Management and Prevention Strategies for Non-communicable Diseases (NCDs) and Their Risk Factors

Preventive health measures in small and medium-sized enterprises: A scoping review on implementation strategies

OBJECTIVE

To describe implementation strategies for preventive health measures in SMEs and the effectiveness of the strategies on implementation outcomes.

METHODS

A literature search was performed in multiple electronic databases. Studies published between 2000 and 2021 that evaluated the implementation of preventive health measures in SMEs were included. Classification of implementation strategies was based on two complementary classification systems.

RESULTS

Nineteen studies, of which 5 RCTs were included. Eighteen distinct implementation strategies were reported. All studies applied a combination of implementation strategies, and nearly all reported a positive effect on one or more implementation outcomes: sustainability, acceptability, feasibility, penetration, fidelity, adoption, and appropriateness.

CONCLUSIONS

Overall, a positive effect of combined implementation strategies on the implementation outcome(s) was found. The 'distribution of educational materials' and 'provide ongoing consultation' combined show positive effects on sustainability.

Cardiorespiratory Fitness as a Predictor of Non-Cardiovascular Disease and Non-Cancer Mortality in Men

OBJECTIVE

To evaluate the association of 5 major cause-specific non-cardiovascular disease (CVD) and non-cancer deaths with cardiorespiratory fitness (CRF).

METHODS

Patients were 36,645 men (43.3±9.3 years) free of known CVD and cancer at baseline who completed a maximal treadmill graded exercise test during a preventive examination at the Cooper Clinic (Dallas, Texas) between 1971 and 2003. CRF was quantified as maximal treadmill exercise test duration and grouped as low (referent), moderate, and high. Cause-specific non-CVD non-cancer deaths were (1) diabetes or kidney disease, (2) chronic respiratory disease, (3) acute respiratory and infectious disease, (4) injuries, and (5) other non-CVD non-cancer deaths.

RESULTS

A total of 694 non-CVD non-cancer deaths occurred during an average of 17 years of follow-up. After adjustment for covariates, hazard ratios (95% confidence intervals) for moderate and high CRF, respectively, were 0.57 (0.47 to 0.69) and 0.43 (0.34 to 0.54) for overall non-CVD non-cancer deaths (P<.0001); 0.39 (0.28 to 0.54) and 0.17 (0.10 to 0.28) for diabetes or kidney disease (P<.001); 0.36 (0.22 to 0.59) and 0.09 (0.04 to 0.20) for chronic respiratory diseases (P<.001 for all); 0.74 (0.47 to 1.16) and 0.34 (0.19 to 0.61) for acute respiratory and infectious diseases (P<.01 for both); and 0.48 (0.35 to 0.66) and 0.38 (0.26 to 0.55) for any other non-CVD non-cancer deaths (P<.0001 for both).

CONCLUSION

Higher levels of CRF were significantly associated with lower risk of mortality from the 5 major non-CVD non-cancer causes. These results suggest that improvement in CRF may reduce non-CVD non-cancer deaths, which account for a significant proportion of adult mortality.

In sickness and health? Examining the co-occurrence and concordance of healthy lifestyle behaviours among spouses in Namibia

OBJECTIVES

This study examines the extent to which healthy lifestyle behaviours co-occur in individuals. We also explore within-couples concordance in healthy lifestyle behaviours in Namibia.

STUDY DESIGN

Cross-sectional study.

METHODS

We used data from 910 couples (1820 individuals) who were interviewed in the Namibia Demographic and Health Survey conducted in 2013. We assessed five different healthy lifestyle behaviours (alcohol non-consumption, non-cigarette smoking, healthy diet, physical exercise, and normal body mass index). An individual healthy lifestyle index (HLI) was derived by summing values across the five behaviours, with a binary indicator categorising each individual's lifestyle behaviour as 'healthy' (HLI ≥ 3) or 'unhealthy' (HLI < 3). Multivariate logistic regression models were fitted to explore the association between binary indicators of men's and their female partner's healthy lifestyles.

RESULTS

About 48% of men and 57% of women had at least three co-occurring healthy lifestyle behaviours. A third of couples were concordant in reporting a healthy lifestyle (HLI ≥ 3), while 27% were concordant in reporting an unhealthy lifestyle (HLI < 3). In multivariate analysis, Namibian men were almost twice (aOR, 1.90; 95%CI, 1.43-2.52) as likely to have a healthy lifestyle if their female partner also had a healthy lifestyle, compared with those who had a female partner who had an unhealthy lifestyle, after adjusting for relevant individual, partner and household characteristics.

CONCLUSION

The observed co-occurrence of healthy lifestyle behaviours and spousal concordance suggests it may be beneficial to consider couples a target for intervention when aiming to promote healthy behaviours and reduce cardiovascular diseases in Namibia.

Prevalence of non-communicable chronic diseases in rural India amongst peri- and post-menopausal women: Can artificial intelligence help in early identification?

AIMS

To identify peri- and post-menopausal women at risk of non-communicable diseases in rural India and to assess their prevalence amongst these groups via the use of artificial intelligence.

SETTINGS AND DESIGN

An observational study conducted by the Indian Menopause Society in collaboration with the Government of Maharashtra. The study included rural women residents of three villages in the Latur district of Maharashtra, India.

MATERIALS AND METHODS

Accredited social health activist workers identified 400 peri- and post-menopausal women aged 45-60 years. Specific symptoms able to predict the presence of a non-communicable disease were identified through the use of artificial intelligence.

STATISTICAL ANALYSIS USED

Descriptive statistics and predictive network charts analysis.

RESULTS

The mean age of 316 women included in the analysis was 50.4 years and the majority of them were illiterate (68 %). The prevalence of dyslipidaemia, osteopenia, diabetes mellitus, obesity and hypertension were 58 %, 50 %, 25 %, 25 %, and 20 % respectively. None of their symptoms or laboratory reports could be significantly correlated directly with any of these non-communicable diseases. Hence, we used a cluster of symptoms to suggest the presence of hypertension, diabetes mellitus, osteoporosis and hypothyroidism via predictive network analysis charts.

CONCLUSIONS

Screening of at-risk women can be done using an artificial intelligence-based screening tool for early diagnosis, timely referral and treatment of non-communicable diseases with the support of community health workers.

Life-Course Pathways to Exceptional Longevity: Evidence From the Lothian Birth Cohort of 1921

BACKGROUND

Longevity, a hallmark of successful aging, is a multifactorial trait with influences from birth onwards. However, limited evidence exists on the pathways linking diverse life-course exposures to longevity, especially within a single cohort.

METHODS

We investigated associations between life-course factors and longevity among community-dwelling adults aged 79 (N = 547) from the Lothian Birth Cohort 1921 with a mortality follow-up of 24 years. Cox proportional hazards and structural equation (path) models were used to explore how factors from early life (social class, childhood intelligence quotient [IQ], education), midlife (social class), and later life (health, lifestyle, psychosocial well-being), as well as sex, personality, and apolipoprotein E e4 status, influence survival time in days.

RESULTS

During follow-up (1999-2023), 538 participants (98%) died (mean age of death = 89.3 years) and 9 survived (mean age = 101.6 years). Factors associated with lower mortality risk in the multivariable Cox model were higher cognitive function (hazard ratio [HR] = 0.72; 95% confidence interval [CI]: 0.59-0.88), better physical function (HR = 0.61; 95% CI: 0.44-0.85), and greater physical activity (HR = 0.81; 95% CI: 0.71-0.92), while history of cancer was associated with higher mortality risk (HR = 1.84; 95% CI: 1.22-2.77). The life-course path model identified the same direct predictors, with additional contributions from female sex and nonsmoking status, to greater longevity. Early- and midlife factors (IQ, education, social class), and emotional stability, conscientiousness, and female sex, were indirectly and positively associated with survival trajectories via multiple dimensions of adult health.

CONCLUSIONS

In understanding why people live to very old ages it is necessary to consider factors from throughout the life course, and to include demographic, psychosocial, and health variables.

