The Limits of the Intervention of Public Power in Individual Health Choices——From the Perspective of the Realization of the Right to Health in the Prevention and Control of Chronic Diseases

Noncommunicable chronic diseases have become the most important public health problem in the world today,so the focus of public health services should be shifted from the traditional area of communicable diseases to the prevention and control of chronic diseases.Since bad living habits are the most direct cause of chronic diseases,the most effective measure to prevent and control chronic diseases is to promote healthy lifestyles for the individual citizen.The theories of equal health opportunity,the right to health from the perspective of human rights,and determinants of a healthy society provide justified reasons for the intervention of public power in individual health choices.In the current legal system,the intervention of public power is limited to flexible measures such as health education,which shows respect for individual autonomy.However,it is inconsistent with the needs of current public health practice.We should expand diversified intervention means to encourage individuals to make healthy choices under the guidance of the management model.The“ladder of intervention”outlines a panoramic view of the intervention measures available.However,for the selection of specific measures,it is necessary to consider the public health objectives and the invasion of individual freedom,introduce the“legal reservation principle”and“proportionality principle”as policy analysis tools,and reasonably choose intervention measures at different levels on the ladder to properly handle the tension between public power and private rights.

The status quo and challenges of prevention and control of chronic obstructive pulmonary disease in China

Introduction Characterized as persistent and progressive pulmonary function declining,chronic obstructive pulmonary disease (COPD) can be accompanied by a systemic inflammatory response.A variety of psychiatric and somatic comorbidities can occur to the patients,such as depression,nutritional disorders,cardiovascular disease,and lung cancer.It is imposing great impacts on the quality of patients' life.In 2010 alone,the economic burden of COPD in the world was as high as 2.1 trillion dollars [1].The high prevalence,mortality,and morbidity have made this disease a major public health problem in socio-economic development with a rapidly aging population in China.

Insights from exploring the interrelated dynamics of gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease

This article delved into the comprehensive study by Jiang et al,which meticulously examined the bidirectional relationships among gallstone disease,nonalcoholic fatty liver disease,and kidney stone disease through a multicenter study,systematic review,and meta-analysis.The study provides significant evidence supporting these associations,offering valuable insights into the etiology and potential prevention strategies for these interconnected conditions.The clinical significance of these bidirectional relationships is profound,as they underscore the importance of recognizing these conditions not only as isolated diseases but as part of a complex network that can influence each other.These results highlight the critical need for thorough screening and personalized prevention strategies for individuals with these interconnected conditions.Explicit implications for prevention strategies and early screening practices are crucial,as they can lead to early detection and intervention,significantly altering disease progression and outcomes.Furthermore,identifying potential therapeutic targets within these shared pathways may enhance treatment efficacy and patient outcomes,making this research highly relevant to clinical practice.By comprehending the common pathophysiological mechanisms and applying specific interventions,healthcare professionals can greatly enhance patient care and lessen the impact of these widespread diseases on global health.

High-intensity interval training for health benefits and care of cardiac diseases——The key to an efficient exercise protocol

Aerobic capacity, which is expressed as peak oxygen consumption (VO2peak), is well-known to be an independent predictor of all-cause mortality and cardiovascular prognosis. This is true even for people with various coronary risk factors and cardiovascular diseases. Although exercise training is the best method to improve VO2peak, the guidelines of most academic societies recommend 150 or 75 min of moderate- or vigorous- intensity physical activities, respectively, every week to gain health benefits. For general health and primary and secondary cardiovascular prevention, high-intensity interval training (HIIT) has been recognized as an efficient exercise protocol with short exercise sessions. Given the availability of the numerous HIIT protocols, which can be classified into aerobic HIIT and anaerobic HIIT [usually called sprint interval training (SIT)], professionals in health-related fields, including primary physicians and cardiologists, may find it confusing when trying to select an appropriate protocol for their patients. This review describes the classifications of aerobic HIIT and SIT, and their differences in terms of effects, target subjects, adaptability, working mechanisms, and safety. Understanding the HIIT protocols and adopting the correct type for each subject would lead to better improvements in VO2peak with higher adherence and less risk.

