Noncommunicable diseases (NCDs) are the most prominent cause of adult mortality, killing 38 million people each year and on the rise[1]. Cancer, heart disease, diabetes and chronic respiratory diseases are responsible for 82% of NCD-related illness and death. These four diseases, along with mental illness, are estimated to cost the developing world $21 trillion over the next two decades.[2] Given the substantial health and economic detriments of NCDs, policy makers, government officials, and enterprises around the globe have begun to focus efforts on better understanding and preventing the proliferation of these diseases. Lifestyle factors, including increased inactivity, poor diet, and alcohol and tobacco consumption are currently the most commonly attributed risk factors of NCDs. With the influx of epidemiological literature linking meat consumption to western disease prevalence, and the World Health Organization (WHO) releasing a statement this year classifying processed meat as a Group 1 carcinogen alongside cigarette smoking, this thesis seeks to understand more thoroughly the role of diet, specifically meat consumption, in the incidence of cancer, heart disease and diabetes around the world. This paper analyzes previous epidemiological studies on dietary consumption and disease incidence as well as conducts an empirical analysis of data from the WHO and the Food and Agriculture Organization of the United Nations (FAO) to understand the relationship between meat consumption and disease prominence. This paper is the first of its kind to compare country-level data on dietary and lifestyle factors with respective disease incidence and mortality rates in order to observe the impact of country consumption trends on health outcomes. The results of this analysis may provide insight into global economic, health policy and individual-level consumption recommendations in order to mitigate the occurrence of ill-health.

京都大学 / 新制・課程博士 / 博士(地域研究) / 甲第24017号 / 地博第296号 / 新制||地||114(附属図書館) / 京都大学大学院アジア・アフリカ地域研究研究科東南アジア地域研究専攻 / (主査)教授 古澤 拓郎, 准教授 坂本 龍太, 教授 竹田 晋也 / 学位規則第4条第1項該当 / Doctor of Area Studies / Kyoto University / DGAM

Yes / Economic, physical, built, cultural, learning, social and service environments have a profound effect on lifelong health. However, policy thinking about health research is dominated by the 'biomedical model' which promotes medicalisation and an emphasis on diagnosis and treatment at the expense of prevention. Prevention research has tended to focus on 'downstream' interventions that rely on individual behaviour change, frequently increasing inequalities. Preventive strategies often focus on isolated leverage points and are scattered across different settings. This paper describes a major new prevention research programme that aims to create City Collaboratory testbeds to support the identification, implementation and evaluation of upstream interventions within a whole system city setting. Prevention of physical and mental ill-health will come from the cumulative effect of multiple system-wide interventions. Rather than scatter these interventions across many settings and evaluate single outcomes, we will test their collective impact across multiple outcomes with the goal of achieving a tipping point for better health. Our focus is on early life (ActEarly) in recognition of childhood and adolescence being such critical periods for influencing lifelong health and wellbeing. / UK Prevention Research Partnership (MR/S037527/1), which is funded by the British Heart Foundation, Cancer Research UK, Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Health and Social Care Research and Development Division (Welsh Government), Medical Research Council, National Institute for Health Research, Natural Environment Research Council, Public Health Agency (Northern Ireland), The Health Foundation and Wellcome.

