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Background: Population physical activity promotion (PPAP) is one of the most effective noncommunicable disease prevention strategies, yet coordination is lacking around the world. Whole-of-system approaches and complex systems methods are called for to advance PPAP. This paper reports on a project which (1) used an Attributes Framework with system mapping (group model building and causal loop diagramming of feedback loops) and (2) identified potential leverage points to address the challenge of effective coordination of multisectoral PPAP in British Columbia. Methods: Key findings from stakeholder interviews and workshops described the current system for PPAP in terms of attributes and dimensions in the framework. These were translated into variables and used in group model building. Participants prioritized the importance of variables to address the coordination challenge and then created causal loop diagrams in 3 small groups. One collective causal loop diagram was created, and top priority variables and associated feedback loops were highlighted to explore potential leverage points. Results: Leverage points included the relationships and feedback loops among priority variables: political leadership, visible policy support and governance, connectivity for knowledge translation, collaborative multisector grants, multisector collaboration, and integrating co-benefits. Leveraging and altering "vicious" cyclical patterns to increase coordinated multisector PPAP are key. Conclusions: The Attributes Framework, group model building and causal loop diagrams, and emergent feedback loops were useful to explore potential leverage points to address the challenge of multisectoral coordination of PPAP. Future research could apply the same methods in other jurisdictions and compare and contrast resultant frameworks, variables, feedback loops, and leverage points. [ABSTRACT FROM AUTHOR]

Background: National physical activity (PA) policy processes are only beginning to be studied in Latin America, and little attention has focused at the subnational level. This study examined national–subnational relations in the policy process (agenda setting, policy formulation, adoption, implementation, and evaluation) in selected Latin American countries. Methods: The Global Observatory for Physical Activity's (GoPA!) INTEGRATE-PA-Pol tool was applied in Colombia, Costa Rica, Ecuador, and Mexico. Data were collected in matched pairs of the capital plus one noncapital city among national and subnational policymakers (n = 27), previously identified by the GoPA! Country Contacts. PA policy development and implementation were assessed using descriptive statistics. Results: Twenty-three (response rate = 85.2%) informants provided data, mainly from the health sector (52.2%), followed by the sport (26.1%), transport (13.0%), and education (8.7%) sectors. Most informants reported that their countries had a current PA policy embedded within noncommunicable diseases prevention plans (46.2%), other plans (46.2%), or obesity prevention/management/control plans (7.7%). Respondents at the subnational level rated PA promotion as central (64.3%), while the national-level role was important but not central (75.0%). National and subnational policymakers indicated low-to-little involvement in the other level's PA policy processes across the 5 policy stages. Conclusions: This study demonstrated that collecting national and subnational PA policy data across countries with the active collaboration of the GoPA! network was feasible. We also successfully identified governmental interactions throughout the PA policy process, suggesting suboptimal engagement between national and subnational levels. [ABSTRACT FROM AUTHOR]

Objective: To explore physical activity (PA) and sedentary behaviors (SB) in individuals with lower limb (LL) Osteoarthritis (OA) and the influence of age, sex, and body mass index (BMI) on these behaviors. Design: Systematic review search: PubMed, Cochrane Library, ScienceDirect, and CINAHL databases were searched from inception until July 2023. Study criteria: Studies that reported quantifiable device-based or self-reported data for PA and SB variables in adults clinically diagnosed with LL OA were included. Data synthesis: A synthesis of PA and SB levels for those diagnosed with LL OA and the influence age, sex, and BMI have on these behaviors. Results: From the 1930 studies identified through the electronic search process, 48 met the inclusion criteria. PA guidelines were met by 33% of the sample population that measured moderate and moderate to vigorous PA. No studies reported 75 minutes per week or more of vigorous PA. Additionally, 58% of the population reporting SB were sedentary for 8 hours per day or more. Also, increasing age, BMI, and the female sex were identified as negative influences on PA levels. There were numerous methodological inconsistencies in how data were collected and reported, such as various activity monitor cut points for PA and SB bout duration. Conclusion: Adults with LL OA may be at an increased risk of noncommunicable diseases due to low PA and high SB levels. It is important to consider age, sex, and BMI when investigating behavior patterns in those with LL OA. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chronic diseases, or non-communicable diseases (NCD), are conditions of long duration and often influenced and contributed by complex interactions of several variables, including genetic, physiological, environmental, and behavioral factors. These conditions contribute to death, disability, and subsequent health care costs. Primary and secondary school settings provide an opportunity to deliver relatively low cost and effective interventions to improve public health outcomes. However, there lacks systematic evidence on the cost-effectiveness of these interventions. METHODS: We systematically searched four databases (PubMed/Medline, Cochrane, Embase, and Web of Science) for published studies on the cost-effectiveness of chronic-disease interventions in school settings. Studies were eligible for inclusion if they assessed interventions of any chronic or non-communicable disease, were conducted in a school setting, undertook a full cost-effectiveness analysis and were available in English, Spanish, or French. RESULTS: Our review identified 1029 articles during our initial search of the databases, and after screening, 33 studies were included in our final analysis. The most used effectiveness outcome measures were summary effectiveness units such as quality-adjusted life years (QALYs) (22 articles; 67%) or disability-adjusted life years (DALYs) (4 articles; 12%). The most common health condition for which an intervention targets is overweight and obesity. Almost all school-based interventions were found to be cost-effective (30 articles; 81%). CONCLUSION: Our review found evidence to support a number of cost-effective school-based interventions targeting NCDs focused on vaccination, routine physical activity, and supplement delivery interventions. Conversely, many classroom-based cognitive behavioral therapy for mental health and certain multi-component interventions for obesity were not found to be cost-effective.

BACKGROUND: In response to the COVID-19 pandemic, educational institutions had to swiftly adapt and transition to remote teaching in order to maintain academic activities. However, these changes presented a number of challenges for professors, which could have negative effects on their health. OBJECTIVE: To analyze the association between changes in dietary and sleep habits, physical activity level, and sedentary behavior with the development of non-communicable diseases (NCDs) among Brazilian higher education professors during the pandemic period. METHODS: This is a cross-sectional and retrospective study conducted using an online form. Generalized linear models, adjusted for age, sex, and body mass index, were used to verify the difference between pre-pandemic and pandemic periods. Logistic regression models were used to predict the odds ratio (OR) for the development of NCDs according to physical activity time, sedentary behavior time, dietary and sleep patterns. RESULTS: A total of 936 professors residing across Brazil participated in the survey. The duration of sedentary behavior increased, sleep duration slightly decreased, and meal times shifted to earlier during the pandemic. A total of 22.9%of the participants reported the diagnosis of some NCDs during this period. Physical activity practice was associated with a lower risk of diseases during the pandemic, regardless of the intensity performed. On the other hand, late eating habits and excessive food consumption during the pandemic were associated with a higher risk. CONCLUSION: The results provide data that can help in the development of public policies that promote health actions to minimize the consequences associated with the pandemic period. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is a major non-communicable disease globally, with increasing prevalence, posing a significant public health challenge. It is the leading non-obstetric cause of perinatal morbidity and mortality, with a substantial number of cardiac fatalities occurring in individuals without any known pre-existing cardiovascular disease. Peripartum cardiomyopathy is a type of de novo heart failure that occurs in pregnant women in the late stages of pregnancy or following delivery. Despite extensive research, diagnosing and managing peripartum cardiomyopathy remains challenging, resulting in significant morbidity and mortality. Recent advancements and novel approaches have been made to better understand and manage peripartum cardiomyopathy, including molecular and non-molecular biomarkers, genetic predisposition and risk prediction, targeted therapies, multidisciplinary care, and improved patient education. This narrative review provides a comprehensive overview and new perspectives on peripartum cardiomyopathy, covering its epidemiology, updated pathophysiological mechanisms, diagnosis, management, and future research directions for healthcare professionals, researchers, and clinicians. [ABSTRACT FROM AUTHOR]

Background: Dental attendance is important for the prevention, diagnosis, and treatment of oral diseases. In this study, we aimed to assess the extent of the association between dental visits, inadequate oral health, and multimorbidity (MM), and whether this association differs by age and sex. Methods: We conducted a cross-sectional analysis of the first follow-up wave (2018) of the Canadian Longitudinal Study on Aging (CLSA). Poor self-reported oral health (SROH), oral health problems, and edentulism were used to indicate inadequate oral health. MM was defined as having 2 or more chronic conditions out of cancer, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental illnesses. Dental visiting was determined as the number of visits to a dental professional within the past 12 months. Covariates included socioeconomic, behavioural factors, and the availability of dental insurance. We constructed multivariable Poisson and logistic regression models with interactions terms and estimated the relative excess risk due to interaction prevalence ratio (RERIPR) to assess the effect measure modification of age and sex on the associations of interest. We conducted sensitivity analyses and estimated E-values for unmeasured confounding. Results: In this sample (n = 44,815), dental visiting was inversely associated with inadequate oral health and MM in adjusted models, reducing the odds/prevalence of poor SROH (OR 0.41, 95% CI 0.34, 0.51), oral health problems (PR 0.89, 95% CI 0.79, 0.94), edentulism (OR 0.10, 95% CI 0.06, 0.15), and MM (PR 0.86, 95% CI 0.79, 0.92). These associations were stronger in older age and females. Conclusion: Dental visiting may contribute to better oral health and reduced chronic diseases in the middle-aged and older population. Our findings suggest the need for age and sex-specific targeted interventions to optimize oral and overall health. [ABSTRACT FROM AUTHOR]

