Louise Hayes

Noncommunicable diseases in sub-Saharan Africa: where do they feature in the health research agenda?

There is no doubt that communicable diseases will remain the predominant health problem for the populations in sub-Saharan Africa, including adults, for the next 10-20 years. Concern has been expressed that the available resources to deal with this problem would be reduced by increasing the emphasis on noncommunicable diseases. The latter, however, already present a substantial burden because their overall age-specific rates are currently higher in adults in sub-Saharan Africa than in populations in Established Market Economies. There is also evidence that the prevalence of certain noncommunicable diseases, such as diabetes and hypertension, is increasing rapidly, particularly in the urban areas, and that significant demands are being made on the health services by patients with these diseases. To ignore the noncommunicable diseases would inevitably lead to an increase in their burden; the provision of health services for them would be largely undirected by issues of clinical and cost effectiveness, and their treatment and prevention would be left to the mercy of local and global commercial interests. Improved surveillance of all diseases within sub-Saharan Africa is needed in order to place noncommunicable diseases properly within the context of the overall burden of disease. Research is needed to guide improvements in the clinical and cost effectiveness of resources currently committed to the care of patients with noncommunicable diseases, and to direct and evaluate preventive measures.

Challenges to Health Care for Diabetes in Africa

The aim of this review is to summarize the contextual, clinical and health system challenges to the delivery of health care for diabetes in Africa. Planners need to allocate sufficient resources in a context where resources for health in general are insufficient. Choices need to be made between different options for health care within this context and mechanisms are required to facilitate the implementation of the selected options and ensure that quality of care is maintained.

Preventing type 2 diabetes after gestational diabetes: women's experiences and implications for diabetes prevention interventions.

To explore factors influencing post‐natal health behaviours following the experience of gestational diabetes, and to elicit womens views about the feasibility of lifestyle intervention to prevent diabetes during the first 2 years after childbirth.

Psychosocial intervention for carers of people with dementia: What components are most effective and when? A systematic review of systematic reviews

BACKGROUND Psychosocial interventions for carers of people with dementia are increasingly recognized as playing an important role in dementia care. We aim to systematically review the evidence from existing systematic reviews of psychosocial interventions for informal carers of people with dementia. METHODS Thirty-one systematic reviews were identified; following quality appraisal, data from 13 reviews, rated as high or moderate quality, were extracted. RESULTS Well-designed, clearly structured multi-component interventions can help maintain the psychological health of carers of people with dementia and delay institutionalization of the latter. To be most effective, such interventions should include both an educational and a therapeutic component; delivery through a support group format may further enhance their effectiveness. CONCLUSIONS Successful translation of evidence into practice in this area remains a challenge. Future research should focus on determining the most cost-effective means of delivering effective multi-component interventions in real-world settings; the cost-effective potential of technology-based interventions is considerable.

Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy

Objectives:Randomised controlled trials are required to address causality in the reported associations between maternal influences and offspring adiposity. The aim of this study was to determine whether an antenatal lifestyle intervention, associated with improvements in maternal diet and reduced gestational weight gain (GWG) in obese pregnant women leads to a reduction in infant adiposity and sustained improvements in maternal lifestyle behaviours at 6 months postpartum.Subjects and methods:We conducted a planned postnatal follow-up of a randomised controlled trial (UK Pregnancies Better Eating and Activity Trial (UPBEAT)) of a complex behavioural intervention targeting maternal diet (glycaemic load (GL) and saturated fat intake) and physical activity in 1555 obese pregnant women. The main outcome measure was infant adiposity, assessed by subscapular and triceps skinfold thicknesses. Maternal diet and physical activity, indices of the familial lifestyle environment, were assessed by questionnaire.Results:A total of 698 (45.9%) infants (342 intervention and 356 standard antenatal care) were followed up at a mean age of 5.92 months. There was no difference in triceps skinfold thickness z-scores between the intervention vs standard care arms (difference −0.14 s.d., 95% confidence interval −0.38 to 0.10, P=0.246), but subscapular skinfold thickness z-score was 0.26 s.d. (−0.49 to −0.02; P=0.03) lower in the intervention arm. Maternal dietary GL (−35.34; −48.0 to −22.67; P<0.001) and saturated fat intake (−1.93% energy; −2.64 to −1.22; P<0.001) were reduced in the intervention arm at 6 months postpartum. Causal mediation analysis suggested that lower infant subscapular skinfold thickness was partially mediated by changes in antenatal maternal diet and GWG rather than postnatal diet.Conclusions:This study provides evidence from follow-up of a randomised controlled trial that a maternal behavioural intervention in obese pregnant women has the potential to reduce infant adiposity and to produce a sustained improvement in maternal diet at 6 months postpartum.