O processo de envelhecimento traz consigo diversas modificação no âmbito pessoal e biológico do indivíduo. Expandindo-se essas transformações, para o âmbito populacional, na questão da saúde, delimita-se um crescente prevalências das denominadas doenças crônicas não transmissíveis. Nesta lógica, um maior número de moléstias crônicas, leva os indivíduos a ingerirem uma maior quantidade de fármacos, sejam eles prescritos por via clínica ou mesmo pela própria automedicação. Em vista disso, o presente trabalho objetivou realizar um levantamento epidemiológico para se traçar o perfil de saúde dos idosos de uma cidade do interior paulista, enfocando-se a presença de doenças crônicas não transmissíveis, medicamentos utilizados, a presença de polifarmácia e a qualidade de vida. A amostra foi composta por 241 idosos residentes da cidade de Duartina, SP. Primeiramente realizou-se um questionário geral para se determinar a presença de doenças e caracterização geral da amostra. Após, os idosos passaram pelo questionário de qualidade de vida e por um questionário sobre os medicamentos utilizados. A partir dos dados deste último, através do site drugs.com determinou-se a presença e os níveis de polifarmácia. Nos resultados, pode-se observar uma considerável prevalência de diabetes, dislipidemias e hipertensão, sendo as idosas as mais afetadas. Quanto ao uso dos fármacos, 22,7% utilizam, ao menos, cinco medicamentos distintos ao dia. Na análise da polifarmácia, 30% não apresentaram interações, 68% apresentaram nível moderado e 2% elevado. Através da correlação de Pearson, identificou-se que com o aumento do número de medicamentos utilizados, houve aumento do nível da intensidade da polifarmácia (p < 0,0001 e r = 0,81). Quanto à qualidade de vida, todos as áreas apresentaram índices relativamente altos, sendo o domínio físico com a melhor média e o ambiental com pior. Na análise por questão, os piores índices ficaram com dor, dependência de medicamentos e sentimentos negativos. Com a Correlação de Spearman, determinou-se que o aumento dos índices de polifarmácia diminuem a qualidade vida (p = 0,03 e r = -0,57). Deste modo, conclui-se que, nos idosos, há uma elevada prevalência de hipertensão, diabetes e das dislipidemias, bem como um considerável uso de diferentes medicamentos diariamente. Anexo a estes dados, a qualidade de vida apresentou índices adequados, sendo afetada negativamente pelo aumento do uso diários de medicamentos. / The process of aging brings with it several modifications in the personal and biological scope of the individual. Expanding these transformations, for the population, in the health issue, delimits a growing prevalence of so-called chronic non-communicable diseases. In this logic, a greater number of chronic diseases, leads individuals to ingest a greater amount of drugs, whether they are prescribed clinically or even by self-medication. In view of this, the present study aimed to carry out an epidemiological survey to trace the health profile of the elderly in a city in the interior of the state of São Paulo, focusing on the presence of chronic noncommunicable diseases, medications used, the presence of polypharmacy and the quality of life. The sample consisted of 241 elderly residents of the city of Duartina, SP. Firstly, a general questionnaire was carried out to determine the presence of diseases and the general characterization of the sample. Afterwards, the elderly passed the quality of life questionnaire and a questionnaire about the medications used. From the data of the latter, through the website drugs.com was determined the presence and levels of polypharmacy. In the results, a considerable prevalence of diabetes, dyslipidemia and hypertension can be observed, with the elderly being the most affected. As for drug use, 22.7% use at least five different drugs a day. In the analysis of polypharmacy, 30% did not present interactions, 68% presented moderate level and 2% elevated. Through the Pearson correlation, it was identified that with the increase in the number of medications used, there was an increase in the level of polypharmacy intensity (p <0.0001 and r = 0.81). As for the quality of life, all the areas presented relatively high indexes, being the physical domain with the best average and the environmental one with worse. In the analysis by question, the worst indexes were pain, drug dependence and negative feelings. With Spearman\'s correlation, it was determined that the increase in polypharmacy indexes decreased the quality of life (p = 0.03 and r = -0.57). Thus, it is concluded that in the elderly, there is a high prevalence of hypertension, diabetes and dyslipidemias, as well as a considerable use of different drugs daily. Annexed to these data, the quality of life presented adequate indexes, being negatively affected by the increase in the daily use of medicines.

If there is one thing that policy makers at the World Health Organisation (WHO) and residents of the South African township of Langa are likely to agree on, it is that ‘just sitting’ is not good for you. The positions from which they approach this conclusion however differ profoundly. This research investigates different conceptualisations of physical activity, health, and wellbeing, and the implications of these differences for policy on the prevention of noncommunicable diseases (NCDs) in low and middle income countries, taking South Africa as a case study. With four out of five deaths from diseases such as diabetes, heart disease and stroke now occurring in low and middle income countries, prevention, of what have been termed ‘NCDs’, in these countries is rising rapidly up the global public health agenda. Physical activity is one of the four primary risk factors which have been identified as intervention targets, but there is an acknowledged paucity of research which helps us to understand how physical activity, and inactivity, are conceptualised in low and middle income country contexts. As a result the evidence base for design of physical activity policy interventions to address NCDs is also weak. The global discourse recognises the determinants of health as socially embedded, but struggles with what this means for policy on prevention. This study explores the detail of this social embeddedness by way of ethnographic research into wellbeing, health and physical activity carried out in a South African township, and juxtaposes this with conceptualisation of these same themes emerging from a review of academic and policy-oriented literature on the prevention of NCDs in low and middle income countries. The struggles of local research groups to reconcile the demands made on them from these very different worlds are explored, and strategies for addressing the specifics of NCD prevention without abstracting health from the broader context of the person or society are discussed. The research is theoretically informed by work on wellbeing in developing countries.