Background: Diabetes is one of the leading causes of noncommunicable diseases worldwide. It is known to induce cardiovascular remodeling, which can result in a variety of complications, including a considerable increase in aortic stiffness. While studies in Western populations have explored these effects, data on Asians, mainly Vietnamese, are limited. This study aimed to assess aortic elasticity in type 2 diabetes mellitus (T2DM) patients compared to healthy individuals. Methods: This quantitative, cross-sectional study compared aortic elasticity indices between individuals with T2DM and healthy controls in Vietnam. Aortic elasticity indices were assessed for all participants using M-mode echocardiography. Results: A comparison between the healthy and T2DM groups revealed substantial differences in aortic elasticity indices. The aortic stiffness index (ASI) was significantly greater in the T2DM group than in the control group, with median values of 6.10 (3.64–12.47) and 3.79 (2.40–8.50), respectively (p = 0.003). Aortic strain (AS) was substantially lower in the T2DM group than in the control group, with median values of 8.21% (4.24–13.07) and 10.66% (6.01–18.23), respectively (p = 0.039). Furthermore, the median aortic compliance (AC, 10-2mm/mmHg) and aortic distensibility (AD, 10-3mmHg-1) in individuals with T2DM were 4.07 (2.28–7.44) and 3.08 (1.57–5.26), respectively, lower than those in the control group, with median values of 6.40 (3.08–10.75) and 5.33 (2.80–9.79). A longer diabetes duration was linked to a greater ASI (r = 0.43, p < 0.05), while the AS decreased (r = -0.37, p < 0.05). Conclusions: Substantial variations in aorta elasticity indices were found in patients with T2DM using M-mode echocardiography. These differences highlight the impact of T2DM on vascular health. More research is needed to investigate the consequences of these discrepancies and their significance for clinical purposes. [ABSTRACT FROM AUTHOR]

The prevalence and factors associated with metabolic syndrome (MetS) between men and women in Mongolia were compared using secondary data from the STEPwise approach to non-communicable disease risk factor surveillance conducted in 2019. In total, 5,695 participants (2,577 males and 3,118 females) aged 18–69 years old were enrolled in the study. The prevalence of MetS was 37.4% in total and the prevalence was significantly higher in women (39.2%) than men (35.2%, P = 0.002). The most prevalent MetS components were abdominal obesity in women (74.2%) and high blood glucose levels in men (58.7%). All of the 2,128 participants who were categorized into MetS met the criteria of abdominal obesity. Factors associated with MetS included being 30–69 years old compared to 18–29 years old, low and moderate physical activity levels compared to high levels, history of hypertension and diabetes mellitus, and a high body mass index (overweight and obesity) compared to a normal body mass index in both sexes. Additional factors included Buryat ethnicity compared to Khalkh ethnicity, living in Ulaanbaatar, no education compared to primary education, higher monthly income, and currently drinking in men; and smoking and sufficient fruit and vegetable intake in women. Significant differences were observed between men and women in terms of the prevalence of MetS, components of MetS, and factors associated with MetS. To reduce MetS prevalence in Mongolia, sex-specific programs should be designed to promote health behavior, such as reducing alcohol consumption in men and smoking in women. [ABSTRACT FROM AUTHOR]

Background: Immunosuppressive therapies are associated with a risk of infections. Nevertheless, their incidence in this population remains unclear. This study aims to determine the incidence of serious respiratory tract infections (SRI) in a population exposed to immunosuppressive therapies. Methods: Data from a representative sample of the French healthcare claims from 01/01/2014 to 12/31/2019 were analyzed. Exposure to immunosuppressive therapy was defined by the dispensation of drugs through community pharmacies or in hospitals. SRI diagnosis was based on ICD-10 codes from hospitalization records. A cohort analysis was performed to estimate standardized SRI incidence rates. A nested case-control analysis within this cohort was used to study the characteristics associated with SRI. Results: We identified 24,122 individuals exposed to immunosuppressive therapies, among which 1,559 developed SRI, resulting in a standardized incidence rate of 1,398 per 100,000 person-years. In this population, the risk of SRI was associated with a history of cancer (OR 2.68, 95% Confidence Intervals (CI) 2.24–3.21; p < 0.001), chronic respiratory disease (2.62, 95%CI 2.17–3.16; p < 0.001), end-stage renal failure (2.38, 95%CI 1.37–4.13; p = 0.003), neurodegenerative diseases (1.52, 95%CI 1.07–2.17; p = 0.026), diabetes (1.44, 95%CI 1.14–1.82; p < 0.001), psychiatric diseases (1.27, 95%CI 1.06–1.52; p < 0.001), and cardiovascular diseases (1.26, 95%CI 1.04–1.52; p = 0.002). Compared to corticosteroids alone, the risk of SRI was lower in individuals treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) only (0.44, 95%CI 0.25–0.78; p < 0.001). Conclusion: In the population exposed to immunosuppressive therapies, a history of chronic disease is associated with an increased risk of SRI. This risk is lower in those receiving csDMARD alone than corticosteroids alone. [ABSTRACT FROM AUTHOR]

Background: Pulmonary Tuberculosis (PTB) is a significant global health issue due to its high incidence, drug resistance, contagious nature, and impact on people with compromised immune systems. As mentioned by the World Health Organization (WHO), TB is responsible for more global fatalities than any other infectious illness. On the other side, WHO also claims that noncommunicable diseases (NCDs) kill 41 million people yearly worldwide. In this regard, several studies suggest that PTB and NCDs are linked in various ways and that people with PTB are more likely to acquire NCDs. At the same time, NCDs can increase susceptibility to active TB infection. Furthermore, because of potential drug interactions and therapeutic challenges, treating individuals with both PTB and NCDs can be difficult. This study focuses on seven NCDs (lung cancer (LC), diabetes mellitus (DM), Parkinson's disease (PD), silicosis (SI), chronic kidney disease (CKD), cardiovascular disease (CVD), and rheumatoid arthritis (RA)) and rigorously presents the genetic relationship with PTB regarding shared genes and outlines possible treatment plans. Objectives: BlueThis study aims to identify the drug components that can regulate abnormal gene expression in NCDs. The study will reveal hub genes, potential biomarkers, and drug components associated with hub genes through statistical measures. This will contribute to targeted therapeutic interventions. Methods: Numerous investigations, including protein-protein interaction (PPI), gene regulatory network (GRN), enrichment analysis, physical interaction, and protein-chemical interaction, have been carried out to demonstrate the genetic correlation between PTB and NCDs. During the study, nine shared genes such as TNF, IL10, NLRP3, IL18, IFNG, HMGB1, CXCL8, IL17A, and NFKB1 were discovered between TB and the above-mentioned NCDs, and five hub genes (NFKB1, TNF, CXCL8, NLRP3, and IL10) were selected based on degree values. Results and conclusion: In this study, we found that all of the hub genes are linked with the 10 drug components, and it was observed that aspirin CTD 00005447 was mostly associated with all the other hub genes. This bio-informatics study may help researchers better understand the cause of PTB and its relationship with NCDs, and eventually, this can lead to exploring effective treatment plans. [ABSTRACT FROM AUTHOR]

A disease is a distinct abnormal state that significantly affects the functioning of all or part of an individual and is not caused by external harm. Diseases are frequently understood as medical conditions connected with distinct indications and symptoms. According to a fairly wide categorization, diseases can also be categorized as mental disorders, deficient diseases, genetic diseases, degenerative diseases, self-inflicted diseases, infectious diseases, non-infectious diseases, social diseases, and physical diseases. Prevention of the diseases is of multiple instances. Primary prevention seeks to prevent illness or harm before it ever happens. Secondary prevention tries to lessen the effect of an illness or damage that has already happened. This is done through diagnosing and treating illness or injury as soon as feasible to stop or delay its course, supporting personal ways to avoid recurrence or reinjury, and implementing programs to restore individuals to their previous health and function to prevent long-term difficulties. Tertiary prevention tries to lessen the impact of a continuing sickness or injury that has enduring repercussions. Diagnosis of the disease at an earlier stage is important for the treatment of the disease. Hence, in this study, deep learning algorithms, such as VGG16, EfficientNetB4, and ResNet, are utilized to diagnose various diseases, such as Alzheimer's, brain tumors, skin diseases, and lung diseases. Chest X-rays, MRI scans, CT scans, and skin lesions are used to diagnose the mentioned diseases. Transfer learning algorithms, such as VGG16, VGG19, ResNet, InceptionV3, and EfficientNetB4, are utilized to categorize various diseases. EfficientNetB4 with the learning rate annealing, having obtained an accuracy of 94.04% on the test dataset, is observed. As a consequence, we observed that every network has unique particular skills on the multi-disease dataset, which includes chest X-rays, MRI scans, etc., [ABSTRACT FROM AUTHOR]