Italian and Middle Eastern adherence to Mediterranean diet in relation to Body Mass Index and non-communicable diseases: nutritional adequacy of simulated weekly food plans

BACKGROUND

The Mediterranean diet (MD), known to prevent obesity, overweight and the related non communicable diseases (NCD), is based on typical dishes, foods and on a common cultural milieu. Although MD is the basis of dietary guidelines, the prevalence of obesity, overweight and NCD, is increasing both in Western regions, and even more in Middle Eastern regions (MER). This study aimed to analyze (i) the impact of different levels of adherence to the MD, in Italy and MER, on body mass index (BMI) (ii) the bromatological composition of a simulated 7-days food plan (7-DFP) based on Italian or MER typical meals, following MD criteria and the Italian or MER food base dietary guideline; (iii) the optimization of nutrients impacting on NCD.

METHODS

The 7-DFPs were implemented using a dietary software. The association between adherence to MD and BMI was evaluated by pooled estimated ORs (with 95% confidence intervals and p-values). Pooled measures were obtained by the methods appropriate for meta-analysis. The different food-based guidelines have been compared.

RESULTS

The pooled ORs of obese status comparing medium vs. high adherence to MD were: 1.19 (95% C.I.: 0.99; 1.42, p-value = 0.062) and 1.12 (95% C.I.: 0.90; 1.38, p-value = 0.311) for MER and Italy respectively. For the comparison of low vs. high adherence, the pooled ORs were 1.05 (95% C.I.: 0.88; 1.24, p-value = 0.598) for MER, and 1.20 (95% C.I.: 1.02; 1.41, p-value = 0.031) for Italy when outliers are removed. High adherence to the MD resulted as potential protective factor against obesity. In MER 7-DFP: total fats is higher (34.5 E%) vs. Italian 7-DFP (29.4 E%); EPA (20 mg) and DHA (40 mg) are lower than recommended (200 mg each); sugars (12.6 E%) are higher than recommended (< 10 E%). Calcium, Zinc, and vitamin D do not reach target values in both 7-DFPs.

CONCLUSION

This study highlights that, even when 7-DFPs follow MD and refer to nutrient needs, it is necessary to verify nutrient excesses or deficits impacting on NCD. High MD adherence is protective toward NCDs. MD principles, and energy balance should be communicated according to socioeconomic and educational levels.

Cross-sectional study to identify health literacy, health behavior, and quality of life in Chofu and Komae cities in Japan: Formative research in community-based nursing practice

The Jikei Academic Nursing Practice Center for the Community developed a community nursing practice that matched community health problems and concerns in Chofu and Komae cities, suburban areas of the Tokyo Metropolis. This study aimed to identify health problems and high-risk populations via an understanding of the practice of health behaviors, health literacy, and quality of life. This was an online, cross-sectional study conducted in September 2023. In total, 1520 (Chofu: n = 1170; Komae: n = 350) participants were enrolled. Participants' demographic characteristics, health literacy, health behaviors, and quality of life scores were obtained. Sleep quality was poor compared with national data. Younger participants had higher poor health literacy, did not practice health behaviors, and had a lower quality of life. In addition, parenting and informal nursing care for family members were associated with unhealthy eating, smoking, drinking, and poor quality of life. This study found that health problems and concerns before planning were significant in increasing the salience of interventions for community residents. Based on the findings of this study, an action plan for community-wide nursing practice was created.

Improving retrospective intervention descriptions: Lessons learned from research on type 2 diabetes programmes in the United Kingdom and the Republic of Ireland

In recent years, multiple countries worldwide have implemented behavioural interventions within national healthcare systems. Describing the content of these interventions is critical to improve their implementation, replication, and effectiveness, as well as to advance behavioural science. Tools, such as the Behaviour Change Technique Taxonomy, can enhance the quality of intervention description and reporting. As interventions are frequently developed without the use of such tools, retrospective coding of existing interventions to accurately characterise their content is becoming more common. However, the use of these tools for retrospective coding poses various challenges, the discussion of which has been neglected to date. This commentary discusses the challenges encountered when retrospectively describing the content of five nationally implemented programmes for type 2 diabetes in the United Kingdom and the Republic of Ireland and suggests recommendations to tackle these challenges. We present important methodological, practical, and ethical considerations for researchers to reflect on, relevant to the retrospective description of existing interventions. Specifically, we discuss (i) the importance of positive relationships and collaboration with intervention stakeholders, (ii) the practical and ethical considerations when analysing the content of implemented interventions, (iii) the independence of research teams and the potential for misclassification of intervention content, and (iv) the challenges associated with the analysis of intervention content using behavioural science tools. There is a growing demand for more robust approaches to address the methodological, practical, and ethical challenges associated with such studies. The present commentary describes key issues to be considered by research teams, as well as concrete recommendations to improve the retrospective characterisation of intervention content.

Vasorelaxant and Hypotensive Effects of Galla chinensis in Rats

Previous studies have revealed the medicinal and therapeutic effects of Galla chinensis. However, no studies have focused on the antihypertensive effects of G. chinensis. Therefore, we aimed to determine the vasorelaxant and hypotensive effects of G. chinensis 50% ethanolic extract (GCE). To evaluate the vascular relaxing effect of GCE, experiments were conducted using aortic segments dissected from Sprague Dawley rats. GCE showed a vasorelaxant effect via the nitric oxide/cyclic guanosine 3',5'-monophosphate pathway, inhibiting Ca2+ channels, and activating K+ channels. The hypotensive effects of GCE were evaluated in spontaneously hypertensive rats (SHRs). The SHRs were randomly divided into a control group and orally administered GCE group (100 or 300 mg/kg). The systolic and diastolic blood pressure decreased significantly by -19.47 ± 4.58% and -31.14 ± 7.66% in the GCE 100 mg/kg group, and -21.64 ± 2.40% and -31.91 ± 5.75% in the GCE 300 mg/kg group at 4 h after administration. Considering its vasorelaxant and hypotensive effects, our results indicate that GCE may be a valuable solution for the control of hypertension. However, further studies on the long-term administration and toxicity of GCE are required.

Association between bilirubin and biomarkers of metabolic health and oxidative stress in the MARK-AGE cohort

Recent studies have shown that elevated concentrations of unconjugated bilirubin (UCB) may be a protective host factor against the development of noncommunicable diseases (NCDs), whereas low levels of UCB are associated with the opposite effect. The results of this European study, in which 2,489 samples were tested for their UCB concentration using high-performance liquid chromatography (HPLC) and additional data from the MARK-AGE database were used for analysis, provide further evidence that elevated UCB concentrations are linked to a lower risk of developing NCDs and may act as a predictive marker of biological aging as individuals with elevated UCB concentrations showed favorable outcomes in metabolic health and oxidative-stress-related biomarkers. These findings underline the significance of studying individuals with moderate hyperbilirubinemia and investigate UCB routinely, also in the setting of aging, since this condition affects millions of people worldwide but has been underrepresented in clinical research and practice until now.

Evaluating the Potential and Pitfalls of AI-Powered Conversational Agents as Humanlike Virtual Health Carers in the Remote Management of Noncommunicable Diseases: Scoping Review

BACKGROUND

The rising prevalence of noncommunicable diseases (NCDs) worldwide and the high recent mortality rates (74.4%) associated with them, especially in low- and middle-income countries, is causing a substantial global burden of disease, necessitating innovative and sustainable long-term care solutions.

OBJECTIVE

This scoping review aims to investigate the impact of artificial intelligence (AI)-based conversational agents (CAs)-including chatbots, voicebots, and anthropomorphic digital avatars-as human-like health caregivers in the remote management of NCDs as well as identify critical areas for future research and provide insights into how these technologies might be used effectively in health care to personalize NCD management strategies.

METHODS

A broad literature search was conducted in July 2023 in 6 electronic databases-Ovid MEDLINE, Embase, PsycINFO, PubMed, CINAHL, and Web of Science-using the search terms "conversational agents," "artificial intelligence," and "noncommunicable diseases," including their associated synonyms. We also manually searched gray literature using sources such as ProQuest Central, ResearchGate, ACM Digital Library, and Google Scholar. We included empirical studies published in English from January 2010 to July 2023 focusing solely on health care-oriented applications of CAs used for remote management of NCDs. The narrative synthesis approach was used to collate and summarize the relevant information extracted from the included studies.