ĮVADAS: Užsienio šalyse atliktos mokslinės studijos parodė, kad miesto parkai bei kita rekreacinė aplinka yra susijusi su įvairaus amžiaus gyventojų fiziniu aktyvumu. Palanki sveikatai ir saugi miesto aplinka gali būti pritaikyta gyventojų sveikatinimui, fiziniam aktyvumui ir rekreacijai. DARBO TIKSLAS: Įvertinti sergamumo ir fizinio aktyvumo paplitimą tarp Kauno miesto gyventojų, pagrindžiant miesto rekreacinių vietų svarbą gyventojų sveikatos stiprinimui. UŽDAVINIAI: 1. Įvertinti Kauno miesto gyventojų fizinio aktyvumo lygį bei su gyvensenos veiksniais susijusių lėtinių ligų paplitimą. 2. Įvertinti oro užterštumą ir triukšmo sklaidą Kauno miesto rekreacinėse vietose. 3. ��vertinti Kauno miesto rekreacinių vietų aplinkos kokybės tinkamumą gyventojų fiziniam aktyvumui skatinti. TYRIMO METODIKA: Kauno miesto gyventojų sergamumui kraujotakos sistemos, onkologinėmis ligomis bei II tipo cukriniu diabetu įvertinti naudojama oficialių statistinių duomenų analizė. Fizinio aktyvumo paplitimui įvertinti tarp įvairaus amžiaus miesto gyventojų naudojama vykdytų tyrimų ir programų duomenų analizė. Azoto dioksido sklaida miesto parkuose vertinama panaudojant taršos modeliavimo programą AIRVIRO, triukšmo sklaida parkų teritorijoje įvertinama pagal miesto triukšmo žemėlapį. REZULTATAI: Duomenų analizė parodė, kad per paskutiniuosius penkerius metus Kauno miesto gyventojų sergamumas kraujotakos sistemos ligomis išaugo 36 proc., sergamumas onkologinėmis ligomis – nuo 12,3 proc. tarp moterų... [toliau žr. visą tekstą] / BACKGROUND: A number of studies have showed that parks provided places for people to experience nature, engage physical activity and relax. Recreation and open spaces are one of the most important urban forms related to residents’ physical activity. Safe and health related environment of the parks may help increase physical activity among residents of all ages. AIM OF THE STUDY: To assess the prevalence of cardiovascular diseases, cancer accidents and diabetes type II among residents of Kaunas city and to substantiate the importance of public parks to promote physical activity there. OBJECTIVES: 1. To assess the level of physical activity and prevalence of noncommunicable diseases among residents of Kaunas city. 2. To assess air pollution and noise in the environment of city public parks. 3. To assess the environmental quality in city recreational places that can be used to promote physical activity and improve public health. METHODS: Statistical data and literature review was undertaken to assess the level of physical activity and prevalence of noncommunicable diseases among residents of Kaunas city. The dispersion of nitrogen dioxide in the area of public parks was measured using AIRVIRO model. The dispersion of noise was identified using Kaunas MapNoise. RESULTS: The data analyze shows that prevalence of cardiovascular diseases among Kaunas city residents has increased by 36 % since 2001 to 2005. The prevalence of cancer during the same period has increased by 12,3 % among... [to full text]