Background: Although national food guides are designed, ostensibly, to translate scientific evidence with respect to food, dietary patterns, and health, their development has increasingly become a corporate/political process as well as scientific one; often with corporate/political influences overriding science. Our aim was to construct an unbiased, sustainable, evidence-informed Universal Food Guide to serve as a template for countries to develop their unique guides, thereby, provide a valid resource for health professionals, health authorities, and the public. Methods: To address our aim, we conducted an integrative review of multiple evidence-informed sources (e.g., established databases, evidence syntheses, scholarly treatises, and policy documents) related to four areas: 1. Food guides' utility and conflicts of interest; 2. The evidence-based healthiest diet; 3. Constituents of the Universal Food Guide template; and 4. Implications for population health; regulation/governance; environment/climate/planetary health; and ethics. Results: The eating pattern that is healthiest for humans (i.e., most natural, and associated with maximal health across the life cycle; reduced non-communicable disease (NCD) risk; and minimal end-of-life illness) is whole food, low fat, plant-based, especially vegan, with the absence of ultra-processed food. Disparities in national food guide recommendations can be explained by factors other than science, specifically, corporate/political interests reflected in heavily government-subsidized, animal-sourced products; and trends toward dominance of daily consumption of processed/ultra-processed foods. Both trends have well-documented adverse consequences, i.e., NCDs and endangered environmental/planetary health. Commitment to an evidence-informed plant-based eating pattern, particularly vegan, will reduce risks/manifestations of NCDs; inform healthy food and nutrition policy regulation/governance; support sustainable environment/climate and planetary health; and is ethical with respect to 'best' evidence-based practice, and human and animal welfare. Conclusion: The Universal Food Guide that serves as a template for national food guides is both urgent and timely given the well-documented health-harming influences that corporate stakeholders/politicians and advisory committees with conflicts of interest, exert on national food guides. Such influence contributes to the largely-preventable NCDs and environmental issues. Policy makers, health professionals, and the public need unbiased, scientific evidence as informed by the Universal Food Guide, to inform their recommendations and choices. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases can be controlled and managed by reducing their associated metabolic risk factors. In this study, a set of intervention packages were designed to reduce the prevalence of three common metabolic risk factors (hypertension, hyperlipidemia, and obesity and overweight) in the community by motivating non-physician health workers. Methods: A field trial study was conducted in 4 districts of Iran. Thirty-two community health centers were randomly selected. A survey of 30 to 70-year-old was conducted to measure baseline metabolic risk factors. The intervention packages focused on improving hypertension, hyperlipidemia, obesity and overweight. The interventions included goal-setting, evidence-based education, operational planning, and incentive payments for non-physician health workers. A second survey to measure the final metabolic risk factors was performed after one year. The difference-in-difference method was used to evaluate the effectiveness of the intervention packages. Results: The average age of participants in both surveys was 49 years. The interventions had statistically significant effects only on decreasing the prevalence of overweight and obesity. The package with all the interventions except pay-for-performance decreased the odds of overweight and obesity to 0.57 (95% CI: 0.34, 0.95). Conclusions: Involving non-physician health workers and having action plans based on the health needs of the covered population can decrease obesity and overweight in the community. However, longer trials are needed to observe the effects on hypertension and hyperlipidemia. [ABSTRACT FROM AUTHOR]

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, non-infectious inflammatory disease with a prevalence of 1 to 2/106, causing multiple lytic bone lesions. There are no established protocols for treating CRMO; thus, current practice is largely empirical. Data on the use of zoledronic acid (ZA) in juvenile CRMO are scarce. A 12-year-old male child with a history of multiple aseptic osteomylitis, affecting the chest wall, right ankle, and wrist, had no fever. Cultures and a bone biopsy ruled out infection or malignancy. The patient's condition stayed stable while taking naproxen (20 mg/kg/day) and methotrexate (10 mg/week) for 1.5 years until he experienced right elbow pain, swelling, no overlying skin erythema, and a restricted range of motion. The laboratory tests all came back normal, including white blood cell (WBC) count, erythrocyte sedimentation rate, C-reactive protein, and immunoglobin assays. The magnetic resonance imaging showed a focal lesion in the medial humeral condyle with increased signal intensity on T2 and short tau inversion recovery, mild joint effusion, and no cortical break. Thus, intravenous ZA infusion commenced at 0.0125 mg/kg initially, followed by 0.025 mg/kg 3 months later, with a marked improvement in the patient's clinical symptoms and radiological findings. Non-steroidal anti-inflammatory drugs and methotrexate were initially effective in treating our patient's condition, but a recurrence necessitated treatment modification. To the best of our knowledge, this case is the first documented instance of the use of ZA in CRMO in Iraq and Arab nations. [ABSTRACT FROM AUTHOR]

Introduction: Currently, mortality by non-communicable diseases is increasing alarmingly. They account for approximately 35 million deaths each year, of which 14% are due to cardiovascular disease and 9.2% occur in Africa. Patients do not have access to healthcare services outside the healthcare setting, resulting in missed follow-ups and appointments and adverse outcomes. This study aimed to assess the willingness to use remote monitoring among cardiovascular patients in a resource-limited setting in Ethiopia. Method: An institution-based cross-sectional study was conducted from April to June 2021 among cardiovascular patients at referral hospitals in Ethiopia. A structured interview questionnaire was used to collect the data. A systematic random sampling technique was used to select 397 study participants. Binary and multivariable logistic regression analyses were employed and a 95% confidence level with a p-value <0.05 was used to determine the level of association between variables. Result: In total, 81.61% of the study participants were willing to use remote patient monitoring [95% confidence interval (CI) = 77.4%-85.1%]. Age [adjusted odds ratio (AOR) = 0.94; 95% CI: 0.90-0.98], having a mobile phone (AOR = 5.70; 95% CI: 1.86-17.22), and perceived usefulness (AOR = 1.50; 95% CI: 1.18-1.82) were significantly associated with willingness to use remote patient monitoring among cardiovascular patients. Conclusion: Cardiovascular patients had a high willingness to use remote patient monitoring. Age, perceived usefulness of remote patient monitoring, and having a mobile phone were significantly associated with a willingness to use remote patient monitoring. [ABSTRACT FROM AUTHOR]

Background: The burden of chronic non-communicable diseases (NCDs) is a growing public health concern. The availability of cost-of-illness data, particularly public healthcare costs for NCDs, is limited in Sub-Saharan Africa (SSA), yet such data evidence is needed for policy action. Objective: The objective of this study was to estimate the economic burden of type 2 diabetes (T2D) on Kenya's public healthcare system in 2021 and project costs for 2045. Methods: This was a cost-of-illness study using the prevalence-based bottom-up costing approach to estimate the economic burden of T2D in the year 2021. We further conducted projections on the estimated costs for the year 2045. The costs were estimated corresponding to the care, treatment, and management of diabetes and some diabetes complications based on the primary data collected from six healthcare facilities in Nairobi and secondary costing data from previous costing studies in low and middle-income countries (LMICs). The data capture and costing analysis were done in Microsoft Excel 16, and sensitivity analysis was conducted on all the parameters to estimate the cost changes. Results: The total cost of managing T2D for the healthcare system in Kenya was estimated to be US$ 635 million (KES 74,521 million) in 2021. This was an increase of US$ 2 million (KES 197 million) considering the screening costs of undiagnosed T2D in the country. The major cost driver representing 59% of the overall costs was attributed to T2D complications, with nephropathy having the highest estimated costs of care and management (US$ 332 million (KES 36, 457 million). The total cost for T2D was projected to rise to US$ 1.6 billion (KES 177 billion) in 2045. Conclusion: This study shows that T2D imposes a huge burden on Kenya's healthcare system. There is a need for government and societal action to develop and implement policies that prevent T2D, and appropriately plan care for those diagnosed with T2D. [ABSTRACT FROM AUTHOR]