RESULTS

The literature search yielded a total of 43 studies that matched the inclusion criteria. Our review unveiled four significant findings: (1) higher user acceptance and compliance with anthropomorphic and avatar-based CAs for remote care; (2) an existing gap in the development of personalized, empathetic, and contextually aware CAs for effective emotional and social interaction with users, along with limited consideration of ethical concerns such as data privacy and patient safety; (3) inadequate evidence of the efficacy of CAs in NCD self-management despite a moderate to high level of optimism among health care professionals regarding CAs' potential in remote health care; and (4) CAs primarily being used for supporting nonpharmacological interventions such as behavioral or lifestyle modifications and patient education for the self-management of NCDs.

CONCLUSIONS

This review makes a unique contribution to the field by not only providing a quantifiable impact analysis but also identifying the areas requiring imminent scholarly attention for the ethical, empathetic, and efficacious implementation of AI in NCD care. This serves as an academic cornerstone for future research in AI-assisted health care for NCD management.

TRIAL REGISTRATION

Open Science Framework; https://doi.org/10.17605/OSF.IO/GU5PX.

Precision nutrition impact on metabolic health and quality of life in aging population after a 3-month intervention: A randomized intervention

OBJECTIVES

Innovative precision dietary procedures are required to promote healthy aging. This study aimed to evaluate the effects of a personalised strategy based on the inclusion of individualised foods and digital tools on overall health status and quality of life within a follow-up of 3 months in older adults with overweight or obesity.

METHODS

127 men and women aged between 50 and 80 years with overweight/obesity participated in the study-between January 2020 and September 2020 at the Center for Nutrition Research-University of Navarra and IMDEA-ALIMENTACIÓN-and were randomly assigned to a usual-care group (standard recommendations) or precision group (precision nutrition strategy based on the inclusion of individualised foods and a mobile application). Anthropometry, body fat percentage, biochemical parameters, diet, and quality of life (SF-36 Health Survey) were assessed at baseline and after 3 months.

RESULTS

Both strategies were found to improve overall metabolic health; however, the precision approach demonstrated significantly better outcomes. The precision strategy reduced body weight at 3 months (-4.3 kg; p < 0.001) with significant improvements in body fat percentage, blood pressure and general metabolic health (glycated haemoglobin; alanine aminotransferase; aspartate aminotransferase; hepatic steatosis index) in comparison with the standard recommendations. The precision approach significantly enhanced the quality of life (SF-36) of individuals, with additional improvements in emotional well-being (p = 0.024) and vitality (p = 0.008). Adherence to the Mediterranean diet was significantly associated with a higher quality of life and vitality.

CONCLUSION

These results support the benefit of precision nutrition approaches for promoting healthy aging and emotional well-being, enhancing the quality of life in aging populations, during the COVID-19 pandemic.

Metabolic and genetic risk factors associated with pre-diabetes and type 2 diabetes in Thai healthcare employees: A long-term study from the Siriraj Health (SIH) cohort study

BACKGROUND

The study of non-communicable diseases (NCDs) in a developing country like Thailand has rarely been conducted in long-term cohorts, especially among the working-age population. We aim to assess the prevalence and incidence of risk factors and their associations underlying NCDs, especially type-2 diabetes mellitus (T2DM) among healthcare workers enrolled in the Siriraj Health (SIH) study cohort.

METHODS

The SIH study was designed as a longitudinal cohort and conducted at Siriraj hospital, Thailand. A total of 5,011 participants (77% women) were recruited and follow-up. Physical examinations, blood biochemical analyses, family history assessments, behavior evaluations, and genetics factors were assessed.

RESULTS

The average age was 35.44±8.24 years and 51% of participants were overweight and obese. We observed that men were more likely to have a prevalence of T2DM and dyslipidemia (DLP) compared to women. Aging was significantly associated with pre-diabetes and T2DM (P<0.001). Additionally, aging, metabolic syndrome, and elevated triglycerides were associated with the development of pre-diabetes and T2DM. The minor T allele of the rs7903146(C/T) and rs4506565 (A/T) were associated with a high risk of developing pre-diabetes with odds ratios of 2.74 (95% confidence interval [CI]: 0.32-23.3) and 2.71 (95% CI: 0.32-23.07), respectively; however, these associations were statistically insignificant (P>0.05).

CONCLUSION

The findings of the SIH study provide a comprehensive understanding of the health status, risk factors, and genetic factors related to T2DM in a specific working population and highlight areas for further research and intervention to address the growing burden of T2DM and NCDs.

The influence of early and current feeding practices, eating behaviors, and screen time on dietary patterns in Polish toddlers - A cross-sectional study

Early nutrition has an important influence on a child's proper health and development, and understanding factors that may be related to desirable dietary patterns is key to improving the diet of future generations. The aim of this study was to assess whether early and current feeding practices, eating behaviors, and screen time viewing are associated with toddlers' dietary patterns. A cross-sectional sample of 467 mothers of toddlers (aged 1 year to 3) was surveyed between 2020 and 2022. Food consumption was evaluated by the Food Frequency Questionnaire (FFQ). The k-means algorithm was used to define dietary patterns on the basis of data collected from the FFQ and mealtime environment patterns, based on the data about practices during meals consumption. The odds of following a prohealth dietary pattern among early feeding factors were lower when infants ate commercial complementary foods more often. Distracted mealtime environment pattern increased the odds of following a non-eaters pattern, and commercial complementary foods pattern increased the odds of following a processed pattern. Currently, the odds of following a processed dietary pattern were higher when children were not breastfed and had higher screen time. Toddlers who ate during distraction and were more fussy had lower odds of following a prohealth dietary pattern, whereas higher enjoyment of food and satiety responsiveness increased the odds. The results indicate the need to increase parents' awareness about the importance of early factors in establishing dietary patterns.

Assessment of non-communicable disease risk factors, functional performance, and health-related quality of life in adults: a comparative analysis in low-resourced urban and rural areas of South Africa

BACKGROUND

Globally, disparities between non-communicable disease (NCD) risk factors, functional performance, and health-related quality of life (HRQoL) exist in people living in rural and low-resourced urban settings. Evidence of these health differences determined with objective NCD risk factors and functional performance measurements in South Africa, is scarce. Therefore, the study aimed to determine the differences in NCD risk factors, functional performance and HRQoL between rural and low-resourced urban areas.

METHODS

The study recruited 311 adults (35-80 years) presenting with at least one NCD risk factor from low-resourced urban- (n = 183) and rural (n = 128) communities. Objective measurements of physical activity (PA) by means of combined heart rate and accelerometery, body composition employing skinfolds, peripheral lipid and glucose concentrations, blood pressure, functional performance indicators (handgrip, single leg stand, sit-to-stand, timed-up-and-go speed, predicted peak VO2 max); and HRQoL were measured according to standard procedures. Independent t-tests, Mann-Whitney U, and chi-square tests were performed to determine differences between the variables of low-resourced urban and rural settings.

RESULTS

The participants from the low-resourced urban setting were significantly older than the rural residents (59.1 ± 10.7 years vs. 52.8 ± 11.3 years; p = 0.001). NCD risk factors were significantly more prevalent in the low-resourced urban participants compared to rural participants, in particular for elevated systolic (85.8% vs. 62.5%; p = 0.001), and diastolic blood pressure (88.5% vs. 65.6%; p = 0.001), physical inactivity (95.9% vs. 87.7%; p = 0.026), increased cholesterol concentrations (22.1% vs. 8.7%; p = 0.002), and increased waist circumference (61.9% vs. 49.2%; p = 0.027). Low-resourced urban residents presented with a higher average body fat percentage (27.69% ± 7.65% vs. 12.23% ± 4.67%; p < 0.001), and lower moderate to vigorous PA levels (37.19 ± 49.55 [95% CI = 29.12-45.27] vs. 62.92 ± 60.43 min/week [95% CI = 47.95-77.90]; p = 0.003) compared to rural residents. Rural residents showed significantly better functional performance, including peak VO2 (23.99 ± 9.89 vs. 16.95 ± 7.64 ml/min/kg; p = 0.001) and single leg stand (right leg: 44.96 ± 18.47 vs. 20.87 ± 19.18 s; p = 0.001) as well as higher HRQoL for the physical (51.06 ± 8.14% vs. 45.62 ± 11.13%; p < 0.001) and mental (54.75 ± 8.24% vs. 48.91 ± 12.27%; p < 0.001) component scores compared to participants from the low-resourced urban areas.