Molecular therapy and prevention of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in some areas of the world with an extremely poor prognosis. The major etiologic risk factors for HCC development include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, toxins (alcohol, aflatoxin BI) and various inherited metabolic liver diseases, such as hemochromatosis and alpha-1-antitrypsin deficiency. Central to the molecular pathogenesis of HCC are mutations of various genes and genetic/chromosomal instability that result from chronic liver disease and the associated enhanced liver cell regeneration and mitotic activity. Alterations in the structure or expression of several tumor suppressor genes and oncogenes have been described. In addition, mechanisms leading to genetic instability due to mismatch repair deficiency or chromosomal instability and aneuploidy due to defective chromosomal segregation appear to be involved. The prognosis of HCC patients is generally very poor. Most studies have shown a five-year survival rate of less than 5% in symptomatic patients. HCC has been found to be quite resistant to radio- or chemotherapy. Investigations of the natural history and clinical course of HCC revealed a long-term survival of patients only with small asymptomatic HCC that could be treated surgically or nonsurgically. For patients with advanced symptomatic HCC, novel therapeutic strategies such as gene therapy are urgently needed. Apart from exploring and refining new HCC treatment strategies, the implementation of the existing measures or the development of novel measures to prevent HCC is most important. Primary HCC prevention could have a major impact on the incidence of HCC. Further, secondary prevention of a local recurrence or of new HCC lesions in patients after successful surgical or nonsurgical HCC treatment is of paramount importance and is expected to significantly improve disease-free and overall survival rates of patients. Based on rapid scientific advances, molecular diagnosis, gene therapy and molecular prevention are becoming increasingly part of our patient management and will eventually complement or in part replace the existing diagnostic, therapeutic and preventive strategies. Overall, this should result in a reduced HCC incidence and an improved clinical outcome for patients with HCC, one of the most devastating malignancies worldwide.

Chronic disease and the link to physical activity

Chronic diseases have become a focal point of public health worldwide with estimates of trillions of dollars in annual health care cost and causing more than 36 million deaths a year. Lifestyle factors such as physical inactivity are heavily correlated with the development of many chronic diseases. New strategies for primary and secondary disease prevention are desperately needed to aid in blunting the negative economic and social impact of these diseases. Physical activity （PA） and exercise are now considered principal interventions for use in primary and secondary prevention of chronic diseases. Currently, more emphasis in primary prevention of disease is necessary to reduce disease risk in youth and adults; however with chronic disease prevalence so high, similar emphasis is also necessary for secondary prevention in those children and adults already inflicted with chronic diseases. Conditions such as cardiovascular disease, type 2 diabetes, obesity, and cancer are drastically improved when PA and exercise are part of a medical management plan. In addition, the national PA guidelines in conjunction with PA promotion tools like Exercise is MedicineTM are needed to promote increased PA and exercise levels worldwide.

Influence of Probiotic Fermented Fruit and Vegetables on Human Health and the Related Industrial Development Trend

The paper briefly discusses the relationship between chronic diseases and gut health,and points out that an imbalance of intestinal microflora and an inadequate intake of dietary fiber are two important causes of chronic diseases.This paper also summarizes the research status of probiotic fermented fruit and vegetables,and discusses the main achievements of our group in this field and future developments of the related industry.The application of fermentation technology to fruit and vegetable processing and the development of a series of probiotic fermented fruit and vegetable products not only increase the added value of fruit and vegetables,but also organically combine probiotics and their active metabolites with prebiotics(dietary fiber,etc.),thereby promoting intestinal health as well as preventing and relieving chronic diseases.Fermentation technology provides a new approach to the study of the effect of probiotics on human health,and will have a revolutionary influence on probiotic application and on the fruit and vegetable processing industry.Thus,fruit and vegetable fermentation technology has excellent market potential.

Obesity and kidney disease： hidden consequences of the epidemic

Obesity has become a worldwide epidemic,and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes,cardiovascular disease and also for Chronic Kidney Disease. A high body mass index is one of the strongest risk factors for new-onset Chronic Kidney Disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing Chronic Kidney Disease in the long-term. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis,and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease,advocating healthy lifestyle and health policy measures that makes preventive behaviors an affordable option.