Introduction: The intersection of infectious diseases, such as HIV, with chronic conditions like hypertension and diabetes poses a significant challenge in global health. While advancements in antiretroviral therapy have transformed HIV into a manageable chronic condition, a growing number of individuals with HIV now grapple with coexisting non-communicable diseases, impacting their Health-Related Quality of Life (HRQoL). Despite strides in HIV care, there is a notable policy gap that undermines efforts to address HIV-associated co-morbidities, particularly hypertension and diabetes, especially efforts to improve access, early detection, and ultimately HRQoL for individuals with HIV and co-morbidities. This study seeks to explore policy interventions aimed at improving the quality of life of HIV patients with hypertension or diabetes. Methods: The study utilized a qualitative descriptive design to explore the experiences and perspectives of healthcare professionals and support staff regarding policy interventions for managing HIV patients with hypertension and/or diabetes co-morbidities in three regions of Ghana. The research was conducted in the Upper West, Ashanti, and Greater Accra regions among 11 participants, chosen purposively from professions involved in HIV patient care to understand their views on the implementation of policy interventions to HRQoL for individuals with HIV and co-morbidities. In-depth interviews were conducted face-to-face and tape-recorded. Thematic analysis approach was used to analyze the data. Results: The study involved 11 participants from three regions with varied years of experience. Implemented policies that potentially improve the HRQoL for individuals with HIV and co-morbidities involve support groups, home visits, provision of free drugs, and counselling. Barriers to policy implementation included non-adherence to medication, stigma, cost of non-communicable diseases (NCDs) medications, accessibility issues to NCDs services, lack of interest or understanding among implementers, and high staff turnover. Facilitators encompassed in-service training, guidelines in common platforms, knowledge sharing, external resources, regular check-ups, and motivational packages for patients. Conclusion: Individuals with HIV and comorbidities face complex challenges impacting their HRQoL, including emotional and financial dimensions. The study identifies critical policies and barriers, underscoring the need for tailored, patient-centered approaches. Facilitators like in-service training and regular check-ups offer actionable insights for effective policy implementation, emphasizing improved health outcomes for those with comorbid conditions. The study recommends integrated care approach and adherence support programs that address the unique challenges faced by people living with HIV. [ABSTRACT FROM AUTHOR]

Background: Language plays a critical role in health communication, particularly in the management and understanding of non-communicable diseases (NCDs) among elderly populations. This study aimed to explore the language barriers that affect elderly participants' comprehension of NCDs, focusing on how these barriers impact their understanding of disease causes, symptoms, treatment, and self-management. The study also investigated how linguistic differences between healthcare workers and patients influence the effectiveness of health interventions in a rural South African context. Methods: This qualitative phenomenological study was conducted with elderly participants aged 60 years and above, all of whom have chronic diseases. In-depth face-to-face interviews were conducted using an interview guide during the AWI-Gen 2 research feedback sessions in the Ga-Dikgale area. Data analysis was performed using QSR NVivo 10 to identify key themes. Results: Five major themes emerged regarding participants' understanding of NCDs and the perceived language barriers. These include Limited Knowledge and Awareness of NCDs, Misconceptions about NCDs, Mixed perceptions regarding NCD causes and treatment, Discrepancies in healthcare workers' communication, and the Importance of interpreters in facilitating NCD-related communication. Conclusion: The study revealed significant misconceptions about diabetes and hypertension, as well as traditional practices like bloodletting, which were perceived to relieve hypertension symptoms. It also identified critical communication barriers, including limited time for health practitioners to explain diagnoses and treatments. The findings emphasize the need for interpreters and culturally sensitive communication strategies to improve health literacy and care. Collaborative efforts between traditional and western health practitioners are recommended to address these issues and enhance community health interventions. [ABSTRACT FROM AUTHOR]

Background: Access to essential diagnostics is crucial for primary healthcare (PHC) in low-and-middle income countries (LMICs). Many LMICs have invested in equipping PHC with point-of-care (PoC) diagnostics for infectious diseases, however there has been no similar investment to improve PHC capacities for clinical chemistry. The biochemistry gap is among the deterrents to universal health coverage. Methods: A social sciences project was conducted with the aim to understand the key PHC stakeholders' insights on the pertinence of PoC biochemistry for PHC in LMICs. Data generation was conducted between July-November 2023 in Mongolia, Nigeria and Peru. Decision-makers in healthcare delivery, healthcare professionals, and patient and community advocates were engaged using a combination of sampling techniques. Unstructured individual and group conversations, and non-participant observation were conducted. Analysis involved an inductive line-by-line coding on printed transcripts, followed by a deductive coding and theme-by-theme analysis on digitized transcripts. Results: Fifteen, 51 and 20 informants from Mongolia, Nigeria and Peru, respectively, participated. Fifty-five of the 94 informants were female. Most informants considered that PoC biochemistry in PHC would be pertinent, from a clinical and a resources-saving perspective. Those households that currently bear the burden of referrals (i.e., the poor, the bedridden, the older adults) would benefit the most from the deployment of PoC biochemistry for essential biochemistry parameters. Improved access to PoC glycated hemoglobin (HbA1c), lipid, liver and kidney profile was perceived as helpful to inform clinicians' decision-taking. The value of PoC biochemistry for the management of noncommunicable diseases (diabetes, hypertension) and infectious conditions (dengue, malaria, tuberculosis), to improve child health outcomes (severe dehydration in children with diarrhea and/or malnutrition) and to reduce preventable causes of death (dengue-related renal failure) was highlighted. Conclusions: PoC biochemistry holds potential to revert the impact that the biochemistry gap has for patient care in some LMICs' PHC settings. PoC equipment for parameters such as HbA1c, urea, creatinine or electrolytes could enhance community-level management of preventable causes of mortality, improve service delivery for patients affected by locally-prevalent infectious conditions, and improve the psychosocial and economic wellbeing of patients facing the burden of referrals to remote biochemistry-equipped centers. Trial Registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: The most frequent risks of noncommunicable diseases include tobacco use, harmful use of alcohol, unhealthy diet, and physical inactivity. In low-income countries, it is not fully understood how serious these risk factors are. To address the issue at the risk factor level, it is essential to produce evidence that aids in the development of policies and initiatives in the area. This review is aimed to estimate the pooled prevalence of noncommunicable disease behavioral risk factors in Sub-Saharan Africa. Methods: Studies published between 2016 and 2023 will be located using searches of the electronic databases PubMed, CINAHL, and African Index Medicus as well as Google and Google Scholar. Two authors will independently review the records, and information will be taken from studies that present statistics on the prevalence of tobacco use, alcohol use, unhealthy diet, and insufficient physical activity among people older than 18 years. Using the I2 and Q statistics, heterogeneity between studies will be evaluated, and it will be investigated using subgroup analyses and meta-regressions. Random effects meta-analysis model will be used and subgroup analysis will be performed by country, study design, and study year. Discussion: The burden of noncommunicable disease risk factors varies throughout the Sub-Saharan Africa. The review will be essential for both research and policy. The finding may even help to identify settings or subgroups of the population where noncommunicable diseases is of higher concern and help to set prevention priorities, to optimize resource allocation, and guide future research to fill knowledge gaps. The protocol has been registered in PROSPERO (CRD42023431348). [ABSTRACT FROM AUTHOR]

Cyanobacteria, especially Arthrospira, are valuable resources of nutrients and natural pigments with many beneficial health-related properties. This study optimized the extraction conditions of Arthrospira to achieve high phenolic contents and antioxidant activities. Under optimized extraction conditions, the bioactive compounds (phenolics and pigment components), antioxidant activities, and inhibitions of the key enzymes relevant to some non-communicable diseases were compared between Arthrospira platensis and Arthrospira maxima. Optimized extraction conditions were determined as 2 h shaking time, 50 °C extraction temperature, and 1% (w/v) solid-to-liquid ratio, giving effective phenolic and phycocyanin contents using aqueous extraction, while 80% (v/v) aqueous ethanolic extraction provided high total chlorophyll content. Most antioxidant activities were higher using 80% (v/v) aqueous ethanolic extracts. Both Arthrospira species inhibited the key enzymes involved in controlling non-communicable diseases including hyperlipidemia (lipase), diabetes (α-amylase, α-glucosidase, and dipeptidyl peptidase-IV), Alzheimer's disease (acetylcholinesterase, butyrylcholinesterase and β-secretase), and hypertension (angiotensin-converting enzyme). High inhibitory activities were detected against β-secretase (BACE-1), the enzyme responsible for β-amyloid plaque formation in the brain that acts as a significant hallmark of Alzheimer's disease. Arthrospira extract and donepezil (Alzheimer's disease drug) synergistically inhibited BACE-1, suggesting the potential of Arthrospira extracts as effective BACE-1 inhibitors. Interestingly, A. maxima exhibited higher bioactive compound contents, antioxidant activities, and key enzyme inhibitions than A. platensis, indicating high potential for future food and medicinal applications. [ABSTRACT FROM AUTHOR]