CONCLUSION

NCD risk factors, functional performance, and HRQoL significantly differ in rural communities compared to low-resourced urban communities in South Africa. Urban areas' most prevalent risk factors were elevated blood pressure, physical inactivity, and increased waist circumference. Participants from rural areas demonstrated significantly better functional performance, such as fitness and balance. HRQoL was better in rural settings than in urban settings. Future intervention programmes should be tailored for specific settings.

Reciprocal and Differential Influences of Mediterranean Diet and Physical Activity on Adiposity in a Cohort of Young and Older than 40 Years Adults

Translational research has documented the conjoint beneficial relationships between dietary and physical activity habits concerning weight maintenance. However, the precise interplay between diet and exercise impacting body composition remains unclear, challenging personalized interventions. This study aimed to explore potential interactions and effect modifications of these factors affecting the body mass index (BMI) within an online adult cohort. Data from 11,883 NUTRiMDEA cohort participants were analyzed in this cross-sectional study, categorizing individuals by age, sex, and BMI using linear regression models to assess the interactions between lifestyle factors and adiposity. Significant differences emerged in anthropometry, lifestyle, and health-related quality of life (HRQoL) across categories. The combined effect of diet and physical activity had a greater impact on BMI than physical activity or Mediterranean diet adherence alone, with lower BMI as physical activity levels increased (β: -0.5) and adherence to the Mediterranean diet decreased, where a modification effect between them was identified (β: -0.28). Participants with lower Mediterranean diet adherence displayed superior BMI when physical activity was low, but when activity levels were higher, their BMI aligned with those with healthier dietary habits. An interaction link between lifestyle factors and BMI was found, showing the differential effects of the Mediterranean diet and physical activity combination concerning adiposity.

New perspectives on the therapeutic potential of quercetin in non-communicable diseases: Targeting Nrf2 to counteract oxidative stress and inflammation

Non-communicable diseases (NCDs), including cardiovascular diseases, cancer, metabolic diseases, and skeletal diseases, pose significant challenges to public health worldwide. The complex pathogenesis of these diseases is closely linked to oxidative stress and inflammatory damage. Nuclear factor erythroid 2-related factor 2 (Nrf2), a critical transcription factor, plays an important role in regulating antioxidant and anti-inflammatory responses to protect the cells from oxidative damage and inflammation-mediated injury. Therefore, Nrf2-targeting therapies hold promise for preventing and treating NCDs. Quercetin (Que) is a widely available flavonoid that has significant antioxidant and anti-inflammatory properties. It modulates the Nrf2 signaling pathway to ameliorate oxidative stress and inflammation. Que modulates mitochondrial function, apoptosis, autophagy, and cell damage biomarkers to regulate oxidative stress and inflammation, highlighting its efficacy as a therapeutic agent against NCDs. Here, we discussed, for the first time, the close association between NCD pathogenesis and the Nrf2 signaling pathway, involved in neurodegenerative diseases (NDDs), cardiovascular disease, cancers, organ damage, and bone damage. Furthermore, we reviewed the availability, pharmacokinetics, pharmaceutics, and therapeutic applications of Que in treating NCDs. In addition, we focused on the challenges and prospects for its clinical use. Que represents a promising candidate for the treatment of NCDs due to its Nrf2-targeting properties.

'Look up from the waiting list and see the bigger picture': a qualitative analysis of clinical specialist physiotherapist perspectives on low back pain care in Ireland

INTRODUCTION

Healthcare systems are struggling to deliver high-quality low back pain (LBP) care. In 2012 specialist physiotherapist-led musculoskeletal (MSK) triage services were introduced in Irish hospitals to expedite patient care and alleviate pressure on elective orthopaedic/ rheumatology consultant clinics. Specialist physiotherapists have expertise to inform health service improvement and reform, but their perspectives of LBP healthcare delivery have received scant attention.

OBJECTIVES

To explore specialist physiotherapists' perspectives on LBP care in Ireland, the barriers and facilitators to quality LBP care and the development of MSK interface services in primary care settings.

DESIGN

Cross-sectional observational study using an anonymous electronic survey with thematic framework analysis of response data from open-ended questions.

PARTICIPANTS

Thirty-four clinical specialist physiotherapists in Irish MSK triage services.

RESULTS

Thematic analysis resulted in six overarching themes, grouped into two categories. One category pertained to LBP healthcare in Ireland with the following three themes: 1) Inadequate health services for patients with LBP; 2) Need for defined LBP clinical pathways; 3) Need for a multisectoral approach to spine health. Themes in the second category, pertaining to the development of community-based MSK interface services, were: 4) Concern regarding isolation from secondary care services; 5) Unrealistic expectations of MSK triage; 6) Improved communication and collaboration with primary care services.

CONCLUSION

Specialist physiotherapists have concerns regarding LBP health services and persistence of a biomedical, secondary care-led approach. They advocate for investment in primary care multi-disciplinary teams, enhanced integration across primary and secondary care, development of a national clinical pathway and a multisectoral approach. CONTRIBUTION OF PAPER.

Health risk factors, status and service utilisation of adults in primary health care settings in Qatar: The HEALTHSIGHT study protocol

BACKGROUND

The emergence of non-communicable diseases (NCDs) has been well documented in recent literature which constitute a significant global burden of disease. Qatar which has a significantly high prevalence of NCDs with early on set. Epidemiological and health service utilization information plays a central role in facilitating informed decision making and application of the fundamental principles of PHC in planning and delivery of healthcare with aim to prevent and control NCDs. To enable this, the Department of Clinical Research at Primary Health Care Corporation (PHCC), Qatar's publicly funded and largest primary care provider designed the Health Assessment Linking Trends in Health Status, Risks, and Healthcare Utilization (HEALTHSIGHT) study. This paper describes the HEALTHSIGHT study protocol.

METHODS

The proposed study will use a cross sectional study design involving a random sample of participants enrolled across all 31 PHCC health centers. Individuals aged 18 and above years old registered with PHCC and hold a valid health card and contact information on PHCC's electronic medical records (EMR) will be eligible for inclusion. A stratified random sample not proportional to size sampling technique will be employed to obtain a representative sample size of the PHCC population (N = 6000). Participants will be scheduled for an appointment at a PHCC health centre where a data collector will obtain informed consent, collect vital sign information and administer a questionnaire. A phlebotomist will collect a blood sample. Health service utilization data will be extracted from PHCC's EMR.

DISCUSSION

Epidemiological and health service utilization information is essential to plan and monitor primary care and public health services. The HEALTHSIGHT study, with the help of a randomly selected representative sample from Qatar's primary healthcare settings, provides a unique opportunity to capture this information. This study design will closely represent a real-world understanding of the health risk, status and utilisation and is likely to provide important data to guide primary care planning and delivery in Qatar. The proposed protocol provides an example of a robust nationwide study that be undertaken in short duration using limited resource which can be undertaken in other similar settings.

Knowledge of gendered needs among the planners and policy makers for prevention of NCDs in Bangladesh: a qualitative exploration

BACKGROUND

Globally, non-communicable diseases (NCDs) are increasingly the primary cause of mortality and morbidity among women. Like many developing countries, Bangladesh also faces a growing burden of NCDs. The "Multisectoral Action Plan for Prevention and Control of Non-communicable Diseases, 2018-2025" signifies Bangladesh's commitment to comprehensively combating the rising burden of NCDs. This study investigates the perceptions of those involved in developing the action plan and if/how a gender lens was incorporated into its implementation.

METHODS

In-depth interviews were conducted with 25 key individuals involved in a high-level committee to develop and implement Bangladesh's multisectoral action plan to address the burden of NCDs. Data were collected between July and November 2021, and thematic analysis was conducted.

RESULTS

The findings revealed that interviewees believed the multisectoral action plan adopted a population-wide approach without considering gender-specific needs. This study presents the explanations for this inattention under five themes: (1) A population-level approach to NCD prevention; (2) Understanding women's health beyond reproductive health; (3) Absence of gender-specific programs; (4) Lack of consideration of gender constraints on physical activity; and (5) Lack of collaborative efforts to address NCDs beyond the health ministry.

CONCLUSION

In conclusion, governments in countries like Bangladesh can develop more effective strategies to reduce the disease burden of NCDs among women by recognizing and addressing the gendered nature of preventive health. This can be achieved by promoting gender-responsive research, programs, and policy initiatives that consider women's specific health concerns, ultimately leading to better health outcomes for all.