Pathogenesis and Prevention of Progression of Chronic Kidney Disease

This treatise of chronic kidney disease (CKD) describes association of hypertension, diabetes and congestive heart failure (CHF) with CKD. CKD is defined by estimated glomerular filtration rate (eGFR) of less than 60 ml/min for three months or more. CKD is generally irreversible but not necessarily progressive. Thus progression of CKD into end stage renal disease (ESRD) is the concern here and what can be done to reduce the progression of CKD. Exact data of CKD with progression are unavailable but high incidence of ESRD (dialysis) eleven times more in 2011 than in 1980 accordingly to United States (US) Renal Data System is a testimonial to progression of CKD in patients with diabetes, hypertension, CHF and other renal diseases. US Renal Data System reveals that ESRD has soared in parallel with marketing of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) drugs, providing strong indirect evidence that these drugs are someway instrumental in the progression of CKD into ESRD. These drugs produce acute renal failure which is an independent risk factor for CKD. Thus shift in therapy with enthusiastic use of ACEI/ARB drugs has led to dialysis bonanza throughout the world benefiting the professionals and corporations at the expense of vegetative life of the patients associated with family and societal burdens. The ways to turn the pendulum is to treat diabetes with insulin and hypertension with beta blocker, calcium channel blocker and diuretic therapy, and avoid the use of ACEI/ARB drugs. It is important to understand that diuretic orally, by intravenous boluses or by continuous infusion, is the cornerstone of therapy for CHF, whereas ACEI/ARB drugs markedly impair the efficacy of diuretics by lowering the blood pressure to a very low level thereby reducing renal perfusion. An evidence for that is marked elevation of BUN with comparatively slight increase of serum creatinine. Thus with the approaches stated above, CKD is less likely to progress;hence rate of ESRD is likely to decrease.

Three Year Community Based Intervention for Chronic Disease Prevention in Epidemiological and Political Transition Context: Example of Tunisia

Objective: Our aim was to determine the effectiveness, feasibility, and necessary cultural adaptations of evidence-based interventions directed at tobacco use, unhealthy diet, and physical inactivity in adults and children in three different sectors: workplace, neighborhood and schools. Materials and Methods: We conducted in Sousse, Tunisia an interventional study through a quasi-experimental design (pre-post with intervention and control groups) to prevent non communicable disease risk factors. The intervention group included different settings and pre and post assessment concerned independent groups (schools with 1929 and 2170 participants, workplaces with 914 and 1098 participants and community with 940 and 1001 participants respectively at pre and post assessment). It was located in the delegation of Sousse Jawhara and Sousse Erriadh. The control group with similar settings (schools with 2074 and 2105 participants, workplaces with 861 and 1015 and community with 940 and 976 participants respectively at pre and post assessment) was located in the delegation of Msaken from the region of Sousse. Results: Tobacco use decreased among neighborhood (26.2% to 23.2%, p = 0.13) workplace (39.2% to 37.5%, p = 0.43) and schools (5.7% to 4.8%, p = 0.19) participants. In control group, it increased significantly in schools and neighborhood. Participants who consumed five fruits and vegetables daily increased significantly in all settings in intervention group (from 30% to 33.2% in schools, 47.5% to 52.1% in workplace and 39.4% to 58.4% in neighborhood). However in control group it increased only in schools and neighborhood. An improvement in physical activity practice was seen both in intervention and control group among adults participants but not in schools. Conclusion: The “Together in Health” project for the prevention of risk factors for NCD is an example of a loco-regional initiative. Such initiatives can only be beneficial with a structure organized by the government.

Health Awareness: A Significant Factor in Chronic Diseases Prevention and Access to Care

Health literacy and awareness are essential strategies in promoting global health and improving access to care. While seen as an essential tool for promoting population health awareness to improve early detection and treatment of chronic diseases, it is yet to be emphasized in most African countries. Health literacy is an essential practice to promote chronic disease prevention and reduce the growing threat to population health. Incidences and mortalities from chronic diseases commonly arise from limited knowledge of the causative risk factors and access to health facilities. Without knowledge about causes, health impacts, and available health services, people continue to indulge in the habits that worsen their health conditions and fail to access care timely. By using health literacy and awareness as a tool for chronic disease prevention, healthcare professionals will develop strategic health awareness programs that fit the socio-demographics of the population they serve. This article explored the significant role health awareness occupies in individual and community health prevention through health promotion and education. It reviewed the concept and dimensions of chronic disease prevention, cultural beliefs and impact on chronic diseases, gaps created by low health literacy, and the significance of health literacy in disease prevention and health promotion. Furthermore, it recommends that health systems and local communities form partnerships to address common and emerging health problems, and health systems should be properly funded.