Introduction: Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, accounting for 74% of deaths annually. Satellite imagery provides previously unattainable data about factors related to NCDs that overcome limitations of traditional, non-satellite-derived environmental data, such as subjectivity and requirements of a smaller geographic area of focus. This systematic literature review determined how satellite imagery has been used to address the top NCDs in the world, including cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. Methods: A literature search was performed using PubMed (including MEDLINE), CINAHL, Web of Science, Science Direct, Green FILE, and Engineering Village for articles published through June 6, 2023. Quantitative, qualitative, and mixed-methods peer-reviewed studies about satellite imagery in the context of the top NCDs (cancer, cardiovascular disease, chronic respiratory disease, and diabetes) were included. Articles were assessed for quality using the criteria from the Oxford Centre for Evidence-Based Medicine. Results: A total of 43 studies were included, including 5 prospective comparative cohort trials, 22 retrospective cohort studies, and 16 cross-sectional studies. Country economies of the included studies were 72% high-income, 16% upper-middle-income, 9% lower-middle-income, and 0% low-income. One study was global. 93% of the studies found an association between the satellite data and NCD outcome(s). A variety of methods were used to extract satellite data, with the main methods being using publicly available algorithms (79.1%), preprocessing techniques (34.9%), external resource tools (30.2%) and publicly available models (13.9%). All four NCD types examined appeared in at least 20% of the studies. Conclusion: Researchers have demonstrated they can successfully use satellite imagery data to investigate the world's top NCDs. However, given the rapid increase in satellite technology and artificial intelligence, much of satellite imagery used to address NCDs remains largely untapped. In particular, with most existing studies focusing on high-income countries, future research should use satellite data, to overcome limitations of traditional data, from lower-income countries which have a greater burden of morbidity and mortality from NCDs. Furthermore, creating and refining effective methods to extract and process satellite data may facilitate satellite data's use among scientists studying NCDs worldwide. [ABSTRACT FROM AUTHOR]

Optimizing 24-hour movement behaviors (physical activity (PA), sleep and sedentary time (ST)) is crucial for the prevention of non-communicable diseases (NCDs). However, the association of 24-hour movement behaviors with NCD risk remains largely obscured in low-middle-income countries. The present study aimed to explore the association between 24-hour movement behaviors and the occurrence of NCDs. An online survey was administered among 310 community-dwelling adults (age 18–65 years) of coastal Karnataka, enquiring sociodemographic profiles, 24-hour movement behaviors and presence of NCD. While spending 33% of daily time in sleep, the respondents spent 30% in light-intensity PA (LIPA), 19% in sedentary and 18% in moderate–vigorous PA (MVPA). Multivariate regression revealed that higher sleep time was significantly associated with higher odds of NCDs (estimate, β = 0.20, odds ratio = 0.82, p < 0.05). However, no significant associations were found for other 24-hour movement behaviors with NCD risk [ST (β = 0.12, p = 0.122), LIPA (β = −0.01, p = 0.184) and MVPA (β = −0.01, p = 0.357)]. Subgroup analyses showed that age and body mass were positively associated with NCDs, while lower socio-economic status was associated with lower sitting time (β = −3.84, p = 0.009) and lower LIPA (−318.49, p = 0.018). Higher age, body mass index and long sleep hours were associated with higher risk of NCDs. These findings may necessitate the inclusion of optimal sleep hours and body mass in health promotion guidelines to prevent chronic diseases among the regional population of coastal Karnataka. [ABSTRACT FROM AUTHOR]

Malnutrition early in life increases the later-life risk of noncommunicable diseases, and previous epidemiologic studies have found a link between famine and renal impairment, but no consensus has been reached. This meta-analysis and systematic review were conducted to assess the correlation between early-life famine exposure and the risk of developing renal impairment. Search in Embase, Scopus, Web of Science, PubMed, and Cochrane using keywords that report the correlation between early famine exposure and renal function indicators. RevMan and Stata software were used for data analysis. This meta-analysis contained twelve observational studies. The findings demonstrated a link between prenatal famine exposure and a higher risk of developing chronic kidney disease (CKD) (odds ratio (OR) = 1.73, 95% confidence interval (CI): 1.25, 2.39), a decreased estimated glomerular filtration rate (eGFR) (mean difference (MD) = −10.05, 95% CI: −11.64, −8.46), and increased serum creatinine (Scr) (MD = 0.02, 95% CI: 0.01, 0.03) compared to unexposed individuals. Famine exposure in childhood was associated with decreased eGFR (MD = −9.43, 95% CI: −12.01, −6.84) and increased Scr (MD = 0.03, 95% CI: 0.01, 0.04), but not with CKD (OR = 0.980, 95% CI: 0.53, 1.81). Famine exposure in adolescence and adulthood was associated with decreased eGFR (MD = −20.73, 95% CI: −22.40, −19.06). Evidence certainty was deemed to be of low or extremely low quality. Famine exposure early in life could pose a greater risk of developing renal impairment in adulthood, but this outcome may be driven by uncontrolled age differences between famine-births and post-famine-births (unexposed). [ABSTRACT FROM AUTHOR]

The prevalence of many chronic noncommunicable diseases has been steadily rising over the past six decades. During this time, over 350,000 new chemical substances have been introduced to the lives of humans. In recent years, the epithelial barrier theory came to light explaining the growing prevalence and exacerbations of these diseases worldwide. It attributes their onset to a functionally impaired epithelial barrier triggered by the toxicity of the exposed substances, associated with microbial dysbiosis, immune system activation, and inflammation. Diseases encompassed by the epithelial barrier theory share common features such as an increased prevalence after the 1960s or 2000s that cannot (solely) be accounted for by the emergence of improved diagnostic methods. Other common traits include epithelial barrier defects, microbial dysbiosis with loss of commensals and colonization of opportunistic pathogens, and circulating inflammatory cells and cytokines. In addition, practically unrelated diseases that fulfill these criteria have started to emerge as multimorbidities during the last decades. Here, we provide a comprehensive overview of diseases encompassed by the epithelial barrier theory and discuss evidence and similarities for their epidemiology, genetic susceptibility, epithelial barrier dysfunction, microbial dysbiosis, and tissue inflammation. [ABSTRACT FROM AUTHOR]

Background: Promoting health equity has been a worldwide goal, but serious challenges remain globally and within China. Multiple decomposition of the sources and determinants of health inequalities has significant implications for narrowing health inequalities and improve health equity. Methods: Life expectancy (LE), healthy life expectancy (HALE), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rates in 31 provinces of mainland China were selected as health status indicators, obtained from the Global Burden of Disease (GBD) database. Temporal convergence analysis was used to test the evolving trends of health status. Dagum's Gini coefficient decomposition was used to decompose the overall Gini coefficient based on intraregional and interregional differences. Oaxaca-Blinder decomposition was used to calculate contributions of determinants to interregional differences. The factor-decomposed Gini coefficient was used to analyze the absolute and marginal contribution of each component to overall Gini coefficients. Results: From 1990-2019, China witnessed notable improvements in health status measured by LE, HALE, ASMR and age-standardized DALY rates.Nevertheless, the three regions (East, Central and West) exhibited significant inter-regional differences in health status, with the differences between the East and West being the largest. The adjusted short-term conditional β-convergence model indicated that the inter-provincial differences in LE, HALE, ASMR, and age-standardized DALY rates significantly converged at annual rates of 0.31%, 0.35%, 0.19%, and 0.28% over 30 years. The overall Gini coefficients of LE, HALE, and age-standardized DALY rates decreased, while the ASMR exhibited an opposite trend. Inter-regional and intra-regional differences accounted for >70% and <30% of overall Gini coefficients, respectively. Attribution analysis showed that socioeconomic determinants explained 85.77% to 91.93% of the eastern-western differences between 2010-2019, followed by health system determinants explaining 7.79% to 11.61%. The source-analysis of Gini coefficients of ASMR and age-standardized DALY rates revealed that noncommunicable diseases (NCDs) made the largest and increasing absolute contribution, while communicable, maternal, neonatal, and nutritional diseases (CMNNDs) had a diminishing and lower impact. However, NCDs exerted a negative marginal effect on the Gini coefficient, whereas CMNNDs exhibited a positive marginal effect, indicating that controlling CMNNDs may be more effective in reducing health inequities. Conclusions: Regional differences are a major source of health inequities in China. Prioritizing prevention and control of CMNNDs, rather than NCDs, may yield more pronounced impacts on reducing health inequalities from the perspective of marginal effect, although NCDs remain the largest absolute contributor to health inequalities. [ABSTRACT FROM AUTHOR]

Background: Obesity is a chronic disease characterized by excess body fat and is a risk factor for other chronic non-communicable diseases. Its multifactorial and complex nature makes its management a challenge for health services. This manuscript presents an investigation protocol that aims to analyze the effectiveness of collective nutritional interventions for obesity management applicable to primary health care. Methods: Randomized Controlled Community Trial (RCCT) in a representative sample of users of the Programa Academia de Saúde (PAS), in Belo Horizonte, Minas Gerais, Brazil, with obesity. The research consists of four phases: (1) Screening to identify the participants eligible for the nutritional interventions (individuals with obesity, readiness for change to lose body weight, and willingness and interest to participate in a group activity for six months or more); (2) Baseline to characterize the participants; (3) Implementation of collective nutritional interventions; (4) Reassessment of the participants. Participants in the control group (CG) will receive the usual health service care, and participants in the intervention group (IG) will participate in collective nutritional interventions based on Therapeutic Group 1 (TG1) or Therapeutic Group 2 (TG2) of the "Instructive of Collective Approach for the obesity management in SUS". Discussion: The strengths of the study include its robust RCCT design, which allows for longitudinal analyses and is suitable for investigating causal hypotheses and applying strategies to improve adherence to interventions. Furthermore, the study included a representative sample of a public health service and aims to evaluate therapeutic proposals from the Brazilian Ministry of Health, which can contribute to implementation and extension in the national territory. Trial registration: RBR-3vzsyqq and RBR-6pg682m. [ABSTRACT FROM AUTHOR]