Darbo tikslas. Įvertinti švietimo sistemos pagrindinių žmogiškųjų išteklių būklę Lietuvos regionuose. Darbo uždaviniai. 1. Ištirti bendrojo ugdymo mokyklų mokytojų demografinės situacijos netolygumus atskiruose Lietuvos regionuose. 2. Įvertinti mokytojų rizikos profilį susirgti lėtinėmis ligomis ir jį palyginti tarp mokytojų dirbančių didmiesčiuose ir miestuose. 3. Palyginti didmiesčių ir miestų bendrojo ugdymo mokyklose dirbančių mokytojų požiūrį į sveikatos priežiūrą ir sveikatos stiprinimą. Tyrimo metodika. Tyrimas buvo vykdomas dviem etapais. 1. Oficialių statistinių duomenų, gautų iš Švietimo ir mokslo ministerijos apie mokytojus, dirbusius bendrojo lavinimo Lietuvos mokyklose 2010 - 2011 m.m. analizė pagal amžių ir lytį penkiuose Lietuvos regionuose. 2. Vienmomentinis keturiose atsitiktinai atrinktose mokyklose (po vieną iš dviejų Lietuvos regionų didmiesčių ir regione esančių miestų) dirbančių mokytojų sveikatos tyrimas. Tyrimas vyko 2011 m. gruodžio – 2012 m. kovo mėnesiais. Tyrimo metu atlikta mokytojų apklausa (dalyvavo 202 mokytojai, tyrimo atsakas - 90,9 proc.) ir objektyvus jų sveikatos patikrinimas, siekiant išaiškinti lėtinių ligų rizikos veiksnių dažnius (dalyvavo 166 mokytojai, tyrimo atsakas - 74.8proc.). Duomenų analizė atlikta duomenų kaupimo ir analizės (IBM SPSS Statistics 20.0 ) programų paketu. Rezultatai: Lietuvoje dažniausiai mokytojais dirba moterys (87 proc.). Vyrų dalis didžiausiuose miestuose nežymiai mažiesnė lyginant su regionais... [toliau žr. visą tekstą] / The goal. To evaluate the status of main human resources. of educational system in different regions of Lithuania. The objectives. 1. To investigate the inequities of the demographic situation of teachers from general education schools in separate regions of Lithuania. 2. To assess the teachers’ NCD risk profile and to compare it between teachers working in cities and towns. 3. To compare the teachers’ attitudes towards health care and health promotion working in cities and regional towns. The methodology. The research was carried out in two phases: 1. The analysis of official statistical data obtained from Ministry of Education and Science according to the age and sex in five regions of Lithuania. 2. Cross-sectional health survey of teachers working in four randomly selected schools (one school from city and one from regional town in two regions of Lithuania). The survey was carried out from December, 2011 untill March 2012. The survey consisted of questionaire survey (202 teachers participated, the response rate – 90,9 %) and health check-up including NCD risk factors detection ( 166 techers participated, the response rate – 74,8%). For data analysis was used the data collection and analysis software package (IBM SPSS Statistics 20.0). Results: Most teachers are woman (83 %) in Lithuania. The proportion of men teachers in cities is smaller than in regional towns. One third of Lithuanian teachers are middle age. In cities more than in regions are working old age or... [to full text]

O processo de envelhecimento traz consigo diversas modificação no âmbito pessoal e biológico do indivíduo. Expandindo-se essas transformações, para o âmbito populacional, na questão da saúde, delimita-se um crescente prevalências das denominadas doenças crônicas não transmissíveis. Nesta lógica, um maior número de moléstias crônicas, leva os indivíduos a ingerirem uma maior quantidade de fármacos, sejam eles prescritos por via clínica ou mesmo pela própria automedicação. Em vista disso, o presente trabalho objetivou realizar um levantamento epidemiológico para se traçar o perfil de saúde dos idosos de uma cidade do interior paulista, enfocando-se a presença de doenças crônicas não transmissíveis, medicamentos utilizados, a presença de polifarmácia e a qualidade de vida. A amostra foi composta por 241 idosos residentes da cidade de Duartina, SP. Primeiramente realizou-se um questionário geral para se determinar a presença de doenças e caracterização geral da amostra. Após, os idosos passaram pelo questionário de qualidade de vida e por um questionário sobre os medicamentos utilizados. A partir dos dados deste último, através do site drugs.com determinou-se a presença e os níveis de polifarmácia. Nos resultados, pode-se observar uma considerável prevalência de diabetes, dislipidemias e hipertensão, sendo as idosas as mais afetadas. Quanto ao uso dos fármacos, 22,7% utilizam, ao menos, cinco medicamentos distintos ao dia. Na análise da polifarmácia, 30% não apresentaram interações, 68% apresentaram nível moderado e 2% elevado. Através da correlação de Pearson, identificou-se que com o aumento do número de medicamentos utilizados, houve aumento do nível da intensidade da polifarmácia (p < 0,0001 e r = 0,81). Quanto à qualidade de vida, todos as áreas apresentaram índices relativamente altos, sendo o domínio físico com a melhor média e o ambiental com pior. Na análise por questão, os piores índices ficaram com dor, dependência de medicamentos e sentimentos negativos. Com a Correlação de Spearman, determinou-se que o aumento dos índices de polifarmácia diminuem a qualidade vida (p = 0,03 e r = -0,57). Deste modo, conclui-se que, nos idosos, há uma elevada prevalência de hipertensão, diabetes e das dislipidemias, bem como um considerável uso de diferentes medicamentos diariamente. Anexo a estes dados, a qualidade de vida apresentou índices adequados, sendo afetada negativamente pelo aumento do uso diários de medicamentos. / The process of aging brings with it several modifications in the personal and biological scope of the individual. Expanding these transformations, for the population, in the health issue, delimits a growing prevalence of so-called chronic non-communicable diseases. In this logic, a greater number of chronic diseases, leads individuals to ingest a greater amount of drugs, whether they are prescribed clinically or even by self-medication. In view of this, the present study aimed to carry out an epidemiological survey to trace the health profile of the elderly in a city in the interior of the state of São Paulo, focusing on the presence of chronic noncommunicable diseases, medications used, the presence of polypharmacy and the quality of life. The sample consisted of 241 elderly residents of the city of Duartina, SP. Firstly, a general questionnaire was carried out to determine the presence of diseases and the general characterization of the sample. Afterwards, the elderly passed the quality of life questionnaire and a questionnaire about the medications used. From the data of the latter, through the website drugs.com was determined the presence and levels of polypharmacy. In the results, a considerable prevalence of diabetes, dyslipidemia and hypertension can be observed, with the elderly being the most affected. As for drug use, 22.7% use at least five different drugs a day. In the analysis of polypharmacy, 30% did not present interactions, 68% presented moderate level and 2% elevated. Through the Pearson correlation, it was identified that with the increase in the number of medications used, there was an increase in the level of polypharmacy intensity (p <0.0001 and r = 0.81). As for the quality of life, all the areas presented relatively high indexes, being the physical domain with the best average and the environmental one with worse. In the analysis by question, the worst indexes were pain, drug dependence and negative feelings. With Spearman\'s correlation, it was determined that the increase in polypharmacy indexes decreased the quality of life (p = 0.03 and r = -0.57). Thus, it is concluded that in the elderly, there is a high prevalence of hypertension, diabetes and dyslipidemias, as well as a considerable use of different drugs daily. Annexed to these data, the quality of life presented adequate indexes, being negatively affected by the increase in the daily use of medicines.