Effectiveness of Interventions for Changing More Than One Behavior at a Time to Manage Chronic Conditions: A Systematic Review and Meta-analysis

BACKGROUND

Health behaviors play a significant role in chronic disease management. Rather than being independent of one another, health behaviors often co-occur, suggesting that targeting more than one health behavior in an intervention has the potential to be more effective in promoting better health outcomes.

PURPOSE

We aimed to conduct a systematic review and meta-analysis of randomized trials of interventions that target more than one behavior to examine the effectiveness of multiple health behavior change interventions in patients with chronic conditions.

METHODS

Five electronic databases (Web of Science, PubMed, CINAHL, EMBASE, and Cochrane) were systematically searched in November 2023, and studies included in previous reviews were also consulted. We included randomized trials of interventions aiming to change more than one health behavior in individuals with chronic conditions. Two independent reviewers screened and extracted data, and used Cochrane's Risk of Bias 2 tool. Meta-analyses were conducted to estimate the effects of interventions on change in health behaviors. Results were presented as Cohen's d for continuous data, and risk ratio for dichotomous data.

RESULTS

Sixty-one studies were included spanning a range of chronic diseases: cardiovascular (k = 25), type 2 diabetes (k = 15), hypertension (k = 10), cancer (k = 7), one or more chronic conditions (k = 3), and multiple conditions (k = 1). Most interventions aimed to change more than one behavior simultaneously (rather than in sequence) and most targeted three particular behaviors at once: "physical activity, diet and smoking" (k = 20). Meta-analysis of 43 eligible studies showed for continuous data (k = 29) a small to substantial positive effect on behavior change for all health behaviors (d = 0.081-2.003) except for smoking (d = -0.019). For dichotomous data (k = 23) all analyses showed positive effects of targeting more than one behavior on all behaviors (RR = 1.026-2.247).

CONCLUSIONS

Targeting more than one behavior at a time is effective in chronic disease management and more research should be directed into developing the science of multiple behavior change.

Older Veteran Experiences of using Technology during a Multicomponent Telerehabilitation Program: A Convergent Mixed Methods Study

Less than half of U.S. veterans meet physical activity guidelines. Even though changing physical activity can be challenging, prior studies have demonstrated that it is possible. Older adults are using technology to aid in such behavior change. However, research that explores the mechanisms of how technology can aid in behavior change is lacking, especially among older veterans. Thus, the purpose of this secondary, convergent mixed methods study was to explore how older veterans engaged with technologies that were used during a multicomponent telerehabilitation program. The study included veterans aged ≥60 years with ≥3 chronic medical conditions and physical function limitation. Quantitative data were collected during the primary randomized controlled trial, and qualitative data were collected via individual interviews following completion of the telerehabilitation program. Data were merged and then analyzed by high vs. low technology engagement groups. Key similarities and differences between groups were identified in five domains: satisfaction with the virtual environment, coping self-efficacy, perceptions of Annie (automated text messaging platform), experiences using the activity monitor, and self-management skills. Findings can help inform the successful integration of similar technologies into physical rehabilitation programs. Further study is warranted to understand additional factors and mechanisms that influence technology engagement in telerehabilitation.

Combined Lifestyle Interventions in the Prevention and Management of Asthma and COPD: A Systematic Review

(1) Background: A healthy lifestyle has a protective role against the onset and management of asthma and chronic obstructive pulmonary disease (COPD). Therefore, combined lifestyle interventions (CLIs) are a potentially valuable prevention approach. This review aims to provide an overview of existing CLIs for the prevention and management of asthma or COPD. (2) Methods: A systematic literature search was conducted using PubMed, EMBASE, and PsycInfo. Studies were included if CLIs targeted at least two lifestyle factors. (3) Results: Among the 56 included studies, 9 addressed asthma and 47 addressed COPD management, with no studies focusing on prevention. For both conditions, the most prevalent combination of lifestyle targets was diet and physical activity (PA), often combined with smoking cessation in COPD. The studied CLIs led to improvements in quality of life, respiratory symptoms, body mass index/weight, and exercise capacity. Behavioural changes were only measured in a limited number of studies and mainly showed improvements in dietary intake and PA level. (4) Conclusions: CLIs are effective within asthma and COPD management. Next to optimising the content and implementation of CLIs, these positive results warrant paying more attention to CLIs for persons with an increased risk profile for these chronic respiratory diseases.

Investigating the role of the built environment, socio-economic status, and lifestyle factors in the prevalence of chronic diseases in Mashhad: PLS-SEM model

Background

Chronic diseases remain a significant contributor to both mortality and disability in our modern world. Physical inactivity and an unhealthy diet are recognized as significant behavioral risk factors for chronic diseases, which can be influenced by the built environment and socio-economic status (SES). This study aims to investigate the relationship between the built environment, SES, and lifestyle factors with chronic diseases.

Methods

The current study was conducted in Mashhad's Persian cohort, which included employees from Mashhad University of Medical Sciences (MUMS). In the study, 5,357 participants from the cohort were included. To assess the state of the built environment in Mashhad, a Geographic Information System (GIS) map was created for the city and participants in the Persian Mashhad study. Food intake and physical exercise were used to assess lifestyle. A food frequency questionnaire (FFQ) was used to assess food intake. To assess food intake, the diet quality index was computed. To assess the link between variables, the structural model was created in accordance with the study's objectives, and partial least square structural equation modeling (PLS-SEM) was utilized.

Results

The chronic diseases were positively associated with male sex (p < 0.001), married (p < 0.001), and higher age (p < 0.001). The chronic diseases were negatively associated with larger family size (p < 0.05), higher SES (p < 0.001), and higher diet quality index (DQI) (p < 0.001). No significant relationship was found between chronic disease and physical activity.

Conclusion

Food intake and socioeconomic status have a direct impact on the prevalence of chronic diseases. It seems that in order to reduce the prevalence of chronic diseases, increasing economic access, reducing the class gap and increasing literacy and awareness should be emphasized, and in the next step, emphasis should be placed on the built environment.

Effectiveness of a media literacy-based smoking prevention program in female adolescents

OBJECTIVES

To examine the effectiveness of a media literacy-based smoking prevention program based on Ajzen's theory of planned behavior in female adolescents.

METHODS

This quasi-experimental study was conducted with female high school students aged 16-17 years in Seoul, Republic of Korea. The program provided eight sessions over 4 weeks. Quantitative data were collected before and after online surveys in an intervention (n = 21) and control (n = 21) groups, and analyzed using mixed analysis of variance. Qualitative data on participation experiences was collected by requesting the participants to answer open-ended questions once a week during the intervention and performing co-occurrence analysis of specific terms in the responses was conducted through text mining.

RESULTS

Although the program decreased smoking intention and increased smoking media literacy in the intervention group, there were no significant differences between the groups. Qualitative results obtained from the intervention group showed cognitive and behavioral changes in the perception of the harmfulness of e-cigarettes in the media and the expression of a willingness to overcome the temptation to smoke.

CONCLUSIONS

Our findings show that the enhancement of smoking media literacy, specifically by correcting misconceptions regarding e-cigarettes promoted by the new media, contributes smoking prevention in female adolescents. It supports calls for an expanded role of public health professionals in health education at the school level.

Purification of exopolysaccharide produced from Lactobacillus spp. using ionic-liquid as adjuvant in alcohol/salt-based aqueous two-phase system for its antidiabetic properties

Diabetes is a chronic, metabolic disease characterized by hyperglycemia resulting from either insufficient insulin production or impaired cellular response to insulin. Exopolysaccharides (EPS) produced by Lactobacillus spp. demonstrated promising therapeutic potential in terms of their anti-diabetic properties. Extraction and purification of EPS produced by Lactobacillus acidophilus and Limosilactobacillus reuteri were performed using ethanol precipitation, followed by alcohol/salt based aqueous two-phase system (ATPS). The purification process involved ethanol precipitation followed by an alcohol/salt-based ATPS. The study systematically investigated various purification parameters in ATPS, including ethanol concentration, type and concentration of ionic liquid, type and concentration of salt and pH of salt. Purified EPS contents from L. acidophilus (63.30 μg/mL) and L. reuteri (146.48 μg/mL) were obtained under optimum conditions of ATPS which consisted of 30 % (w/w) ethanol, 25 % (w/w) dipotassium hydrogen phosphate at pH 10 and 2 % (w/w) 1-butyl-3-methylimidazolium octyl sulfate. The extracted EPS content was determined using phenol sulphuric acid method. In α-amylase inhibition tests, the inhibitory rate was found to be 92.52 % (L. reuteri) and 90.64 % (L. acidophilus), while in α-glucosidase inhibition tests, the inhibitory rate was 73.58 % (L. reuteri) and 68.77 % (L. acidophilus), based on the optimized parameters selected in ATPS. These results suggest that the purified EPS derived from the postbiotics of Lactobacillus spp. hold promise as potential antidiabetic agents.