Introduction: Primary health care has regained its importance in global policy making. In 2018, the Government of India initiated the Ayushman Bharat - Comprehensive Primary Health Care (AB-CPHC) programme. It was based on upgrading the existing primary health facilities into Health and Wellness Centers (HWCs). The current study aimed to assess the readiness and performance of HWCs in providing comprehensive primary health care services in India's Chhattisgarh state. Methods: We conducted a cross-sectional health facility assessment with a state-representative sample of 404 HWCs. A standardized health facility survey tool was used to collect information on essential inputs and service outputs of HWCs. The expected population healthcare needs were estimated using secondary sources. The performance of HWCs was assessed by comparing the volume of services provided against the expected population need for outpatient care. Results: On an average, 358 outpatients including 128 non-communicable disease (NCD) patients were treated monthly at an HWC. HWCs were able to cover 31% of the total population's health need for outpatient care, 26% for hypertension, and 21% for diabetes care. In addition to services for reproductive and child health, HWCs provided services for common acute ailments (cold, cough, fever, aches and pains); infections of skin, eye, ear, and reproductive tract, and minor injuries. HWCs were also contributing significantly to national disease control programmes. Acute ailments followed by NCDs and communicable diseases had the largest share among services provided. The key gaps were in coverage of mental illnesses and chronic respiratory diseases. Most of the HWCs showed adequate readiness for the availability of required human resources, supplies, and infrastructure. Conclusion: HWCs were able to provide a comprehensive range of primary care services and able to cater to a sizable portion of the rural population's acute and chronic health care needs. The performance was made possible by the adequate availability of medicines, staff, training programmes and tele-consultation linkages. If HWCs in other states are able to reach a similar level of performance, the initiative will prove to be a game changer for equitable primary care in India. [ABSTRACT FROM AUTHOR]

Background: In Europe, mortality rates from noncommunicable diseases (NCDs) among persons 30–69 years of age ("NCD premature mortality rates") have declined significantly, except in twelve countries of Eastern Europe and Central Asia, namely Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. Data on long-term trends in NCD mortality in these countries are limited. We analyzed NCD premature mortality rates, identified change points in NCD mortality trends and forecasted how likely countries are to achieve the global NCD targets, stratified by gender and NCD type. Methods: We used the 1990–2019 Global Burden of Disease database to analyze NCD trends and identified country-specific change points by using piecewise linear regression. We assessed the likelihood of achieving the global targets for reducing NCD premature mortality rates among persons 30–69 years of age from four NCDs: cancers, diabetes, cardiovascular and chronic respiratory diseases. The global NCD targets are 25% reduction in mortality from 2010 to 2025 (WHO 25X25 target) and 33%—from 2015 to 2030 (SDG 3.4.1). We applied the analysis to both genders and four NCDs. Results: Only Kazakhstan and Russia are likely to achieve the global NCD targets. For Kazakhstan, WHO 25X25 and SDG 3.4.1 global targets for mortality rates were 494.3 and 374.8 per 100,000 population respectively; the corresponding predicted values (PVs) were 360.6 [CI 260.1–461.1] and 245.1 [CI 113.4–376.8]. For Russia, WHO 25X25 and SDG 3.4.1 global targets were 560.5 and 442.8 per 100,000 population respectively; the corresponding PVs were 427.7 [CI 270.3–585.1] and 311.0 [CI 102.8–519.1]. Achieving NCD global targets is less likely for Kyrgyzstan, while it is unlikely for the rest of countries. Most countries had higher mortality rates and slower progress among men compared with women. The likelihood of achieving overall global NCD targets was mainly explained by reduction in cardiovascular mortality. Conclusions: In most Eastern Europe and Central Asia countries, progress towards achieving NCD global targets is slow, or there's a reverse trend. Further quantitative and qualitative research is needed to understand the underlying reasons. Separate indicators are needed to monitor trends for cancers, diabetes and chronic respiratory diseases. [ABSTRACT FROM AUTHOR]

This document explores the impact of warfare on cardiovascular health, emphasizing the devastating effects it has on individuals, families, communities, and the environment. It discusses how the use of various weapons in warfare can lead to significant human casualties and long-term health implications. Both civilians and veterans are at a higher risk of cardiovascular diseases and related risk factors due to war-related stressors and traumatic injuries. The document also highlights the long-term effects of wartime stress on mental and physical health. The authors advocate for global efforts to de-escalate armed conflicts and prioritize the health of affected populations through comprehensive healthcare systems and peace-building initiatives. [Extracted from the article]

Background: To mitigate the growing burden of non-communicable diseases, doctors training to become paediatricians should be equipped with concepts and knowledge regarding Developmental Origins of Health and Disease (DOHaD). Methods: We assessed the knowledge, attitudes, and practices (KAP) of medical officers, resident physicians, as well as junior and senior residents practising in the paediatric department of a tertiary women's and children's hospital. This was done through a cross-sectional online survey, with questions developed after focused group discussions with domain experts, and responses based on a 5-point Likert scale. Results: A total of 95 physicians met the inclusion criteria, grouped into Medical Officers (MOs) and Registrars (REGs), and we received a 100% response rate. Results showed that few physicians (n = 22, 23.2%) knew the term DOHaD, and majority rated their colleagues to be inadequately informed (n = 84, 88.4%). Among the physicians, one third (n = 32, 33.7%) were not confident in their ability to counsel patients about initiating healthy feeding practices to prevent future metabolic diseases in their children. However, there was a readiness to be better equipped with DOHaD principles and knowledge, and 95.8% (n = 91) strongly acknowledged the physician's responsibility to optimise early life determinants of cardiometabolic health. Conclusion: In conclusion, the findings suggest a poor translation of DOHaD concepts, indicating that bridging the gap between DOHaD research knowledge and clinical application represents an unmet need. These principles should be inculcated early in the professional training of all healthcare providers. [ABSTRACT FROM AUTHOR]

Issue Addressed: The global epidemic of obesity is overtaking many parts of the world with the Pacific Islands at particular risk. Tonga population surveys identify significant increases in overweight and obesity with Social and Behaviour Change Communication (SBCC) offering opportunities for curbing the rise in non‐communicable diseases. Formative research was conducted during the Covid‐19 pandemic to assess stakeholder and program beneficiary needs and wants toward an obesity prevention SBCC strategy in Tonga. Methods: Semi‐structured interviews with 17 key informants and 18 focus group discussions (N = 168) were conducted in Tongatapu. Data analysis was conducted on Nvivo 2020 qualitative software with desk research of secondary data supporting in‐field findings. Results: Potential barriers to behavioural compliance included social/cultural norms, poor attitudes; low motivation and capability; and vulnerabilities of gender and other social determinants. Opportunities included the Tongan collective mindset and the desire for greater social interaction and fun. Strong political will to affect change was apparent with the need to consider targeting to youth, social mobilisation of communities through empowering messaging, and an integrated range of activities. Conclusions: Co‐design in the formative research process was able to be fostered via online communication processes to overcome the challenges of Covid‐19 travel restrictions. The innovative approach provided a number of learnings including identification of national and regional priorities and improved efficiencies in SBCC planning, implementation and evaluation. So What?: Formative research adopting co‐design approaches with stakeholders and program beneficiaries can provide optimal engagement and ownership in the SBCC strategy including insights into messaging approaches. [ABSTRACT FROM AUTHOR]

Background: Infectious and nutritional diseases are on the decline, while non-communicable diseases (NCDs) are becoming increasingly prevalent among adults, emerging as a significant cause of morbidity and mortality. The majority of NCD-related deaths are attributed to cardiovascular diseases (CVDs). Coronary artery disease (CAD) is a complex, multifactorial condition associated with various risk factors, both modifiable and non-modifiable, that may be generalized or systemic. However, many of the risk factors for CAD are modifiable and contribute substantially to the population's overall risk. Methods: A hospital-based casecontrol study was conducted involving newly diagnosed cases of coronary artery disease. The control group consisted of patients admitted to the same hospital for eye, ear, or nose conditions, or those admitted to the surgical ward for non-systemic diseases, excluding cancer and prostatic hypertrophy. Cases and controls were selected in a 1:1 ratio, comprising 130 cases and 130 controls. Matching for age and gender was performed. Results: The factors which were significantly associated with CAD in univariate analysis in decreasing order of strength of association were total cholesterol more than or equal to 200mg/dl, hypertension, tobacco smoking, family history of CAD, LDL cholesterol more than or equal to 130mg/dl, diabetes mellitus, physical activity less than 30min/d, and screen time more than 2h/d. On multiple logistic regression, among risk factors, the decreasing order of strength of association with CAD were tobacco smoking, hypertension, family history of CAD, and diabetes mellitus. Conclusion: Risk factors like tobacco smoking, hypertension, family history of CAD and diabetes mellitus were significantly associated with CAD. [ABSTRACT FROM AUTHOR]