Effect of the Mediterranean Diet on BMI in Middle-Aged Hispanic Women with Pre-Obesity and Obesity Central Washington State

Background: Conclusive evidence has yet to emerge regarding the effectiveness and applicability of the Mediterranean diet on middle-aged Hispanic women, the largest female minority group in the United States who is at-risk of metabolic disorders. Objective: The aim of this study is to evaluate the effect of the Mediterranean diet (MED) on the BMI in middle-aged Hispanic women with pre-obesity and obesity in Central Washington State. Design: A prospective study was performed to determine the effect of Mediterranean diet on the BMI of 67 Hispanic women with pre-obesity and obesity between 45 to 65 years of age in Central Washington State. The study was carried out for eight weeks. Dietary adherence was monitored to ensure consistent results. Results: The proportion of Hispanic women who reported a reduction in BMI was 94%, with a decrease in mean BMI after eight weeks of 2.8 (95% CI: 2.5 to 3.0) and P = 0.02, with an odds ratio of 2.6. Multiple linear regression analysis was used to adjust for age, education, physical activity, and smoking. Conclusion: The reduction in BMI demonstrates that the Mediterranean diet can be a promising, culturally appropriate therapy to address the obesity epidemic that is prevalent among Hispanic women.

Investigation of Relationship with Health Problems and Environmental Problems in the Silivri District of Istanbul

The purpose of this study is to investigate relationship between health and environmental problems in the district of Istanbul. This study is a cross-sectional questionnaire study that was conducted in the Silivri among the dates of 25th May-24th July, 2015. Questionnaires were conducted from 221 people living in Silivri with face to face interviews by researchers. Most of participants （82.4%） thought the presence of hazardous environmental factors deteriorated their health （n = 182）. Water pollution （48.4%, n = 107） and absence of free water （50.7%, n = 112） were the most common complaints of the participants. Analyzing distribution of factors which disrupt health and history of chronic disease to urban and rural areas revealed more complaints about those factors and diseases in the rural areas than urban areas. The most common chronic diseases diagnosed were hypertension （15.8%, n = 35）, chronic lung diseases （10.4%, n = 23）, diabetes and coronary artery disease. Silivri people reported a lot of environmental problems which impair the public health. People living in villages close to industrial zone and seas which have marine pollution have more history of diseases and report more factors that negatively influence the health than people living in urban area.

Clinical Characteristics and Prevention Strategies of Falls in Hospitalized Patients with Chronic Kidney Disease

Objectives: To analyze the clinical features of falls in hospitalized patients with chronic kidney disease (CKD), and to provide basis for preventing the occurrence of falls in hospitalized patients with CKD. Method: A retrospective study was conducted to analyze the 27 adverse events of falls in hospitalized patients from the department of nephrology in Peking University Shenzhen Hospital during May 2009 and May 2019. Results: Among the 27 patients with falls, people over 65 years old accounted for 55.56%;74.07% of the patients had caregivers;the peak period of falls was from June to August, accounting for 40.74%, mainly occurring from 7:00 to 8:00, 12:00 to 13:30 and 19:00 to 21:00;the locations of falls were mostly near the bed and in the bathroom, accounting for 33.33% and 22.22%, respectively;suffering from anemia, hypoproteinemia, abnormal serum potassium, calcium-phosphorus metabolism disorders accompanied by abnormal parathyroid hormone and hypertension accounted for 88.89%, 85.19%, 29.63%, 96.30% and 81.48% respectively. The inpatients on dialysis therapy accounted for 66.67%. Conclusion: The occurrence of falls in hospitalized patients with CKD was not only related to age, caregivers, time, months, locations or other conventional factors, but also the complications and dialysis therapies. To effectively reduce the occurrence of falls, it’s necessary to enhance the sense of safety and responsibility of caregivers. Besides, nurses should strengthen the inspection of wards for inpatients engaging in some intensive activities, and nurses should also pay more attention to the inpatients with anemia, hypoproteinemia, calcium-phosphorus metabolism disorders and those on dialysis therapies.

Frequent office visits of patients with chronic kidney disease: Is a prelude to prevention of dialysis

This study is an excerpt of broad-based offce practice which is designed to treat patients with diabetes and hypertension, the two most common causes of chronic kidney disease （CKD）, as well as CKD of unknown etiology. This model of offce practice is dedicated to evaluating patients with CKD for their complete well-being; blood pressure control, fuid control and main-tenance of acid-base status and hemoglobin. Frequent offce visits, every four to six weeks, confer a healthy life style year after year associated with a feeling of good well-being and a positive outlook. Having gained that, such patients remain compliant to their medica-tion and diet, and scheduled laboratory and offce vis-its which are determinant of a dialysis-free life.

