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The purpose of this article is to clarify the social burden of Japan’s three major diseases including Long-term Care (LTC) burden.

A modification of the Cost of Illness (COI)—the Comprehensive-COI (C-COI) was utilized to estimate three major diseases: cancer, heart disease, and cerebrovascular diseases (CVD). The C-COI consists of five parts: medical direct cost, morbidity cost, mortality cost, formal LTC cost and informal LTC cost. The latter was calculated by two approaches: opportunity cost approach (OC) and replacement approach (RA), which assumed that informal caregivers were substituted by paid caregivers.

The C-COI of cancer, heart disease and CVD in 2017 amounted to 10.5 trillion JPY, 5.2 trillion JPY, and 6.7 trillion JPY, respectively (110 JPY= 1 US$). The mortality cost was preponderant for cancer (61 percent) and heart disease (47.9 percent); while the informal LTC cost was preponderant for CVD (27.5 percent). The informal LTC cost of the CVD in OC amounted to 1.8 trillion JPY; while the RA amounted to 3.0 trillion JPY.

The LTC burden accounted for a significant proportion of the social burden of chronic diseases. The informal care was maintained by unsustainable structures such as the elderly providing care for the elderly. This result can affect health policy decisions.

The C-COI is more appropriate for estimating the social burden of chronic diseases including the LTC burden and can be calculated using governmental statistics.

This study aimed to determine mothers' knowledge of children with congenital heart disease (CHD) and to examine the relationship between types of CHD, the duration of treatments, the perception of the severity of illness and the mothers' knowledge.

A correlation study was conducted among 84 mothers of children (from infancy to six years old) with CHD who had attended pediatric cardiology clinics and pediatric units in three tertiary hospitals in Bangkok, Thailand. The two questionnaires aimed to evaluate the mothers' knowledge and perceptions of the severity of illness. Descriptive statistics, Spearman's rank-order correlation and Fisher's exact test were used to analyze the data.

Knowledge levels of mothers of children with CHD were at a high level with a mean score of 34.79 (SD = 8.23), but the knowledge domain of preventing complications was at a low level with a mean score of 14.95 (SD = 5.28). The types of CHD and the perceptions of illness were not correlated with the mothers' knowledge, but the duration of treatments was significantly correlated (r = 0.271, p < 0.05).

Healthcare professionals, especially nurses, should emphasize proper health education on complication prevention and the duration of treatments for children. Moreover, mothers should be supported to nurture children with CHD to reduce possible complications and prepare for cardiac surgery where needed.

The objective of this study was to examine the causal relationships among sex, social support, disease severity, symptoms, physical activity, general health perception and health-related quality of life (HRQOL) in Thai adolescents with congenital heart disease (CHD).

A cross-sectional study was conducted using convenience sampling to recruit 200 Thai adolescents with CHD aged between 13 and18 years from four tertiary university hospitals in Bangkok. Interview method and self-administered questionnaires were used for data collection held between November 2018 and February 2019. Data were analyzed using path analysis to test the hypothesized model of the relationships.

The causal model of HRQOL revealed a good fit with the data. This model of relationship could explain 48% of the variances in HRQOL. Only direct effects of disease severity, symptoms and social support on HRQOL were found while indirect effects were not.

Due to the lack of study focusing on factors influencing HRQOL in Thai adolescents with CHD, this empirical study provides the evidence in Thai literature. The modifiable influencing factors for HRQOL found in this study can be manipulated through psycho-educational intervention given to the adolescents and significant others, especially parents, to help increase quality of life in adolescents with CHD.

The purpose of this study is to identify best practices for innovative primary care models and to describe a potential future primary care (PC) model for Texas to address the burden of chronic disease in a population-based approach.

A systematic literature review was conducted and identified 1,880 published records through PubMed using 26 search terms. After abstract and full-text review, 70 articles remained as potential models.

Although there is already a severe shortage of physicians in Texas, emerging practice patterns and choices among physicians are likely to erode access to primary care services in the state. Health-care leaders are encouraged to consider models such as complex adaptive systems for team-based care, pharmacist hypertension care management program and combined nurse-led care management with group visit structure.

As with any study, this research has its limitations; for example, models that might work in one state, or under a unique state-funded academic medical center, might not be “do-able” in another state within the nuances of a different funding mechanism.

Results of this research provide a model for implementing IPCM for the state of Texas first and will guide IPCM planning and implementation in other states.

This study is “land grant-centric” and focused on carrying out the mission of a major, top-tier research university with an emerging college of medicine at an academic medical center.

The substantial increase in non-communicable diseases (NCDs) is considered a major threat to developing countries. According to various international organizations and researchers, Kerala is reputed to have the best health system in India. However, many economists and health-care experts have discussed the risks embedded in the asymmetrical developmental pattern of the state, considering its high health-care and human development index and low economic growth. This study, a scoping review, aims to explore four major health economic issues related to the Kerala health system.