Lifecourse predictors of normal metabolic parameters in overweight and obese adults

Objective:Not all overweight and obese individuals appear to be at equal risk of developing metabolic abnormalities. We sought to examine the effect of factors from different stages of life on risk of metabolic abnormalities at age 50 years in overweight and obese adults.Design and subjects:Longitudinal study of all persons born in Newcastle upon Tyne, UK in May and June 1947 and followed to age 50 years when a clinical examination took place and a detailed questionnaire on health and lifestyle was completed. Participants in this study (n=223) were those defined as being overweight or obese with a body mass index (BMI) greater than or equal to 25 at age 50 years. Subjects were defined as ‘metabolically normal’ if they had normal lipids, glucose and blood pressure.Results:Lower BMI was the strongest predictor of remaining metabolically normal in both men and women. After adjusting for BMI, lower levels of cigarette smoking and higher levels of physical activity were independently associated with being metabolically normal in men. No other factors were independently associated with being metabolically normal in women. A stronger inverse relationship between BMI and metabolic status was found in men (Odds ratio (OR) per unit increase in BMI=0.65, 95% confidence intervals (95% CI) 0.52–0.81) than in women (OR=0.90, 95% CI 0.82–0.99). No association was seen for factors operating in fetal, infant and childhood life.Conclusions:Adult factors made a greater contribution to remaining metabolically normal than birth or childhood factors in this sample of overweight and obese adults. A lower adult BMI appeared to reduce the risk in men and women and lower cigarette smoking and higher level of physical activity also independently reduced the risk in men. Public health policy to reduce the burden of morbidity associated with obesity should continue to encourage weight loss, physical activity and smoking cessation.

Prevalence of wheeze and self-reported asthma and asthma care in an urban and rural area of Tanzania and Cameroon.

We investigated the prevalence of wheeze, self-reported asthma, and asthma care via four cross-sectional surveys among adults and children (5-15 years) in urban and rural populations from Tanzania and Cameroon. Age-standardized prevalence of current wheeze (in the previous year) was 2.2% to 5.0% in adults and 1.9% to 5.2% in children in Tanzania, and 1.3% to 2.5% (adults) and 0.8% to 5.4% (children) in Cameroon. There were no consistent patterns of urban:rural prevalence. Peak flow rates varied with age, peaking at 25-34 years, and were higher in urban areas (age adjusted difference 22-70 L/min) and in the Tanzania populations. Awareness (83%–86% versus 52%–58%) and treatment (43%–71% versus 30%–44%) of asthma was higher among those with current wheeze in rural areas. Use of inhaled drugs, particularly steroids, was rare. Diagnosis by traditional healers (15%) and use of traditional remedies (62% of those recalling any treatment) were common only among self-reported asthmatic patients in rural Cameroon. Asthma is an important clinical condition in sub-Saharan Africa. There were major gaps in clinical care, particularly in urban areas. Sustainable methods for delivering accessible and effective asthma care in sub-Saharan Africa are required.

Diabetes in care homes: current care standards and residents' experience.

Diabet. Med. 29, 132–135 (2012)

Undiagnosed diabetes in the over-60s: performance of the Association of Public Health Observatories (APHO) Diabetes Prevalence Model in a general practice

Diabet. Med. 29, 115–120 (2012)

Universal screening to identify gestational diabetes: A multi-centre study in the North of England

We conducted an audit of treatment and outcomes in 116 women with gestational diabetes. These women received intense monitoring and high levels of medical and obstetric intervention. 24% would not have been identified by risk factor based screening. Cost effective strategies to identify all women with gestational diabetes are needed.