Future challenges and solutions for safety in China:China CDC’s exploration of injury prevention strategies

As an important component of worldwide injury prevention,China has made great contribution to the development.China is serving as a model for other countries in the world,especially developing countries,and China’s experience has great implications for them.Besides the description of the present situation and trends of China’s injury prevention work and review for its development history,this paper has also introduced the existing issues and the current challenges,and informed the e orts of the sta in related eld to nd solutions from di erent aspects.All of them jointly boosted the development of global injury prevention.

How are adolescents engaged in obesity and chronic disease prevention policy and guideline development?A scoping review

Background Adolescent consumer engagement is widely accepted,with global calls to meaningfully involve ado-lescents for effective and tailored policy and guideline development.However,it is still unclear if and how adolescents are engaged.The aim of this review was to determine if and how adolescents meaningfully participate in policy and guideline development for obesity and chronic disease prevention.Methods A scoping review was conducted guided by the Arksey and O’Malley six stage framework.Official government websites for Australia,Canada,United Kingdom,and United States including intergovernmental organizations(World Health Organisation and United Nations)were examined.Universal databases Tripdatabase and Google advanced search were also searched.Current and published international and national obesity or chronic disease prevention policies,guidelines,strategies,or frameworks that engaged adolescents aged 10-24 years in meaningful decision-making during the development process were included.The Lansdown-UNICEF conceptual framework was used to define mode of participation.Results Nine policies and guidelines(n=5 national,n=4 international)engaged adolescents in a meaningful capacity,all focused on improving‘health and well-being’.Demographic characteristics were poorly reported,still most ensured representation from disadvantaged groups.Adolescents were primarily engaged in consultative modes(n=6),via focus groups and consultation exercises.Predominantly in formative phases e.g.,scoping the topic or identifying needs(n=8)and to a lesser extent in the final stage of policy and guideline development e.g.,implementation or dissemination(n=4).No policy or guideline engaged adolescents in all stages of the policy and guideline development process.Conclusion Overall,adolescent engagement in obesity and chronic disease prevention policy and guideline devel-opment is consultative and rarely extends throughout the entire development and implementation process.

China's Medium-to-Long Term Plan for the Prevention and Treatment of Chronic Diseases (2017-2025) under the Healthy China Initiative

A new milestone in the prevention and treatment of chronic diseases The General Office of the State Council of the People's Republic of China issued the 'Medium-to-Long Term Plan of China for the Prevention and Treatment of Chronic Diseases (2017-2025)' (here-inafter referred to as'Plan') on January 22, 2017.

Strengthen national action for the prevention and control of chronic respiratory diseases

Chronic respiratory diseases are chronic diseases of the airways and other structures of the lung.Some of the most common are asthma,chronic obstructive pulmonary disease （COPD）,respiratory allergies,occupational lung diseases and pulmonary hypertension.Hundreds of millions of people suffer every day from chronic respiratory diseases.COPD is one of the most representative chronic respiratory diseases.A population-based,cross-sectional survey of COPD conducted between 2003 and 2004 showed that the overall prevalence of the disease in people aged above 40 years was 8.2%,1 which would result in a COPD patient population of over 43 million.

Hepatitis C virus cure with direct acting antivirals: Clinical,economic, societal and patient value for China

About 10 million people in China are infected with hepatitis C virus(HCV),with the seroprevalence of anti-HCV in the general population estimated at 0.6%.Delaying effective treatment of chronic hepatitis C(CHC)is associated with liver disease progression,cirrhosis,hepatocellular carcinoma,and liver-related mortality.The extrahepatic manifestations of CHC further add to the disease burden of patients.Managing CHC-related advanced liver diseases and systemic manifestations are costly for both the healthcare system and society.Loss of work productivity due to reduced well-being and quality of life in CHC patients further compounds the economic burden of the disease.Traditionally,pegylatedinterferon plus ribavirin(PR)was the standard of care.However,a substantial number of patients are ineligible for PR treatment,and only 40%–75%achieved sustained virologic response.Furthermore,PR is associated with impairment of patient-reported outcomes(PROs),high rates of adverse events,and poor adherence.With the advent of direct acting antivirals(DAAs),the treatment of CHC patients has been revolutionized.DAAs have broader eligible patient populations,higher efficacy,better PRO profiles,fewer adverse events,and better adherence rates,thereby making it possible to cure a large proportion of all CHC patients.This article aims to provide a comprehensive evaluation on the value of effective,curative hepatitis C treatment from the clinical,economic,societal,and patient experience perspectives,with a focus on recent data from China,supplemented with other Asian and international experiences where China data are not available.