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Non-communicable diseases

Anand Bhopal: Alcohol in society—the search for nuance in a fractious debate

5 Nov, 14 | by BMJ

anand_bhopalAlcohol is a historical part of British culture, and pubs remain central to communities across the country. Yet the same liquor is also responsible for filling A&E departments; absorbing police time; and adversely affecting millions through dependency, addiction, social problems, and disease. Too much of the current discourse on alcohol policy overlooks this spectrum and continues to draw on the simplistic narrative of “moderation” versus “excess,” which poorly delineates the variety of drinkers and their motives for doing so. This is a complex problem; it is not simply a question of how much are we drinking, but where, why, and when? more…

Sally Norton: Weight loss—help us to help ourselves

23 Oct, 14 | by BMJ

sally_nortonIf I hear one more time that keeping your weight down is all about personal responsibility—”just eat less and exercise more”—I will take a double chocolate, banana, and salted caramel, extra large, two for the price of one muffin and ram it into the mouth from whence this smug platitude came.

Of course weight control is about personal responsibility, but with two thirds of the English population classed as overweight, most of us are clearly unable to do the necessary on our own. So, do we just carry on, failing to manage our weight ourselves, or do we ask for help? more…

Wilm Quentin: NCDs and the private sector—part of the problem or part of the solution?

21 Oct, 14 | by BMJ

Wilm_QuentinOne of the last sessions of the European Health Forum Gastein aimed to find answers to the question of how to engage the private sector in the prevention and control of non-communicable diseases (NCDs).

Gauden Galea, director of the Division of NCDs and Life-Course at the World Health Organization’s Regional Office for Europe, and organiser and moderator of the session, asked: “What are the first steps that we can take to activate the private sector in collaboration for NCD prevention and control?” more…

Ahmed Rashid: Junk food history taking

16 Oct, 14 | by BMJ

ahmed_rashid“Listen to the patient and they will tell you the diagnosis.”

Widely attributed to Sir William Osler, this quote is often shared with new medical students, and I often find myself repeating it to the undergraduate clinical students I currently supervise. Regardless of the specialty area or examination skills we cover, clinical history taking remains a recurring topic in our tutorials. more…

Richard Smith: Improving health through the community in Tunisia

3 Oct, 14 | by BMJ

richard_smith_2014Tunisia, like all low and middle income countries, is having to respond to non-communicable disease after making good progress in reducing infectious disease and improving child and maternal health. Premature deaths from cardiovascular disease increased there by 35% between 1990 and 2010; they increased by 112% in Egypt and by 61% in Saudi Arabia—but fell by 21% in the United States. How best Tunisia might respond was discussed recently at a meeting in Sousse, organised by the Department of Epidemiology, University Hospital Farhat Hached.

Tunisia doesn’t have to start with a blank sheet. High income countries have already experienced the transition from infectious to non-communicable disease, and the aspiration is that countries like Tunisia can learn from the successes of high income countries without having to repeat their mistakes. more…

Richard Smith: Is global health too medicalised?

16 Sep, 14 | by BMJ

richard_smith_2014When I teach young doctors in Amsterdam about responding to NCD (non-communicable disease) in low and middle income countries, I ask them how they would allocate 100 units of resource. I give them four buckets.

One bucket is for treating people with established disease: patients with heart attacks, strokes, cancer, and chronic obstructive pulmonary disease. The second bucket is for treating metabolic risk factors, such as hypertension, hyperlipidemia, and raised blood glucose. The third bucket is for acting on the four risk factors—tobacco use, poor diet, physical inactivity, and the harmful use of alcohol—recognising that many of the interventions will be political, actions like raising the price of tobacco. The fourth bucket is for working on social determinants, such as poverty, housing, globalisation, and urbanisation. I ask the doctors not only how they will distribute their resources, but what they will do with the resources. more…

Anneli Hujala: Multimorbidity challenges care professionals to cross boundaries

4 Aug, 14 | by BMJ

PrintThe ICARE4EU project wants to improve the care of people who are suffering from multiple chronic conditions. It will describe, analyse, and identify innovative integrated care models for people with multimorbidity in 31 European countries, and aims to contribute to the more effective implementation of such models. During the project (which runs from 2013 to mid 2016), members of the ICARE4EU consortium will keep readers of The BMJ informed about project developments. Previous project blogs can be found here.

To improve the care of people with multiple chronic diseases, professionals will have to take a new direction. From the patient’s perspective, the current fragmented care systems often look like a labyrinth, in which patients wander along many criss crossing paths to find the services they need. Integration that emphasizes interdisciplinary and multi-professional collaboration will hold a key position in the development of care practices that can meet the needs of multimorbid patients. more…

Dinesh C Sharma: India’s heart disease problem—connecting the dots

1 Aug, 14 | by BMJ

dinesh sharmaAs a science and health journalist, I have written a number of stories highlighting how lifestyle ailments, like diabetes and heart disease, have emerged as major health issue in India—including in rural areas. Scientists and doctors are pretty much unanimous on what we need to do to prevent the rising tide of cardiovascular diseases: eat healthy food (fruits and vegetables), cut down on unhealthy diets, exercise, avoid alcohol and tobacco, and so on.

Although slow to act, India’s policy makers are also responding by creating new facilities for diagnosis, treatment, and even screening. Is this enough to deal with the situation though? Is the advice to “eat healthy and exercise” enough to motivate people to modify their lifestyles? Is it a good strategy to let people fall sick, and go on building hospitals to treat them? more…

Lavanya Malhotra: Tackling obesity with gold

24 Jul, 14 | by BMJ

Lavanya MalhotraThe Dubai municipality has come up with a novel way to promote a balanced diet and exercise in the city: slim down, and the reward will be worth your weight in gold. Or rather, you will receive 1 g of gold for every kg shed. Earlier this week it was estimated that more than 15 000 people had signed up, with the final numbers expected to be more since registration closed yesterday. Already this is more than the 9666 people who took part in a similar scheme last year.

An initiative like this is especially important in Dubai. The United Arab Emirates (UAE) has been ranked as the fifth most obese nation in the world, according to a 2012 report published in the BMC Public Health journal. More than 66% of men and 60% of women in the UAE are overweight or obese, according to the Lancet‘s Global Burden of Disease Study 2013. more…

Bijal Chheda-Varma: Bariatric surgery is unsustainable

22 Jul, 14 | by BMJ

Bijal Chheda-Varma2Obesity is widely recognised as one of the greatest health threats of the 21st century across the developed world, with about a third of the global population now obese or overweight.

While the evidence of the problem is undisputed, there is little agreement as to how to solve it. Many solutions are being brandished about in terms of both prevention and cure; in the UK, for example, a sugar tax has been suggested, and NICE has issued its headline grabbing draft recommendations that patients with a BMI of 30 or more should be given bariatric surgery. From my experience of treating overweight and obese patients, it seems clear that, as standalone solutions, these are not sustainable as they do not address the root causes of obesity. more…

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