Novartis Foundation

About: Novartis Foundation is a nonprofit organization based out in Basel, Switzerland. It is known for research contribution in the topics: Health care & Leprosy. The organization has 99 authors who have published 85 publications receiving 3993 citations.

Effects of a School-Based Health Intervention Program in Marginalized Communities of Port Elizabeth, South Africa (the KaziBantu Study): Protocol for a Randomized Controlled Trial.

Abstract: Background: The burden of poverty-related infectious diseases remains high in low- and middle-income countries, while noncommunicable diseases (NCDs) are rapidly gaining importance. To address this dual disease burden, the KaziBantu project aims at improving and promoting health literacy as a means for a healthy and active lifestyle. The project implements a school-based health intervention package consisting of physical education, moving-to-music, and specific health and nutrition education lessons from the KaziKidz toolkit. It is complemented by the KaziHealth workplace health intervention program for teachers. Objectives: The aim of the KaziBantu project is to assess the effect of a school-based health intervention package on risk factors for NCDs, health behaviors, and psychosocial health in primary school children in disadvantaged communities in Port Elizabeth, South Africa. In addition, we aim to test a workplace health intervention for teachers. Methods: A randomized controlled trial (RCT) will be conducted in 8 schools. Approximately 1000 grade 4 to grade 6 school children, aged 9 to 13 years, and approximately 60 teachers will be recruited during a baseline survey in early 2019. For school children, the study is designed as a 36-week, cluster RCT (KaziKidz intervention), whereas for teachers, a 24-week intervention phase (KaziHealth intervention) is planned. The intervention program consists of 3 main components; namely, (1) KaziKidz and KaziHealth teaching material, (2) workshops, and (3) teacher coaches. After randomization, 4 of the 8 schools will receive the education program, whereas the other schools will serve as the control group. Intervention schools will be further randomized to the different combinations of 2 additional intervention components: teacher workshops and teacher coaching. Results: This study builds on previous experience and will generate new evidence on health intervention responses to NCD risk factors in school settings as a decision tool for future controlled studies that will enable comparisons among marginalized communities between South African and other African settings. Conclusions: The KaziKidz teaching material is a holistic educational and instructional tool designed for primary school teachers in low-resource settings, which is in line with South Africa’s Curriculum and Assessment Policy Statement. The ready-to-use lessons and assessments within KaziKidz should facilitate the use and implementation of the teaching material. Furthermore, the KaziHealth interventions should empower teachers to take care of their health through knowledge gains regarding disease risk factors, physical activity, fitness, psychosocial health, and nutrition indicators. Teachers as role models will be able to promote better health behaviors and encourage a healthy and active lifestyle for children at school. We conjecture that improved health and well-being increase teachers’ productivity with trickle-down effects on the children they teach and train. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 18485542; http://www.isrctn.com/ISRCTN18485542 International Registered Report Identifier (IRRID): DERR1-10.2196/14097

Hypertension, knowledge, attitudes, and practices of primary care physicians in Ulaanbaatar, Mongolia.

Abstract: We examined the knowledge, attitudes, and practices of primary care doctors in Ulaanbaatar, Mongolia using a recently developed World Hypertension League survey. The survey was administered as part of a quality assurance initiative to enhance hypertension control. A total of 577 surveys were distributed and 467 were completed (81% response rate). The respondents had an average age of 35 years and 90.1% were female. Knowledge of hypertension epidemiology was low (13.5% of questions answered correctly); 31% of clinical practice questions had correct answers and confidence in performing specific tasks to improve hypertension control had 63.2% "desirable/correct" answers. Primary care doctors mostly had a positive attitude toward hypertension management (76.5% desirable/correct answers) and highly prioritized hypertension management activities (85.7% desirable/correct answers). Some important highlights included the majority (> 80%) overestimating hypertension awareness, treatment, and control rates; 78.2% used aneroid blood pressure manometers; 15% systematically screened adults for hypertension in their clinics; 21.8% reported 2 or more drugs were required to control hypertension in most people; and 16.1% reported most people could be controlled by lifestyle changes alone. 55% of respondents were not comfortable prescribing more than 1 or 2 antihypertensive drugs in a patient and the percentage of desirable/correct responses to treating various high-risk patients was low. Most (53%-74%) supported task shifting to nonphysician health care providers except for drug prescribing, which only 13.9% supported. A hypertension clinical education program is currently being designed based on the specific needs identified in the survey.