Aims: The intricate connections between health and the environment are often overlooked globally, yet they play a pivotal role in shaping our well-being. Results: Astonishingly, environmental risk factors contribute to nearly 24% of the global disease burden, underscoring the critical impact of our surroundings on health. At the crossroads of this issue lies Diabetes, a rapidly growing non-communicable disease that highlights the delicate balance between human health and environmental sustainability. This epidemic offers a unique lens through which to explore how environmental factors contribute to the prevalence of Diabetes, revealing the complex interplay at work. Despite growing awareness, healthcare systems worldwide face challenges integrating environmental threats into more effective diabetes care strategies Conclusions: This perspective highlights the urgent need for collaborative efforts and innovative solutions that address the environmental dimensions of diabetes management. Doing so can build healthier communities and pave the way for a more sustainable future. [ABSTRACT FROM AUTHOR]

Neutrophils, the most abundant white blood cells in the human circulation, play crucial roles in various diseases, including kidney disease. Traditionally viewed as short-lived pro-inflammatory phagocytes that release reactive oxygen species, cytokines and neutrophil extracellular traps, recent studies have revealed their complexity and heterogeneity, thereby challenging this perception. Neutrophils are now recognized as transcriptionally active cells capable of proliferation and reverse migration, displaying phenotypic and functional heterogeneity. They respond to a wide range of signals and deploy various cargo to influence the activity of other cells in the circulation and in tissues. They can regulate the behavior of multiple immune cell types, exhibit innate immune memory, and contribute to both acute and chronic inflammatory responses while also promoting inflammation resolution in a context-dependent manner. Here, we explore the origin and heterogeneity of neutrophils, their functional diversity, and the cues that regulate their effector functions. We also examine their emerging role in infectious and non-infectious diseases with a particular emphasis on kidney disease. Understanding the complex behavior of neutrophils during tissue injury and inflammation may provide novel insights, thereby paving the way for potential therapeutic strategies to manage acute and chronic conditions. By deciphering their multifaceted role, targeted interventions can be developed to address the intricacies of neutrophil-mediated immune responses and improve disease outcomes. [ABSTRACT FROM AUTHOR]

Non‐communicable diseases (NCDs), such as type 2 diabetes (T2D) and metabolic dysfunction‐associated fatty liver disease, have reached epidemic proportions worldwide. The global increase in dietary sugar consumption, which is largely attributed to the production and widespread use of cheap alternatives such as high‐fructose corn syrup, is a major driving factor of NCDs. Therefore, a comprehensive understanding of sugar metabolism and its impact on host health is imperative to rise to the challenge of reducing NCDs. Notably, fructose appears to exert more pronounced deleterious effects than glucose, as hepatic fructose metabolism induces de novo lipogenesis and insulin resistance through distinct mechanisms. Furthermore, recent studies have demonstrated an intricate relationship between sugar metabolism and the small intestinal microbiota (SIM). In contrast to the beneficial role of colonic microbiota in complex carbohydrate metabolism, sugar metabolism by the SIM appears to be less beneficial to the host as it can generate toxic metabolites. These fermentation products can serve as a substrate for fatty acid synthesis, imposing negative health effects on the host. Nevertheless, due to the challenging accessibility of the small intestine, our knowledge of the SIM and its involvement in sugar metabolism remains limited. This review presents an overview of the current knowledge in this field along with implications for future research, ultimately offering potential therapeutic avenues for addressing NCDs. [ABSTRACT FROM AUTHOR]

Background Clinical practice guidelines (CPGs) are statements to assist practitioners and stakeholders in decisions about healthcare. Low methodological quality guidelines may prejudice decision-making and negatively affect clinical outcomes in non-communicable diseases, such as cardiovascular diseases worsted by poor lipid management. We appraised the quality of CPGs on dyslipidemia management and synthesized the most updated pharmacological recommendations. Methods A systematic review following international recommendations was performed. Searches to retrieve CPG on pharmacological treatments in adults with dyslipidaemia were conducted in PubMed, Scopus, and Trip databases. Eligible articles were assessed using AGREE II (methodological quality) and AGREE-REX (recommendation excellence) tools. Descriptive statistics were used to summarize data. The most updated guidelines (published after 2019) had their recommendations qualitatively synthesized in an exploratory analysis. Results Overall, 66 guidelines authored by professional societies (75%) and targeting clinicians as primary users were selected. The AGREE II domains Scope and Purpose (89%) and Clarity of Presentation (97%), and the AGREE-REX item Clinical Applicability (77.0%) obtained the highest values. Conversely, guidelines were methodologically poorly performed/documented (46%) and scarcely provided data on the implementability of practical recommendations (38%). Recommendations on pharmacological treatments are overall similar, with slight differences concerning the use of supplements and the availability of drugs. Conclusion High-quality dyslipidaemia CPG, especially outside North America and Europe, and strictly addressing evidence synthesis, appraisal, and recommendations are needed, especially to guide primary care decisions. CPG developers should consider stakeholders' values and preferences and adapt existing statements to individual populations and healthcare systems to ensure successful implementation interventions. [ABSTRACT FROM AUTHOR]

Osteoporotic fracture is a prevalent noncommunicable disease globally, causing significant mortality, morbidity, and disability. As the population ages, the healthcare and economic burden of osteoporotic fracture is expected to increase further. Due to its multifactorial features, the development of osteoporotic fracture involves a complex interplay of multiple risk factors, including genetic, environmental, and lifestyle factors. Helicobacter pylori, which infects approximately 43% of the world's population, has been associated with increased fracture risk due to hypochlorhydria from atrophic gastritis and systemic inflammation from elevated pro‐inflammatory cytokines. However, the potential impact of H. pylori infection and eradication on fracture risk remains contentious among various studies due to the study design and inadequate adjustment of confounding factors including baseline gastritis phenotype. In this review, we provided a comprehensive evaluation of the current evidence focusing on the underlying mechanisms and clinical evidence of the association between H. pylori infection and osteoporotic fracture. We also discussed the potential benefits of H. pylori eradication on fracture risk. [ABSTRACT FROM AUTHOR]

Lifestyle (LS)-related risk factors are the most important factors for increasing noncommunicable chronic diseases (NCDs). Coronavirus disease 2019 (COVID-19) is known to have a significant impact on LS, exposing patients with NCDs to adverse outcomes. This study aimed to investigate the LS changes after the COVID-19 pandemic and the strategies that can be used to manage the LS changes in the four levels of disease prevention. The prevalence of LS-related problems such as obesity and overweight has an upward trend and physical activity has declined dramatically in COVID-19 pandemic time. COVID-19 pandemic can worsen the patients' mental disorders or, as a major stressor, trigger mental disorders in the people. Moreover, stress and anxiety of pandemic situation may induce the consumption of smoking and alcohol in societies under disease. In addition, poor sleep and excessive use of social networks have been associated with poor health outcomes. LS modification is a substantial strategy for the prevention and management of NCDs that due to the pandemic situation, has become more serious now. The comprehensive LS modification program can promote various dimensions of knowledge, attitude, and LS-related behaviors at four levels of prevention. Primordial prevention by preventing LS-related risk factors, primary prevention by reducing or eliminating LS-related risk factors, secondary prevention by using LS modification in the treatment approach, and tertiary prevention by integrating LS interventions into rehabilitation make up the basics of a comprehensive LS reform program. [ABSTRACT FROM AUTHOR]

Background: The substantial exposure to chronic non-communicable respiratory diseases in news coverage impacts readers' understanding of the situation's seriousness. Hence, in the context of Texas newspapers, this study explores the coverage of non-communicable respiratory disease issues. Methods: News articles were gathered spanning from January 2020 to April 2022 to investigate the media coverage of noncommunicable respiratory diseases within Texas newspapers. To identify meaningful associations, a co-occurrence network was employed, revealing the prevalent co-occurring keywords. Complementing this, sentiment analysis was applied to discern the prevailing emotional tones conveyed within the news narratives. These methodologies provide a comprehensive understanding of the media's portrayal of respiratory diseases and the underlying emotions, enhancing insights into public perception and awareness. Results: The outcomes identified a comprehensive understanding of implications of respiratory ailments. Notably, individuals afflicted with chronic obstructive pulmonary disease (COPD) may also contend with other persistent health conditions. Pollution, particularly air pollution, has been recognized as a significant contributor to the development and exacerbation of chronic non-communicable respiratory conditions. Sentiment analysis revealed that words that contain the trust emotion appeared in about 24% of news frames. The second most prevalent emotion was anticipation, which appeared in 17% of news frames. The presence of fear (16%) and sadness (13%) emotions was also notable. Conclusions: Although previous research attempted to explore the portrayal of different public health issues in the news media, no study has been conducted to explore the coverage of chronic non-communicable respiratory diseases in newspapers within the context of Texas. Thus, this research provides insights into how health policymakers can shape health strategies based upon news coverage by focusing on the crucial frames identified in this study. [ABSTRACT FROM AUTHOR]