The effect of psychoactive bacteria, Bifidobacterium longum Rosell®-175 and Lactobacillus rhamnosus JB-1, on brain proteome profiles in mice

RATIONALE

The gut microbiota may play an important role in the development and functioning of the mammalian central nervous system. The assumption of the experiment was to prove that the use of probiotic bacterial strains in the diet of mice modifies the expression of brain proteins involved in metabolic and immunological processes.

OBJECTIVES AND RESULTS

Albino Swiss mice were administered with Bifidobacterium longum Rosell®-175 or Lactobacillus rhamnosus JB-1 every 24 h for 28 days. Protein maps were prepared from hippocampal homogenates of euthanized mice. Selected proteins that were statistically significant were purified and concentrated and identified using MALDI-TOF mass spectrometry. Among the analysed samples, 13 proteins were identified. The mean volumes of calcyon, secreted frizzled-associated protein 3, and catalase in the hippocampus of mice from both experimental groups were statistically significantly higher than in the control group. In mice supplemented with Lactobacillus rhamnosus JB-1, a lower mean volume of fragrance binding protein 2, shadow of prion protein, and glycine receptor α4 subunit was observed compared to the control.

CONCLUSION

The psychobiotics Bifidobacterium longum Rosell®-175 and Lactobacillus rhamnosus JB-1enhances expression of proteins involved in the activation and maturation of nerve cells, as well as myelination and homeostatic regulation of neurogenesis in mice. The tested psychobiotics cause a decrease in the expression of proteins associated with CNS development and in synaptic transmission, thereby reducing the capacity for communication between nerve cells. The results of the study indicate that psychobiotic bacteria can be used in auxiliary treatment of neurological disorders.

The Thai Health Promotion Foundation: Two Decades of Joint Contributions to Addressing Noncommunicable Diseases and Creating Healthy Populations

Globally, the current investment in preventive care is inadequate and ineffective for addressing noncommunicable diseases and their causes. The Thai Health Promotion Foundation, with its sustainable funding from 2% levies on tobacco and alcohol, together with partners, has been used to address noncommunicable diseases effectively.

Assessing nutrition literacy and nutrition counseling proficiency following an interdisciplinary culinary medicine elective

CONTEXT

Culinary medicine (CM) is a growing field of education that aims to bridge the gap between the clinical need for nutritional counseling and the lack of education on the topic. Healthcare professionals can aid in nutrition-related noncommunicable disease (NCD) prevention by improving a patient's dietary behavior. However, the presence of nutrition education in healthcare curricula is lacking. Early evidence indicates that CM could address this gap.

OBJECTIVES

The objectives of this study are to determine if the provision of an interdisciplinary CM elective will improve student knowledge and confidence with counseling on nutrition and culinary principles, and to improve personal dietary habits of students.

METHODS

This was a one-group pretest-posttest quasi-experimental design. First- and second-year osteopathic medical students (OMS) and nurse practitioner students were recruited to participate in a CM elective via email. Participants were excluded if they were not in good academic standing at their respective institutions. Twelve individuals (n=8 medical; n=4 nursing) were enrolled in the course. Participants completed pre- and postcourse surveys to determine changes in nutrition literacy (Nutrition Literacy Assessment Instrument [NLit42]), nutrition counseling proficiency (Nutrition Survey for Family Practitioners), and dietary quality (Automated Self-Administered 24-h dietary assessment tool; ASA24®). A two-sided, paired t test was conducted to determine changes in outcome variables.

RESULTS

All 12 participants completed the precourse assessments, and 8 participants completed the postcourse assessments. Culinary activity attendance was 94.5 %. Participants exhibited a statistically significant increase in their overall nutrition literacy scores after completing the CM elective (p=0.006). Literacy subcategories indicated that the improvement came from the participant's ability to understand household measurements (p=0.005) better. Increases in self-reported proficiency were observed for participants' confidence to counsel on nutrition and prevention/wellness (p=0.02) and macronutrients in health and food safety (p=0.01). No statistically significant changes in the personal dietary pattern or quality were observed.

CONCLUSIONS

The interdisciplinary CM elective improved nutrition literacy and some aspects of counseling proficiency. Although small shifts in dietary variables were observed, the elective did not statistically improve participants' dietary pattern. However, some changes that were observed may lead to clinically relevant outcomes if maintained long-term. These findings are encouraging. Implementing CM as an educational tool could improve healthcare practitioners' ability to understand and counsel patients on nutrition to prevent the nutrition-related NCDs.

Cytotoxic Potential of the Monoterpene Isoespintanol against Human Tumor Cell Lines

Cancer is a disease that encompasses multiple and different malignant conditions and is among the leading causes of death in the world. Therefore, the search for new pharmacotherapeutic options and potential candidates that can be used as treatments or adjuvants to control this disease is urgent. Natural products, especially those obtained from plants, have played an important role as a source of specialized metabolites with recognized pharmacological properties against cancer, therefore, they are an excellent alternative to be used. The objective of this research was to evaluate the action of the monoterpene isoespintanol (ISO) against the human tumor cell lines MDA-MB-231, A549, DU145, A2780, A2780-cis and the non-tumor line MRC-5. Experiments with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and fluorescence with propidium iodide (PI), 4',6-diamidino-2-phenylindole dilactate (DAPI) and green plasma revealed the cytotoxicity of ISO against these cells; furthermore, morphological and chromogenic studies revealed the action of ISO on cell morphology and the inhibitory capacity on reproductive viability to form colonies in MDA-MB-231 cells. Likewise, 3D experiments validated the damage in these cells caused by this monoterpene. These results serve as a basis for progress in studies of the mechanisms of action of these compounds and the development of derivatives or synthetic analogues with a better antitumor profile.

Exploring the Wound Healing Potential of a Cuscuta chinensis Extract-Loaded Nanoemulsion-Based Gel

Cuscuta chinensis (C. chinensis) presents many pharmacological activities, including antidiabetic effects, and antioxidant, anti-inflammatory, and antitumor properties. However, the wound care properties of this plant have not yet been reported. Therefore, this research aimed to evaluate the antioxidant, anti-inflammatory, and antibacterial activities of ethanol and ethyl acetate C. chinensis extracts. The phytochemical markers in the extracts were analyzed using high-performance liquid chromatography (HPLC). Then, the selected C. chinensis extract was developed into a nanoemulsion-based gel for wound care testing in rats. The results showed that both of the C. chinensis extracts exhibited antioxidant activity when tested using 2,2-Diphenyl-1-picrylhydrazyl (DPPH), ferric reducing antioxidant power (FRAP), and lipid peroxidation inhibition assays. They reduced the expression of IL-1β, IL-6, and TNF-α in RAW264.7 cells induced with lipopolysaccharide (LPS). The ethyl acetate extract also had antibacterial properties. Kaempferol was found in both extracts, whereas hyperoside was found only in the ethanol extract. These compounds were found to be related to the biological activities of the extracts, confirmed via molecular docking. The C. chinensis extract-loaded nanoemulsions had a small particle size, a narrow polydispersity index (PDI), and good stability. Furthermore, the C. chinensis extract-loaded nanoemulsion-based gel had a positive effect on wound healing, presenting a better percentage wound contraction Fucidin cream. In conclusion, this formulation has the potential for use as an alternative wound treatment and warrants further study in clinical trials.