Strengthening local health systems for hypertension prevention and control: the Communities for Healthy Hearts program in Ho Chi Minh City, Vietnam

Abstract: Background: Hypertension leads to an estimate of 91,000 deaths yearly, accounting for 21% of total mortality in Vietnam. However, the national health system is under-resourced to meet the population's needs for hypertension prevention and care. The Communities for Healthy Hearts program (the Program) introduced an innovative health service delivery model to address hypertension in underserved communities in 4 districts of Ho Chi Minh City (HCMC). This study evaluated a 3-year implementation of this program (2016–2019) on the strengthening of local health system and its capacity to better prevent and manage hypertension. Methods: A mixed approach of quantitative and qualitative studies was applied. The WHO’s health systems building blocks framework was employed to assess impact of the Program on the local health system. Results: Findings revealed that the Program developed a hypertension-ready system supported by enabling factors that are aligned with the WHO's building blocks. These were: increased availability of preventive and treatment services for hypertension; improved capacity of healthcare staff through trainings; effective communication materials, available technical guidelines; provision of stipends for collaborators; establishment of a collaborators network and blood pressure checkpoints with a strong collaboration among stakeholders. However, there was room for improvement and the Program provides a few lessons learned regarding planning in personnel changes and recruitment, efficacy of capacity building via training sessions, sustainability of financing, and completeness of patient information management. Conclusion: Given national objectives in Vietnam to strengthen primary care and address the rising tide of NCDs, The Communities for Healthy Hearts program provided a promising approach to strengthen HCMC's health system and extend coverage of community-based approaches to improve prevention and control of hypertension. This model provides several approaches and lessons learned that can support health providers and policy makers in their efforts to strengthen national health programs in Vietnam to address NCDs.

Is alcohol really good for you

Abstract: The much-publicized beneficial effects of light to moderate alcohol consumption may have been vastly overestimated. Epidemiologists, cardiologists, public health experts and sociologists at a Novartis Foundation Symposium on Alcohol and Cardiovascular Disease in October (and at a one-day open meeting at the RSM) expressed concern that the 'J-shaped' alcohol-consumption/coronary-heartdisease-risk curve for the over 50s could be explained largely in terms of inappropriate questionnaires, misleading classifications and poor statistical analysis. The relation between alcohol and total mortality depends on the distribution of causes of death amongst the population studied and on the level and patterns of alcohol consumption within the population. The most consistent observation is that, in industrialized countries, non-drinkers (ex-drinkers and lifelong teetotallers) have higher rates of all-cause morbidity and mortality than light/ moderate drinkersl. However, having seen little evidence that light-drinkers owe their good health to alcohol, researchers are beginning to wonder whether drinking habits are a reflection of other, more powerful, risk factors such as social class, education and general ill-health. Despite the overwhelming consensus that, beyond a certain age, alcohol consumption of 5-20g/day (10g=1 UK unit) attenuates the risk of major coronary heart disease (CHD) events, the degree of protection has almost certainly been exaggerated by use of inappropriate control groups said Professor Gerry Shaper (Royal Free Hospital, London). Shaper's work on the British Regional Heart Study (a longitudinal study of over 7000 men), whose detailed meta-analysis of six other large-scale surveys has revealed that the J-shape could result largely from two factors that make non-drinkers a seriously biased baseline group2. First, there is a strong downward drift from heavy or moderate drinking towards non-drinldng as people get older associated with declining health; secondly, nondrinkers (like heavy drinkers) are usually working class, of limited education and in poorer health than regular light drinkers who are the healthiest, wealthiest and fittest group of all3. Taking all this into consideration Shaper concludes that the alcoholinduced reductions in CHD we are talking about are in the region of 1-3 fewer heart attacks per 1000 person years. A minuscule benefit then, and at what cost? For individuals under 50 years of age 20 g of alcohol per day increases all-cause mortality by 15-20%4. Or, as Dr Peter Anderson of the World Health Organization put it, 'to talk about alcohol as though it were some new prophylactic drug is ridiculous and dangerous. In a clinical trial it would fall at the first fence: it's addictive, it impairs neurological function, it increases the risk of violent death, suicide, hypertension, haemorrhagic stroke, cirrhosis, and many cancers and causes huge social problems. Already one-third of men, and one in ten women, in Europe drink more than 20 g per day. In the developed world alcohol is responsible for 3% of all deaths and for 7% of all potential life-years lost. Given that there is a vast panoply of very effective and under-used cardiovascular drugs and that the beneficial effects of alcohol are small and ill-understood, all those present at the Novartis Foundation meeting concurred that global recommendations such as '1-3 drinks per day are good for you' are not only meaningless but also irresponsible. Michael Gaziano (Harvard Medical School), who works on alcohol's impressive ability to raise high density lipoprotein and thus reduce CHD risk by reverse cholesterol transport, was none the less enthusiastic: 'Even if the size of this effect is less than anticipated it could have real implications for society as a whole'. He conceded that, in terms of being able to make recommendations, researchers know about as much about alcohol as they did about cholesterol 40 years ago. What we need now, ifwe are to secure information relevant to healthcare, are more large-scale, tailor-made epidemiological studies with frequent cycles involving all age groups and using modem interviewing techniques. Considering that in some studies almost twice as much alcohol is sold as people admit to consuming, there is also a crying need for a non-invasive bloodalcohol marker to winkle out the truth about how much is really drunk. Until then, the public health message should be that, whatever the effects of light drinking, heavy drinking is bad for