The epidemiological transition and its interpretations

A critical analysis of A. Omran's theory of epidemiological transition (ET) and its various interpretations. The periodization of ET proposed by Omran is questioned, and the differentiation of the two "epidemiological revolutions" by M. Terris is compared with it. The great world historical significance of ET as a trigger and an integral part of the demographic transition as a whole is noted, and disagreement with the interpretation of ET as an integral part of the “sanitary transition” is substantiated. The concept of the "cardiovascular revolution" is contested. A method of graphical representation of ET is proposed and criteria for its completion are discussed. Grounds are given for disagreement with ideas about the "first", Neolithic, and coming "third" ET, as well as about a "reverse" ET. The problems of “catching-up” ET in developing countries are considered.

Pharmaceutical policies for diseases related to poverty in Brazil: a review

The "epidemiological transition" has fostered increasing attention to chronic and non-communicable diseases, but neglected diseases are still present and their relationship with the population's socioeconomic inequalities is increasingly evident, so much so that there has been a conceptual conversion to call them “poverty-related diseases”. It is a necessary to review and to discuss the characteristics and challenges of Brazilian pharmaceutical policies for populations affected by diseases related to poverty. This review of the literature was carried out, with works of the last 10 years dealing with the theme and the Brazilian reality. Out of the 272 identified articles, only 43 publications were included in this study. The results were: (i) the difficulties of investing in the research, development and production of new drugs for these diseases; (ii) the characteristics of access policies to medicines already available, their advances and limitations; (iii) and issues related to the right to comprehensive pharmaceutical assistance. Therefore, for the available therapies, national production and federal funding contributed to guarantee the supply. Assisted qualification actions are necessary and little discussed in area studies.

Analyzing the Magnitude of Global Epidemiological Transition in Sub-Saharan Africa: A Need to Review the Current Healthcare Management Approach

Since after World War II, the world has been grappling with the grumbling rising prevalence and economic burden of non-communicable diseases (NCDs). The rise of these chronic diseases has reached an epidemic proportion and a melting point in many communities of the world. This has been made worse by the recent COVID-19 pandemic. While the world is still battling this debilitating reality, a more gruesome scenario is evolving in low-income and Middle-Income Countries (LMICs). Although these countries account for the highest poverty index in the world, they also account for a disproportionately higher burden of NCDs. More than 80% of NCD-related deaths are presently recorded among the LMICs. Ironically, although most sub-Saharan Africa (SSA) countries can be categorized as LMICs, yet communicable diseases (CDs) still constitute the highest disease burden in this region. However, based on global projections, SSA may soon lose this ‘advantage’ and may become the region with the highest burden of NCDs by the year 2030. If the present trajectory is left unshattered, the resulting heavy double burden of CDs and NCDs will likely crumble the already fragile economy of most SSA countries and tilt the region into an unprecedented recession. A critical review of the present disease-centered healthcare management approach and adoption of a more evidence-based health promotion-centered management approach may be vital in salvaging the situation. This article briefly reviewed the global epidemiologic transition, compared the disease- and health promotion-centered healthcare models, and made a case for a change in health management strategy in SSA. Keywords: Disease-centered approach, Epidemiological transition, Health promotion-centered approach, lifestyle modification, Non-communicable Diseases Risk factors, sub-Saharan Africa.

1167Disease Burden and Universal Health Coverage Monitoring

Background Achieving universal health coverage (UHC) is a target of the Sustainable Development Goals, and the monitoring of its progress is of use to clarify what to be enhanced for better health. While the WHO and the World Bank Group jointly developed a scale with the above purpose (WHO/WB index: Hogan et al., 2018), it fails to reflect the fact that different needs to health coverages may exist depending on a stage of epidemiological transition. Methods To consider potential differences in health coverage needs depending on the stage of the epidemiological transition, we reformulated the index by incorporating weight as the proportion of age-adjusted mortality rate among monitored domains (i.e. reproductive, maternal, new-born and child health, infectious disease, non-communicable diseases [NCD]), of which data collected from the WHO Global Health Observatory. Additionally, we utilised indicators of policy achievements on NCD by the WHO’s Noncommunicable Diseases Progress Monitor 2015. Results The UHC progress monitored by the WHO/WB index had a mean of 61.83 (%) while it declined by about 4% point on average when NCD indicators were replaced. Furthermore, the UHC progresses evaluated with weights calculated from disease burden decreased by about 10% point for both measures, suggesting that some countries may not provide demanded health coverages. Conclusion The UHC progress decreased when disease burden for each country was taken into consideration. This indicates the necessity to assess the UHC progressby reflecting disease structure of each country, not by an identical scale for all nations. Key messages The monitoring of universal health coverage is required to reflect disease structure of each country.

EFFECT OF EECP (ENHANCED EXTERNAL COUNTER PULSATION) ON LEFT VENTRICULAR FUNCTION AS MEASURED BY ECHOCARDIOGRAPHY USING STRAIN.

India stands as one of the fastest developing countries in the world. It has entered quickly into an epidemiological transition leading to a 1 phenomenal increase in non-communicable diseases . Of them leading the way is coronary artery disease. 0 It has been estimated that 4 lakh 2 deaths a year are attributable to cardiovascular disease. The most common symptom in CAD is angina pectoris. The treatment for angina includes medical therapy and coronary revascularization by PTCA or CABG. However, a large number of these patients are not suitable to the usual procedures due to unfavorable coronary anatomy, repeated revascularization attempts, elderly age group, associated comorbidities and patient's preference.

The epidemiological transition

The epidemiological transition was thought to be a unidirectional process, beginning when infectious diseases were predominant and ending when noncommunicable diseases dominated the causes of death. It is now evident that this transition is more complex and dynamic where health and disease evolve in diverse ways. It is rather a continuous transformation process with some diseases disappearing and others re-emerging. This paper addresses the mechanisms involved and the indicators that demonstrate the changing patterns of diseases

The rise and fall of diseases: reflections on the history of population health in Europe since ca. 1700

This essay explores the amazing phenomenon that in Europe since ca. 1700 most diseases have shown a pattern of 'rise-and-fall'. It argues that the rise of so many diseases indicates that their ultimate cause is not to be sought within the body, but in the interaction between humans and their environment. In their tireless pursuit of a better life, Europeans have constantly engaged in new activities which exposed them to new health risks, at a pace that evolution could not keep up with. Fortunately, most diseases have also declined again, mainly as a result of human interventions, in the form of public health interventions or improvements in medical care. The virtually continuous succession of diseases starting to fall in the 18th, 19th and 20th centuries suggests that the concept of an “epidemiological transition” has limited usefulness.

Epidemiological transition to mortality and refracture following an initial fracture

This study sought to redefine the concept of fracture risk that includes refracture and mortality, and to transform the risk into "skeletal age". We analysed data obtained from 3521 women and men aged 60 years and older, whose fracture incidence, mortality, and bone mineral density (BMD) have been monitored since 1989. During the 20-year follow-up period, among 632 women and 184 men with a first incident fracture, the risk of sustaining a second fracture was higher in women (36%) than in men (22%), but mortality risk was higher in men (41%) than in women (25%). The increased risk of mortality was not only present with an initial fracture, but was accelerated with refractures. Key predictors of post-fracture mortality were male gender (hazard ratio [HR] 2.4; 95% CI, 1.79–3.21), advancing age (HR 1.67; 1.53–1.83), and lower femoral neck BMD (HR 1.16; 1.01–1.33). A 70-year-old man with a fracture is predicted to have a skeletal age of 75. These results were incorporated into a prediction model to aid patient-doctor discussion about fracture vulnerability and treatment decisions.