Noncommunicable disease are the leading cause of death and disability in the majority of theworld, and particularly for Sweden. Modifiable lifestyle behaviors such as smoking, alcohol consumption, unhealthy diets and lack of physical activity are main contributors and risk factors to acquiring these diseases. Despite the evidence linking these risk factors to the diseases, thehealthcare sector has often fallen short in implementing preventive strategies due to severalbarriers and factors within this setting. ICT in the health sector, known as eHealth, cancontribute greatly to relieve the burden in the health systems in implementing new prevention strategies, however eHealth has its own set of barriers hindering implementation that delayadoption of such interventions. In the context of Sweden, emphasis has been made to incorporate increase eHealth initiative to reach their Vision 2025. To investigate how implementing eHealth strategies have been experienced in Sweden, this research has conducted a case study on a specific intervention implemented in the Southern Region of Skåne that incorporated an eHealth tool to aid in the intervention called “health discussions with 40-yearolds” aimed to address the NCD burden. A qualitative case study methodology was taken to investigate how was implementing a new eHealth tool within a prevention and screening of NCDs intervention in the healthcare setting experienced by the project implementation team during its pilot phase. Key challenges and factors for implementing the eHealth tool were extracted from the four interviews and reportcollected on the case to increase understanding of how the implementation was experienced by the program implementors. By focusing on the organizational level of the implementation only, the results from this study aimed to provide insights to key aspects in implementing new eHealth tools within interventions in the healthcare settings with similar organizational structures. Results from the qualitative thematic analysis led to a series of categories subcategories and themes to describe the experiences from the interviewees. The theme to describe the overall experiences was labeled positive but demanding, while the theme for challenges was labeled dintricacies of the health system structure, and the theme for factors was eHealth contingent on the human-social interaction. Core components were summarized for future eHealth implementation implications in this setting and/or similar settings. Challenges faced in this case reflect similar challenges in implementing eHealth in Sweden due to the complex fragmented health system structure. Business modeling and agile project management approaches may aid future health organizational settings eHealth implementation process. Future research isrequired to provide clear frameworks that can be applied in more local fragmented healthsystems

In the last two decades, global action to address noncommunicable diseases (NCDs) has accelerated, but policy adoption and implementation at the national level has been inadequate. This analysis examines the role of rationalities of governing, or governmentality, in national-level adoption of global recommendations. Critical discourse analysis was conducted using 49 formal institutional and organizational documents obtained through snowball sampling methodology. Text were coded using a framework of five forms of governmentality and analyzed to describe the order of discourse which has emerged within the global NCD policy domain. The dominant political rationality used to frame NCDs is rooted in risk governmentality. Recommendations for tobacco control and prevention of harmful alcohol use rely on a governmentality of police mixed with discipline. The promotion of physical activity relies heavily on disciplinary governmentality, and the prevention of unhealthy diet mixed disciplinary measures, discipline, and neoliberal governmentalities. To translate global NCD prevention and control strategies to national action, acceptability for the political rationalities embodied in policy options must be nurtured as new norms, procedures, and institutions appropriate to the political rationalities of specific interventions are developed.