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Depuis le début des années 1990, l'importance des maladies non transmissibles chroniques (MNT) a fait l'objet d'un regain d'attention et de reconnaissance, dû principalement à l'évolution démographique mondiale et à la question corollaire du vieillissement. Ce rapport contient un agenda d'action visant à répondre aux problèmes économiques, sociaux et sanitaires croissants posés par les MNT et éviter ainsi une crise sanitaire à grande échelle. Son objectif est de permettre à la Banque mondiale et ses partenaires de réexaminer leur approche de la politique publique en tant qu'outil de prévention et de lutte contre les MNT (conduites préventives, thérapies adaptées), et, là où cela s'impose, de la modifier afin de contrôler les dépenses de santé, fournir des services aussi efficaces et équitables que possible et de mettre à disposition des décideurs une structure leur permettant d'aborder ces enjeux dans leurs pays.

Chronic diseases.

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Chronic diseases.

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Tonga has experienced a high burden of noncommunicable diseases (NCDs) in the past two decades. Data indicate the continuing rise of four major NCDs -cardiovascular disease, diabetes, cancer,and respiratory diseases - as the leading causes of premature death and disability. According to latest data, NCDs accounted for four out of five leading causes of mortality in Tonga, and 99.9 percent of Tongan adults aged 25-64 are at moderate to high risk of developing an NCD. The increase in behavioral-related risk factors such as smoking, poor diet (e.g. high in sugar, salt, trans-fat and saturated fat, and low in fruit, vegetables, legumes, fish et cetera), harmful alcohol intake, and physical inactivity are acknowledged as the major contributing factors to the rise in NCDs in Tonga. According to its 2012 STEPS Survey, Tonga has one of the highest rates of overweight and obesity.

Chronic diseases.

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Chronic diseases

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The Norwegian Knowledge Center for Health Services was asked by Diakonhjemmet Hospital, Oslo, to review available research on effect of various forms of coordination between hospital and the community health service when discharging patients with chronic illnesses. This review is thought to inform about choices of interventions and consideration of how to design a coordination intervention. The key results1. We included 45 studies about coordination interventions, performed both with and without other interventions at the same time. This is a subject of substantial interest, and the studies also imply a large number of different way of operationalisating the concept. 2. Regardless of whether the coordination was studied as the only element in an intervention, or alongside other interventions, there were no sigificant differences between the intervention and control group for the outcomes readmissions and deaths. 3. Of four studies performed without other simultaneous interventions, only one was of such quality that we trust the documentation of effect of the intervention: 1.1. Inviting the GP to the hospital before discharge may possibly increase the proportion of geriatric patients receiving community services after 6 months, than if the GP is not invited. 4. In the remaining studies, the coordination was a part of a multifaceted intervention where also other interventions were performed simultaneously. It is possible that: 1.1. Coordinators provided with considerably more time than usually available, to provide case management, including telephone follow-up, liaison with local councils and nursing agencies, and coordination of service provision, instead of usual hospital discharge planning may result in a higher proportion living at home after one month, a more extensive use of community services, personal care and higher costs within 6 months. 1.2. Comprehensive geriatric assessment in addition to the usual emergency department care, and a referral faxed from the emergency department to the community agency to expedite home care services may result in lower use of nursing home after 30 days, but no significant differences in costs after 30 days and 6 months or in use of nursing home after 6 months. We evaluated the quality of the documentation for all the reported outcomes as low or very low. This means that we expect futher research to influence our conclusions.

Chronic diseases.