Evaluator's alignment as an important indicator of adequacy of the criteria and assessment procedure for recognizing the good practice in public health

Background

Public health interventions aim to reduce the burden of chronic non-communicable diseases. Implementing evidence-based interventions that are proven to be successful and effective is widely recognized as the best approach to addressing public health challenges. To avoid the development and implementation of less effective or successful or even harmful practices, clear criteria for the assessment of practices, that consider different dimensions of the interventions in public health, are needed. The main aim of the research was to test our Criteria and assessment procedure for recognizing good practices in the field of public health by estimating the consistency between the evaluators and thereby gaining insight into the adequacy and reliability of the criteria as well as to check how the evaluators understand the criteria and methodology and if it is properly used in assessing the interventions.

Methods

The assessment of the interventions took place from 2021 to 2022. The individual evaluator's scores on the scale from 1 to 5 for each specific sub-criterion were collected, which was followed by a panel discussion to reach a final score for each sub-criterion. The inter-rater agreement was measured using percent overall agreement and Fleiss' kappa coefficient.

Results

We found moderate inter-rater agreement on the level of the assessment criteria group. The lowest agreement was observed for the effectiveness and efficiency sub-criteria group, which also received the lowest scores from the evaluators. Challenges identified with the scoring process were due to the descriptive 1 to 5 scale and the varying specificity of the criteria.

Conclusion

The results showed that studying consistency between evaluators can highlight areas for improvement or adjustment in the assessment criteria and enhance the quality of the assessment instrument. Therefore, such analysis would be useful part of both newly and well-established health promotion and prevention program registries.

Yogurt, in the context of a healthy diet, for the prevention and management of diabetes and obesity: a perspective from Argentina

Diabetes is a non-communicable chronic, but preventable, disease whose occurrence is related to unhealthy lifestyles, including inadequate diet. Obesity is a risk factor for diabetes. In Argentina, 12.7% of the population is living with diabetes. In this work, we aimed at giving a perspective on the role of yogurt, as part of a healthy lifestyle, for the prevention and management of obesity and diabetes. The intake of yogurt declined in the last decade in Argentina. In the context of the global diet, the contribution of a moderate increase of yogurt consumption has the potential to improve up to 10% the nutritional density of the Argentine population's diet, given its present low diversity and wide gaps in nutritive foods. The consumption of yogurt can be beneficial in the prevention and management of obesity and T2DM. The ready availability of yogurt and its easy introduction to diverse diets suggests that educating the general public to incorporate this fermented milk as part of a healthy diet may potentially contribute to improved public health through prevention of NCDs and the costs associated with them.

Spatial characteristics of non-communicable diseases and their associations to social conditions in a large urban cohort in Germany-Results from the Hamburg City Health Study

BACKGROUND

Non-communicable diseases (NCDs) are responsible for many deaths. They are associated with several modifiable and metabolic risk factors and are therefore prone to significant regional variations on different scales. However, only few intra-urban studies examined spatial variation in NCDs and its association with social circumstances, especially in Germany. Thus, the present study aimed to identify associations of personal risk factors and local social conditions with NCDs in a large German city.

METHODS

This study is based on a population-based cohort of the Hamburg City Health Study including 10,000 probands. Six NCDs were analyzed (chronic obstructive pulmonary disease [COPD], coronary heart disease [CHD], diabetes mellitus, heart failure, depression, and hypertension) in 68 city district clusters. As risk factors, we considered socio-demographic variables (age, sex, education) and risk behaviour variables (smoking, alcohol consumption). Logistic regression analyses identified associations between the district clusters and the prevalence rates for each NCD. Regional variation was detected by Gini coefficients and spatial cluster analyses. Local social condition indexes were correlated with prevalence rates of NCDs on city district level and hot-spot analyses were performed for significant high or low values.

RESULTS

The analyses included 7,308 participants with a mean age of 63.1 years (51.5% female). The prevalence of hypertension (67.6%) was the highest. Risk factor associations were identified between smoking, alcohol consumption and education and the prevalence of NCDs (hypertension, diabetes, and COPD). Significant regional variations were detected and persisted after adjusting for personal risk factors. Correlations for prevalence rates with the local social conditions were significant for hypertension (r = 0.294, p < 0.02), diabetes (r = 0.259, p = 0.03), and COPD (r = 0.360, p < 0.01).

CONCLUSIONS

The study shows that regional differences in NCD prevalence persist even after adjusting for personal risk factors. This highlights the central role of both personal socio-economic status and behaviors such as alcohol and tobacco consumption. It also highlights the importance of other potential regional factors (e.g. the environment) in shaping NCD prevalence. This knowledge helps policy- and decision-makers to develop intervention strategies.

Intake of Table Sugar and Their Corresponding Food Sources in Adults from the 2017-2018 Brazilian National Dietary Survey

Excessive intake of free sugars is associated with adverse health outcomes. Table sugar is one of the main dietary sources of free sugars; however, the amount added by Brazilian consumers in their culinary preparations is unknown. The aims were to estimate the daily intake of table sugar (g/day), its contribution to total energy intake (E%) and the main food groups that contribute to the intake of this sugar in a nationwide multi-ethnic sample of Brazilian adults (2017-2018 Brazilian National Dietary Survey). Based on two 24-h recalls adjusted for the within-person variation, the overall median table sugar intake was 14.3 g/day, corresponding to 3.2 E%. Males, individuals living in rural areas, with low income, low education and experiencing food insecurity had a higher intake of table sugar. The main food sources of table sugar were coffee (55.8%), juice (33.9%), milk-based preparations and smoothies (3.1%), powdered and processed juice (2.7%), whole milk (1.9%), and tea (1.6%). There are no recommendations regarding the limit of table sugar intake, but considering that the WHO limits the intake of free sugars to <10 E%, it is concluded that table sugar intake by Brazilians corresponds to about 30% of the upper recommended daily intake of free sugars.

A Study on Communication Practices in Reducing Non-Communicable Diseases in Bahir Dar City, Ethiopia

Background

Non-communicable diseases (NCDs) pose special challenges in developing countries In Ethiopia, the growing NCD burden has raised a public health concern with significant social, economic, and developmental effects. Thus, the study sought to examine health communication practices in addressing the NCDs in Bahir Dar City of the Amhara Region of Ethiopia.

Methods

A qualitative case study was conducted from January to April 2023. The study employed in-depth interviews, focus group discussions, and observations to gather data from health extension workers, NCD experts, and NCD focal persons about their experiences and perspectives regarding NCD prevention and control. The participants were purposively selected, and a thematic analysis technique was employed to analyze the data.

Results

The study found that several health communication strategies, such as health promotion, training and creating model households, screening, referrals, follow-ups, rehabilitation services, and activities reporting were employed. Nevertheless, there was a lack of consistent, reliable, and long-lasting and professional health communication regarding NCD prevention and management. Some of the challenges contributing to such deficient practices were overloading HEWs with various tasks, allocating many households to a single HEW, shortage of screening tools, shortage of financial and human resources, weak interdisciplinary collaboration, COVID-19, and recurrent conflicts in the city and the region. Above all, lack of health communication skills affected the health interventions. Concerning communication methods, one-to-one communication was frequently employed, while mass media and social media were rare. Generally, NCD communication, in particular, and health communication, in general, did not receive priority as other health-related activities in the city.

Conclusion

The study found that there were poor health communication practices in preventing and controlling NCDs. Thus, professional practice of health communication about NCDs must be prioritized, and emphasis should be given to inter-sectoral collaborations. Prioritizing financial and human resources is also essential for effective NCD communication.

Which behaviour change techniques work best for diabetes self-management mobile apps? Results from a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Self-management is pivotal in addressing noncommunicable diseases, such as diabetes. The increased availability of digital behaviour change interventions (DBCIs) delivered through mobile health apps offers unprecedented opportunities to enhance self-management and improve health outcomes. However, little is known about the characteristics of DBCIs for diabetes that significantly impact glycaemic control. Therefore, our systematic review with meta-analysis aimed to summarize characteristics and behaviour change components in DBCIs for diabetes self-management and explore potential associations with metabolic outcomes.

METHODS

A systematic search was conducted in PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Scopus to identify randomized controlled trials published until November 2023. The main outcome variable was the change in the mean difference of HbA1c levels between baseline and follow-up across intervention and control groups. Random-effects meta-regression was used to explore variation in glycaemic control as a function of prespecified characteristics of study designs and app interventions.

