Download - Session 3: Nick Wareham
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Supporting and Undertaking International Public Health Research in NCD prevention
Nick Wareham
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Source: Global Diabetes Plan, IDF 2011
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• Training and capacity development
• Supporting epidemiological research
• Supporting public health research
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• Training and capacity development
• Supporting epidemiological research
• Supporting public health research
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• Cambridge Seminar on Epidemiology and Public Health aspects of Diabetes
• Free, 2 week course, Residential with resident faculty
• International with priority given to people from countries where training is difficult to obtain
• People selected on the basis of capacity to make a difference once they return to their countries of origin
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The 1st Cambridge Seminar 1981
Harry Keen John Jarrett
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The 11th Cambridge Seminar, 2011
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Regional linked seminars
Cambridge Seminar in Hangzhou, China 2010
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• Training and capacity development
• Supporting epidemiological research
• Supporting public health research
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Source: The International Expert Committee. Diabetes Care 2009
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The IDF Diabetes Atlas5th Edition
A summary of the figures and key findings
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Prevalence of diabetes, 2011
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The global burden
366 million people have diabetes in 2011; by 2030 this will have risen to 552 million
The number of people with type 2 diabetes is increasing in every country
80% of people with diabetes live in low-and middle-income countries The greatest number of people with diabetes are between 40 to 59
years of age 183 million people (50%) with diabetes are undiagnosed Diabetes caused 4.6 million deaths in 2011 Diabetes caused at least USD 465 billion dollars in healthcare
expenditures in 2011; 11% of total healthcare expenditures in adults (20-79 years)
78,000 children develop type 1 diabetes every year
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WHO multinational studyInternational collaboration for study on disease outcomes
Source: Fuller et al, Diabetologia 2001
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• Training and capacity development
• Supporting epidemiological research
• Supporting public health research
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Source: Gillies et al, BMJ 2007
Meta-analysis of RCTs
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Percentage progression to diabetes by successful achievement of intervention targets
Success score
%
0
5
10
15
20
25
30
35
40
45
50
0 1 2 3 4 5
Intervention Control
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Rate of developing diabetes according to the number of diabetes healthy behaviour goals met
χ² test for trend p <0.001
0
1
2
3
4
5
6
7
8
0 1 2 3 4 5Number of diabetes healthy behaviour goals met
Dia
be
tes
in
cid
en
ce
ra
te/1
00
0 p
-yrs
Source: Simmons et al, Diabetologia 2006
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Shift the whole population distribution of risk factor
• Focus on high risk individuals
• Low impact on population attributable risk (PAR) or preventable fraction
• Ineffective public health strategy
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• Aim: to develop effective public health interventions for population level change in dietary and physical activity behaviour
• CEDAR Partnership: • Medical Research Council Units, University of East Anglia, University of
Cambridge • Erpho – East of England Public Health Observatory
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The Indian Diabetes Prevention ProgrammesProf A Ramachandran
Source: Ramachandran et al, Diabetologia 2006
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MRC-ICMR initiative
Chennai-Imperial-Cambridge
Evaluation of a scaleable and feasible mass intervention to promote lifestyle changes
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Professor Jean-Claude MbanyaPresident IDF
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Diabetes prevalence in Africa
Source: Mbanya et al, Lancet 2010
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Felix Assah
Attendee Cambridge SeminarMPhil in EpidemiologyPhD in EpidemiologyWellcome Trust Clinical Fellow
“The Cambridge sequence … has been invaluable in providing an Introduction to NCD research and then going further to provide expert level training over a five year period. I am ready to give back to my society the knowledge and skills acquired through hands-on training of students and junior researchers.”
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Rural Area in Cameroon Mbankomo
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Rural lifestyle
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Urban Area in CameroonBiyem-Assi, Yaounde
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Urban lifestyle
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Objectives
To objectively quantify physical activity levels in an urban and a rural population in Cameroon
To describe patterns of activities in these populations
to examine possible correlates of physical activity levels.
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Population distribution of physical activity energy expenditure (PAEE)
0.0
05.0
1.0
15.0
2.0
25D
ens
ity
0 50 100 150PAEE (kJ/kg/day)
Rural Urban
Assah FK et al, Diabetes Care 2011
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Activity and Clustered Metabolic Risk in Cameroon Rural and urban differences in 552 adults
zMS
-3
-2
-1
0
1
2
3
Q1 Q2 Q3 Q4PAEE quartile
p<0.001 for trend
Source: Assah et al, Diabetes Care 2011
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Domains of Physical Activity in Rural and Urban dwellers
05
01
001
502
002
50
Rural - Bafut Urban - Yaounde
Distribution of domians of PA using GPAQ
Work TravelLeisure
Assah FK et al, Unpublished, 2010
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Seasonal trends of physical activity
Dark bars = Rural Light bars = Urban
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Seasonal trends of physical activity
Dark bars = Rural Light bars = Urban
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Some correlates of physical activity
PAEE (kJ/kg/day)
Rural (N=271) Urban (N=317)Correlates β SE p value β SE p value
Demographic and anthropometricBMI (kg/m2) -1.53 0.33 <0.001 -1.0 0.21 <0.001 Normal -- -- Overweight -11.11 3.41 0.001 -4.50 2.60 0.09 Obese -17.15 4.78 <0.001 -11.52 2.69 <0.001
Related lifestyle behavioursSmoking 0.57 5.70 0.9 12.77 3.81 0.001Alcohol drinking 5.05 3.56 0.2 4.84 2.56 0.06Fruits and vegetables <3 times/week -- -- 3 – 6 times/week 9.19 3.35 0.007 4.34 2.23 0.05 >=7 times/week 11.53 3.98 0.004 8.28 3.23 0.01
School duration (years) -0.55 0.35 0.1 -0.98 0.19 <0.001
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• Training and capacity development - sustainable support for integrated programme of training and
capacity building at different levels
• Supporting epidemiological research
• Supporting public health research- focus on building global capacity to undertake translational public health research for NCD prevention