A systematic review of the literature was performed using PRISMA to facilitate selection, sampling and analysis. Qualitative data were collected for thematic content analysis.

Chronic diseases in a significant proportion of the population, low compliance with emergency medical systems, high health-care costs and poor health insurance coverage were observed in the Kerala community.

The present study was undertaken to determine the scope for future research on Kerala's health system. Based on the study findings, a structured health economic survey is being conducted and is scheduled to be completed by 2021. In addition, the scope for future research on Kerala's health system includes: (1) research on pathways to address root causes of NCDs in the state, (2) determine socio-economic and health system factors that shape health-seeking behavior of the Kerala community, (3) evaluation of regional differences in health system performance within the state, (4) causes of high out-of-pocket expenditure within the state.

Given the internationally recognized standard of Kerala's vital statistics and health system, this review paper highlights some of the challenges encountered to elicit future research that contributes to the continuous development of health systems in Kerala.

The purpose of this research aimed to identify the risk factors for non-communicable diseases (NCDs) and determine their prevalence and characteristics in a semi-urban community in Thailand.

The survey was designed to determine the type and prevalence of risk factors for NCDs among populations in semi-urban areas in the Takianleurn subdistrict of Nakhonsawan, Thailand. A stratified random sampling design was used to select 352 subjects, aged over 15 years and living in this region. Data were collected by questionnaire and analyzed to show frequency, percentage, mean, standard deviation, chi-squared, prevalence rate and prevalence rate ratio with significance indicated by p-value < 0.05 and confidence interval 95 percent.

The implications for the future study are as follows: (1) a comparative study between rural and urban or rural and semi-urban or urban and semi-urban should be studied to understand how risk factors cause NCDs and (2) Participatory action research should be introduced to assess the effectiveness of the decrease in NCDs risk factors management in the community.

(1) To scale up public health interventions measures to promote and prevent NCDs should be focused on behavioral risk factors of NCDs such as eating habits, physical activity, smoking and alcohol consumption. (2) Health promotion and disease prevention for decrease in NCDs should consist of reducing alcohol consumption and enhancing healthy eating habits and (3) To manage unmodified risk factors such as age, gender, educational level, etc. should be focused on surveillance and physical health examination yearly.

The results revealed a prevalence of NCDs of 14.8 percent. The main unmodifiable risk factors affecting NCD prevalence were gender, age, low level of education and poverty; behavioral risk factors included not eating enough fruit and vegetables, high alcohol consumption, a high-fat fast-food diet and smoking.

The prevention of NCDs requires more focus on changing the eating behavior of high-risk groups and providing easily accessible health care information and services. The entire family should be involved in the process of maintaining good health and disease prevention for all family members.

The purpose of this study was to define and outline areas prone to disease causing elements by analyzing the spatial distribution and concentration of toxic and essential elements in a section of the Voltaian sedimentary basin.

A total of 2,668 soil samples were analysed by the inductively coupled plasma mass spectrometry technique and were re-appraised by comparing with baseline values of elements accepted globally to be in soils. The concentrations of arsenic (As), chromium (Cr), iron (Fe) and magnesium (Mg) were evaluated. Factor analysis, hierarchical cluster analysis and principal component analysis multivariate techniques were used to identify the source patterns of the elements in the soils. The Getis-Ord Gi method was used to generate the optimised maps for these selected elements. These maps spatially defined and outlined high value clusters which imply potential pollution or areas with high background values (hotspots), whereas the low value clusters imply areas with low background values (cold-spots).

The multivariate analysis supports a dominant geogenic source of these heavy elements with obvious influences from variably metamorphosed mafic–ultramafic rocks known to have contributed to the deposition of sediments in the basin. The hotspots for As were located around Nalerigu and to the east of Nawchugu. A Cr hotspot was located to the east of Nawchugu with Cr cold-spots located within Nalerigu and Yunyuo. Fe hotspots were observed to the south of Nalerigu and the east of Nawchugu with Fe cold-spots around Yunyuo, Bongo-Da and Nagbo. The spatial maps demonstrated the presence of toxic and deficient areas of all the selected elements used in the investigation. Therefore, it suggested the likely health implications depending on the exposed elements, their pathways and recommended the usefulness of using the results displayed in the spatial maps to guide in devising appropriate remediation techniques.

This paper fulfils an identified need to study the distribution of elements and the possible effects it may have on the health and livelihoods of those residing in these areas.

This paper aims to review the known and anticipated medical geology problems in Ghana, to highlight the impact of some trace elements on human health and to reveal some essential aspects of medical geology on health.

Literature and empirical studies relating to medical geological issues in Ghana were reviewed. Secondary data were used in the present study such as case studies, reports, geological bulletins and published research studies.