Background: Stroke is a leading cause of death and disability worldwide. In India, it is the fourth leading cause of death and fifth leading cause of disability, posing a major public health concern. National surveys reveal an increasing trend in stroke risk factors such as tobacco use, physical activity, alcohol use, hypertension, and dyslipidemia. However, knowledge regarding the combined effect of these risk factors and their various combinations is limited. Understanding the individual, combined, and synergistic effects of known risk factors, along with new risk factors, is essential to address gaps in stroke epidemiology. This study aims to examine the effect of various risk factors of acute stroke and their association with stroke occurrence and its outcomes (survival, disability and quality of life). Methods: This retrospective-prospective cohort will be conducted in one taluka of Kolara district and two urban wards of Bengaluru with a total population of ~400,000. All stroke-free individuals above 30 years of age ~200,000 individuals in the selected sites will be participants of stroke-free period and all first ever stroke patients in the community will be part of stroke and post-stroke period respectively. The study subjects will be recruited through a complete house-to-house survey at baseline and undergo annual follow-ups during the stroke-free period, with specific assessments at defined time points during the stroke and post-stroke period for a period of one year. Efforts are implemented to minimize loss to follow-up, including community engagement, a helpline number, and hospital-based surveillance. Discussion: This large population-based cohort study addressing stroke epidemiology in the country, is one -of-its-kind, attempting to fill certain critical gaps in the natural history, management, and outcomes of stroke in India. This research has the potential to provide important insights into the effect of novel risk factors of stroke and various combinations of risk factors of stroke. Furthermore, the development of a stroke risk predictability calculator will add value to the existing Indian National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) and offers a model for similar countries once developed. [ABSTRACT FROM AUTHOR]

Background: Understanding the clustering of two or more risk factors of non-communicable disease, such as smoking, overweight/obesity, and hypertension, among women of reproductive age could facilitate the design and implementation of strategies for prevention and control measures. This study examined the factors associated with smoking, overweight/obesity, and hypertension among Nepalese women of reproductive age (15–49 years). Methods: This study used the Nepal Demographic and Health Surveys (NDHS) 2016 (6,079 women for smoking and overweight/obesity, 6076 for hypertension) and 2022 (6,957 women for overweight/obesity and smoking status and 3,749 women for hypertension) for comparison of trends of NCD risk factors among women aged 15–49 years. Additionally, for each participant, risk factors score (range of 0 to 3) was created by summing individual risk factors. We assessed the determinants of risk factor clustering using multivariable Poisson regression models with robust sandwich variance estimator to calculate adjusted prevalence ratios using NDHS 2022. Results: The national prevalence of overweight/obesity increased from 22.2% in 2016 to 29.2% in 2022 among women of reproductive age. In 2022, the prevalence for smoking, overweight/obesity, and hypertension were 3.8%, 29.2%, and 9.6%, respectively. More than one in four women (28.7%) had one NCD risk factor, while 6.5% had two such risk factors. Higher aged women (40–49 years) were more likely to have multiple NCD risk factors than those aged 15–29 years (APR: 3.19; 95% CI: 2.68–3.80). Those in the richest wealth quintile (APR: 1.52; 95% CI: 1.24–1.85), as well as married (APR: 3.02; 95% CI: 2.43–3.76) and widowed/divorced (APR: 2.85; 95% CI: 2.14–3.80) were more likely to have multiple NCD risk factors. Women from Koshi province (APR: 1.74; 95% CI: 1.41–2.15) had more NCD risk factors than those from the Sudurpaschim province. Working women also had a higher prevalence of NCD risk factors compared to non-working women (APR: 1.23; 95% CI: 1.06–1.43). Additionally, Hill Janajatis (APR: 1.44; 95% CI: 1.21–1.72) and Dalits (APR: 1.42; 95% CI: 1.15–1.75) women were more likely to have NCD risk factors compared to women of Brahmin hill origin. Conclusions: Clustering of two or more NCD risk factors was higher among women aged ≥30 years, those who are currently married or widowed/divorced/separated, working women, and individuals from the wealthiest socioeconomic groups. A higher burden of risk factors underscores the importance of targeted public health interventions, particularly among women from advantaged socio-economic groups, those of affluent regions, and in the workplace. [ABSTRACT FROM AUTHOR]

Aim: To assess the prevalence of non‐communicable disease risk factors among the nursing staff and educate them on prevention. Background: Nursing staff is integral to the Indian community healthcare systems. Recent studies report a high prevalence of non‐communicable diseases in Indian nursing staff. Therefore, data on the prevalence of non‐communicable disease risk factors among nursing staff are crucial for education on prevention. Design: A cross‐sectional digital survey‐based study. Method: We invited 4435 nursing staff to attend our online survey. We used a customized questionnaire for data collection, including a digitized version of the Community‐Based Assessment Checklist form. A score of >4 was considered high risk and warranted screening. Result: Among 682 nursing staff who attended, 70% had never undergone screening for non‐communicable diseases. The prevalence of non‐communicable disease risk factors was significantly higher in male nursing staff. In addition, logistic regression analysis showed that age, tobacco and alcohol use, increased waist circumference, physical inactivity and family history of non‐communicable diseases were significant risk factors among nursing staff. Conclusion: The study findings suggest that the nursing staff have suboptimal self‐health concerns on non‐communicable diseases. This situation warrants continued medical education, awareness campaigns on adopting a healthy lifestyle and health promotion. Summary statement: What is already known about this topic? The prevalence of non‐communicable diseases (NCDs) among Indian nursing staff is a growing concern, underscoring the need for comprehensive research and targeted interventions.Despite the significant health risks faced by this demographic, there is a notable lack of data on NCD risk factors specific to Indian nursing professionals. What this paper adds? This paper adds information on the prevalence of NCD risk factors chiefly among nursing staff in the Delhi National Capital Region.Male nursing staff have particularly high NCD risk factors. The implications of this paper: Findings may help develop routine screening programmes for nursing staff, continued nursing education and good, safe nursing practice. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis (AR) is a non-infectious inflammatory disease of the nasal mucosa mediated by IgE and involving a variety of immune cells such as mast cells. In previous studies, AR was considered as an isolated disease of the immune system. However, recent studies have found that the nervous system is closely related to the development of AR. Bidirectional communication between the nervous and immune systems plays an important role in AR. Summary: The nervous system and immune system depend on the anatomical relationship between nerve fibers and immune cells, as well as various neurotransmitters, cytokines, inflammatory mediators, etc. to produce bidirectional connections, which affect the development of AR. Key messages: This article reviews the impact of neuro-immune interactions in AR on the development of AR, including neuro-immune cell units. [ABSTRACT FROM AUTHOR]

Background Consumption of alcohol is a risk factor for non-communicable and infectious diseases, mental health problems, and can lead injuries and violence. The aim of this study was to evaluate the prevalence of alcohol-involved deaths among decedents who died of external causes and underwent autopsy in Lithuania. Methods Study includes age persons of any age (from 0 to 110 years) who died and were autopsied in Lithuania from 1 January 2017 to 31 December 2020. Data were obtained from the Lithuanian State Register of Deaths and Their Causes. Results Among external causes of death, the presence of alcohol was detected in 55.0% of cases. Male decedents had a significantly higher number of positive BAC level recorded, at 46.6%, compared with female decedents (32.1%; P  < 0.001). The highest incidence of deaths where the alcohol was detected in the deceased's blood was found when the decedent was listed as being in the victims of assault group (71.5%, 95% CI 65.4–77.2). However, the highest median BAC score was found for those in the accidents group (59.7%, 95% CI: 58.2–61.2, BAC 2.42 ‰, IQR 1.86). Conclusions The findings of this study suggest that alcohol use may be a contributing factor in a wide range of fatal incidents, including accidents, injuries, and cases of violent intent. Inequalities between males and females were identified, with a higher proportion of males with alcohol detected in blood at the time of death. [ABSTRACT FROM AUTHOR]

The authors calls for countries to implement policies that require mandatory front-of-package nutrition labels to prevent further increases in obesity, type 2 diabetes and other noncommunicable diseases. Cited are the effectiveness of mandatory front-of-package nutrition label policies compared to voluntary labelling policies, the design of voluntary labelling that makes it less effective, and the evidence-based and stricter nutrient profile models employed by mandatory labelling.

This article discusses a study on the lifestyle of patients with psoriasis and their motivation to make changes. The study found that psoriasis is associated with other health conditions that can be improved through lifestyle changes. The majority of patients were motivated to change their lifestyle, particularly in terms of physical activity and diet. However, only a small percentage of patients were compliant with recommended guidelines. Unmotivated patients tended to be older, have less visible psoriasis, and use systemic treatments more frequently. The study suggests that targeted interventions focusing on physical activity and diet could be effective in improving the lifestyle of patients with psoriasis. [Extracted from the article]