations in urban areas. Objective: To examine the burden and health system responsiveness to NCDs in Hanoi, Vietnam and investigate the role of socioeconomic inequalities in their prevalence, subsequent healthcare utilization and related impoverishment due to health expenditures. Methods: A cross-sectional study was conducted among 3,736 individuals aged 15 years and over who lived in 1211 randomly selected households in 2013 in urban Hanoi, Vietnam. The study collected information on household’s characteristics, household expenditures, and household member information. A qualitative approach was implemented to explore the responsiveness of commune health stations to the increasing burden of NCDs in urban Hanoi. In-depth interview approach was conducted among health staff involved in NCD tasks at four commune health stations in urban Hanoi. Furthermore, NCD managers at relevance district, provincial and national levels were interviewed. Results: The prevalence of self-reported NCDs was significantly higher among individuals in non-slum areas (11.6%) than those in slum areas (7.9%). However, the prevalence of self-reported NCDs concentrated among the poor in both slum and non-slum areas. In slum areas, the poor needed more health care services, but the rich consumed more health care services. Among households with at least one household member reporting diagnosis of NCDs, the proportion of household facing catastrophic health expenditure and impoverishment were the greater in slum areas than in non-slum areas. Poor households in slum areas were more likely to face catastrophic health expenditure and impoverishment. The poor in non-slum areas were also more likely to face impoverishment if their household members experienced NCDs. Health system responses to NCDs at commune health stations in urban Hanoi were weak, characterized by the lack of health information, inadequate human resources, poor financing, inadequate quality and quantity of services, lack of essential medicines. The commune health stations were not prepared to respond to the rising prevalence of NCDs in urban Hanoi. Conclusion: This thesis shows the existence of socioeconomic inequalities in the prevalence of self-reported NCDs in both non-slum and slum areas in urban Hanoi. NCDs associated with the inequalities in health care utilization, catastrophic health expenditure and impoverishment, particular in slum areas. Appropriate interventions should focus more on specific population groups to reduce the socioeconomic inequalities in the NCD prevalence and health care utilization related to NCDs to prevent catastrophic health expenditure and impoverishment among the households of NCD patients. The functions of commune health stations in the urban setting should be strengthened through the development of NCDs service packages covered by the health insurance.

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Torres, Nuno. "Disorders of emotional containment and their somatic correlates : the protomental nature of addictions, self-harm and non-communicable diseases." Thesis, University of Essex, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.486197.

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This study is concerned with the emotional nature of determined forms of illness which seem to be largely determined by stressful social conditions rather than as a consequence of primarily biologic and somatic factors, and have been identified with labels such as 'diseases of comfort', 'lifestyle related diseases', 'degenerative causes of death'. The models we have for understanding the mechanisms by which human subjects are affected by social environment stresses are still tentative, although some of the diversity of the psychosocial factors is reasonab1y well established. This thesis is an exploration of the theories of Wilfred Bion, which offer an under-researched approach to the nature and origin of such conditions. I have chosen three of these conditions as the subject of this study -drug and alcohol dependence, self-harming behaviours and a certain set of psychosomatic conditions - to test whether predictions formulated from the hypotheses are supported by a set of empirical measures. The hypotheses are that a determined type of emotional containment mechanism can affect certain types of health outcomes via disturbing the natural expression of primitive emotional systems embedded in the human organism. These primitive emotional systems are known as basic assumptions or valencies and are of 3 main types: dependence, fight-flight and pairing

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Dissertations / Theses on the topic 'Chronic Non Communicable Diseases'

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