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Non-communicable diseases

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…

Richard Smith: Three myths blocking progress against NCD

16 Jul, 14 | by BMJ

richard_smith2The church at the House of St Barnabas was standing room only to hear Professor Robert Lustig, a paediatric endocrinologist from San Francisco, castigate our current attempts to counter the global pandemic of NCD. (I judge that we’ve reached the stage where NCD, like AIDS, no longer needs to be spelt out.)

Lustig, who has a YouTube video that has been viewed 4.9 million times and who has been interviewed by The BMJ, is clearly somebody who loves his high profile and his capacity to bewitch an audience. Although I’d heard a professor I admire dismiss him as “wholly wrong,” he didn’t encounter much dissent at the meeting organised by C3 Collaborating for Health. He spoke without notes and a PowerPoint presentation, the modern way.

Lustig built his talk around the three myths that he thinks are blocking progress on reducing the burden of NCD. For 30 years, he said, we’ve been concentrating on reducing total calories and fat but made little or no progress. Thinking has been based on bad science. more…

Richard Smith: Rebranding and telling stories about NCD

3 Jun, 14 | by BMJ

richard_smith2I was delighted to be asked to organise this series of events on non-communicable diseases, but I had a problem—I had no idea what NCDs are or were. So Kate Hoyland from UCL’s Grand Challenge of Global Health introduced an evening entitled “The NCD Makeover Show.”

We who live in the NCD ghetto don’t know how to get our message across. The person in the street has never heard of NCD and so will not demand global action or change their own lives. We can’t even agree on our name. We don’t like being defined by what we are not so we don’t like “non-communicable disease”; and we’ve abandoned the term chronic disease. So we’ve homed in on the acronym of NCD—but sometimes it’s NCDs and sometimes NCD.

So how can we do better? “Recognise,” said Fred Hersch from NCDFree, “that the solutions lie outside traditional thinking.” Thus we heard about branding and storytelling. more…

K M Venkat Narayan: Global non-communicable diseases—the second in a series of reflections

2 Jun, 14 | by BMJ

On 30 April 2014, I wrote my first reflection on the topic of non-communicable diseases to whet your appetite, and promised seven more. My first reflection, if you recall, was: “Keep the growth of NCDs in perspective by acknowledging the incredible positive changes in life expectancy and economic wellbeing the world over—thanks to development and mechanization.” Here is the second:

Acknowledge the increasing convergence of health and economic challenges worldwide

The traditional view in international health has generally been that the health priorities for developed and developing countries are different. For example, when people think of developing countries, they often think of diseases of poverty: undernutrition, infectious diseases, and maternal and child health. This agenda is still unfinished, but as data from the massive Global Burden of Disease project are beginning to show, the world is making huge progress in reducing infant and maternal deaths, and deaths from major infectious diseases. In fact, the top three leading causes of death worldwide in 2010 were all chronic non-communicable diseases: ischemic heart disease, stroke, and chronic obstructive pulmonary disease. Furthermore, diabetes has jumped from number 15 in 1990 to number nine in 2010 as a cause of death. To put this in context: cardiovascular disease is now the leading cause of death even in rural Bangladesh. more…

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