High levels of heavy metals including arsenic, cadmium and mercury in gold extraction processes through artisanal small-scale mining have contributed to high concentrations of toxic elements in the environment. The distribution and availability of these elements in the environment are facilitated by the geological, chemical and local environmental activities that are irregularly spread exposing people mining areas to pollutions. Exposures to these elements in above and below baseline levels contributed to health implications including fluorosis, intellectual or developmental disability and death in some regions of Ghana. Cardiovascular and cerebrovascular diseases linked to mining activities were also presented in this study. Similarly, non-communicable diseases can affect many people if correct measures are not considered. Following the geometric increase in mining activities, it is anticipated that deleterious environmental and health impacts associated with mining may persist in mining areas in Ghana. Reported implications and continuous contamination of water bodies in mining areas could result in high pollution levels beyond treatment for human use or destroy aquatic habitats and aquatic lives through acid drainage. Above-threshold concentrations of heavy metals in soils could bio-accumulate in crops, and this could pose deleterious public health implications on consumers. Continuous effects posed on the environment and public health may prompt communities, regulatory institutions and government to reduce or ban mineral development.

This review has significantly revealed potential public health issues from the impact on the natural environment and recommends that medical geologists work together with medical workers to devise preventive and therapeutic techniques to address many geology-related-health issues in Ghana.

Blood lipid and lipoprotein abnormalities are common among patients with diabetes. The study aimed to assess dietary fat intake and its association with blood lipids among patients with Type 2 diabetes mellitus (T2DM) considering sex differences.

A cross-sectional observational study was conducted with patients (207 males and 197 females) with T2DM. The daily food intake and its contents of fat and fat types were assessed through face-to-face interview. Anthropometric measurements, glycated hemoglobin (HbA1c), triglyceride, total cholesterol (TC), high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol were initially recorded.

The results revealed that TC, LDL and HDL cholesterol levels were significantly higher in females than in males. However, the TC: HDL ratio was significantly higher in males than in females. The results also showed that the daily intake of saturated fatty acid (SFA) slightly exceeded the daily recommended allowance. However, the monounsaturated fatty acid + polyunsaturated fatty acid/SFA (MUFA + PUFA/SFA) ratio was within the recommended ratio. In addition, this study found that the main sources of SFA and cholesterol intake were milk and milk products. A significant association between high fat intake and HbA1c levels was observed (r = 0.234, p < 0.001).

As it is a cross-sectional observational study, this study has the natural limitation where it can only demonstrate an association.

The types of dietary fat intake may contribute to blood lipid abnormalities and differences effects may exist among male and female. Studies on the effect of daily fat intake and its types on blood lipids in patients with diabetes, in particular Saudi patients with diabetes are limited. This study focused on the amount and type of the consumed fat among male and female Saudi patients with T2DM and studied the relationship between the type of consumed fat and blood lipid profiles.

This systematic review examined the emerging threat of indoor and outdoor pollutants to public health in Latin America and the Caribbean (LAC).

Pollutants and pollution levels are becoming an increasing cause for concern within the LAC region, primarily because of the rapid increase in urbanization and the use of fossil fuels. The rise in indoor and outdoor air pollutants impacts public health, and there are limited regional studies on the impact of these pollutants and how they affect public health. A comprehensive literature search was conducted using Google Scholar, PubMed, Scopus, EBSCOhost, Web of Science and ScienceDirect databases. Significant search terms included “indoor air pollution,” “outdoor air pollution,” “pollution,” “Latin America,” “Central America,” “South America” and “Caribbean was used.” The systematic review utilized the Rayyan systematic software for uploading and sorting study references.

Database searches produced 1,674 results, of which, after using the inclusion–exclusion criteria and assessing for bias, 16 studies were included and used for the systematic review. These studies covered both indoor and outdoor pollution. Various indoor and outdoor air pollutants linked to low birth weight, asthma, cancer and DNA impairment were reported in this review. Even though only some intervention programs are available within the region to mitigate the harmful effects of pollution, these programs need to be robust and appropriately implemented, causing possible threats to public health. Significant gaps in the research were identified, especially in the Caribbean.

Limitations of the study include limited available research done within LAC, with most of the research quantifying pollutants rather than addressing their impacts. Additionally, most studies focus on air pollution but neglect water and land pollution’s effects on public health. For this reason, the 16 studies included limited robustness of the review.

Although available studies quantifying pollution threats in LAC were identified in this review, research on the adverse impacts of pollution, especially concerning public health, is limited. LAC countries should explore making cities more energy-efficient, compact and green while improving the transportation sector by utilizing clean power generation. In order to properly lessen the effects of pollution on public health, more research needs to be done and implemented programs that are working need to be strengthened and expanded.