FINDINGS

A total of 57 studies was included in the analysis, showing a statistically significant percentage point reduction in HbA1c for the intervention group compared to the control arm (-0.36, 95% CI = -0.46 to -0.26, p < 0.001). The inclusion of "self-monitoring of behaviour" as a behaviour change technique (β = -0.22, p = 0.04) and "taking medication" as a target behaviour (β = -0.20, p = 0.05) was associated with improved metabolic outcomes.

INTERPRETATION

Our analyses endorse the use of diabetes self-management apps, highlighting characteristics statistically associated with intervention effectiveness and guiding the design of more effective DBCIs.

FUNDING

This project received funding from the European Union's Horizon 2020 programme.

Knowledge, Attitudes, and Practices Regarding Tropical Diseases among Nursing Students: A Comparative Cross-Sectional Study

This study aimed to compare bachelor nursing students' knowledge, attitudes, and practices (KAP) regarding tropical diseases. This cross-sectional study was conducted with 128 participants who were recruited using stratified random sampling and completed a sociodemographics questionnaire and KAP questionnaire concerning tropical diseases. Descriptive statistics were used to present the data, and inferential statistics, including one-way analysis of variance and Mann-Whitney U tests, were calculated to identify potential differences between variables. The study found nursing students who took the tropical nursing courses had better knowledge and attitudes regarding preventing tropical diseases than those who did not. Participants who took the tropical nursing courses had a significantly higher median knowledge score of 22 with an interquartile range (IQR) of 2 (P <0.001) and a median attitude score of 31 (IQR: 6, P = 0.02) compared with those who did not take it. However, there were no significant differences between the two groups in practice regarding tropical diseases (P = 0.20). In conclusion, students who take tropical nursing courses may improve their knowledge and attitudes toward tropical diseases, but the two groups in this study did not significantly differ in practice, possibly because of self-reported practices rather than direct observation. This study highlights the potential of accurate digital information to provide credible resources in enhancing nursing students' KAP concerning tropical diseases.

Maillard-type glycated collagen with alginate oligosaccharide suppresses inflammation and oxidative stress by attenuating the expression of LPS receptors Tlr4 and Cd14 in macrophages

Inflammation and oxidative stress contribute to noncommunicable diseases (NCDs), with macrophages playing pivotal roles. Glycated collagen through Maillard-type glycation holds promise for enhancing anti-inflammatory properties, but its mechanism remains unclear. This study investigates the cellular mechanism and aims to contribute to expanding collagen utilization. Collagen was glycated with alginate oligosaccharide (AO) and glucose (Glc: as a comparative case) at 60 °C and 35% relative humidity for up to 24 h (C-AO and C-Glc, respectively). The anti-inflammatory activities of both C-AO and C-Glc were evaluated using an LPS-stimulated macrophage model. 18 h AO-glycated collagen (C-AO18 h) was found to significantly reduce the production of nitric oxide and proinflammatory cytokines (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β). In contrast, C-Glc did not exhibit enhanced anti-inflammatory activity during any of the glycation periods. The enhanced anti-inflammatory activity of C-AO18 h was attributed to its downregulating effect on LPS receptors (toll-like receptor 4, Tlr4; cluster of differentiation 14, Cd14) and myeloid differentiation primary response 88 (Myd88) mRNA expression, with suppression in receptor expression resulting in decreased phagocytic ability of macrophages against E. coli. In addition, compared with intact collagen, C-AO18 h exhibited improved antioxidant activity in the LPS-stimulated macrophage model, as it significantly upregulated superoxide dismutase (SOD) and catalase (CAT) activities while reducing malondialdehyde (MDA) levels. Overall, this study contributes to the development of collagen-based functional foods for mitigating inflammation and oxidative stress in NCDs.

Prevalence and impact of endocrine disorders in advanced metastatic cancer patients undergoing cancer-directed therapy: A prospective observational study

BACKGROUND

Noncommunicable diseases (NCDs) contribute significantly to global morbidity and mortality, with cancer being one of the leading causes. In this prospective observational study, we aimed to investigate the prevalence and impact of endocrine disorders, specifically diabetes and thyroid dysfunction, in patients with advanced metastatic cancer undergoing cancer-directed therapy.

METHODS

Over 15 months, we recruited 100 histologically proven advanced metastatic cancer patients from the Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, and conducted institutional-based prospective observational study. All participants over 18 years of age, treatment-naive, and potential candidates for systemic chemotherapy with an expected clinical survival of at least 6 months were included in the study. Patients with prior therapy, secondary neoplasms, and those unable to complete 3 months of palliative chemotherapy were excluded. Patients were assessed for diabetes and thyroid function at presentation, after 3 and 6 months of cancer-directed standard therapy. These data were analyzed, processed, and presented as results.

RESULTS

The mean age of participants was 50.45 years, with a near-equal distribution of males and females. At baseline, 10% of the study population had preexisting endocrine disorders (2% hypothyroidism, 8% diabetes). By the end of 6 months, the prevalence increased to 18%, with females being more affected. Notably, the prevalence of new-onset endocrine disorders during cancer-directed therapy was only 3% for diabetes and 4% for thyroid dysfunction.

CONCLUSION

Analysis of sociodemographic and cancer-related characteristics showed no significant association with changes in diabetic and thyroid status at 3 and 6 months. However, substance use, particularly smoking, was associated with an increased risk of diabetes development (p < .05). Cancer type and treatment regimen did not show statistically significant correlations with endocrine dysfunction.

IMPLICATIONS

Our study highlights the importance of considering endocrine disorders in advanced metastatic cancer patients undergoing therapy. The prevalence of diabetes and thyroid dysfunction increased during cancer-directed therapy, particularly in females. Careful monitoring and timely intervention are essential to improve the quality of life for these patients. Further research is warranted to explore the long-term effects of cancer-directed therapy on endocrine health and develop tailored management strategies for this vulnerable population.

Cancer control collaborations between China and African countries

Over the past decade, China has emerged as Africa's largest trade partner and source of foreign direct investment, with public health ranked as a top priority in China-Africa collaborations. During the same period, cancer has emerged as a leading cause of death in Africa, with more than 700 000 deaths per year and projections of more than 1 million deaths per year by 2030. In this Review, we explore the effects of increasing China-Africa collaborations on cancer control in Africa. We review the published literature on health-care assistance, research, education and training, and infrastructure and present the results of an institutional review board-approved survey of African oncology health-care professionals and institutional leaders that assessed their perception of the effects of China-Africa collaborations. From peer-reviewed articles and grey literature, we found that the number of China-Africa collaborations have grown substantially over the past decade in different areas, especially in patient care and infrastructure. Research publications have also surged in quantity in the past decade compared with previous years. However, the survey results suggest research collaborations remain infrequent and that medical professionals in African cancer centres rarely participate in direct research collaborations with Chinese institutions. The Review also highlights the challenges and benefits of increasing China-Africa collaborations. Challenges include insufficient monitoring and evaluation of the projects in Africa and poor coordination and alignment of the various initiatives. The benefits of these collaborations for Africa include improved health outcomes, strengthened health systems, and socioeconomic development. Benefits are also apparent for China, such as securing energy and resource supplies, expanded trade and investment opportunities, and improved diplomatic relations. Overall, China-Africa collaborations are increasing and having a substantial effect in both China and the African continent. Recommendations to minimise the challenges and maximise the benefits for more positive consequences on cancer control in Africa are discussed.

Gender differential in the pattern and severity of perceived symptoms among diabetes patients in India

Objective

To analyze the pattern of diabetes symptoms and to estimate the association between diabetes symptom severity (level of discomfort perceived by a patient due to diabetes symptoms) among different socio-demographic variables for both women and men.

Methods

Primary cross-sectional data of 583 diagnosed patients (51.3% and 48.7%, women and men, respectively) were collected from Punjab, India. Frequency percentage distribution and negative binomial regressions (NBR) were used for analysis.

Results

More men were asymptomatic compared to women. Both genders perceived increased hunger, thirst, and frequent urination in their early stages of diabetes. More women than men have experienced hormonal change as their first symptom with a higher severity level. NBR analyzed the association between discomfort perceived by both genders due to symptoms among different socio-demographic categories. Urban patients (incidence rate ratio-IRR: 0.90) were significantly (p = 0.056) less likely to perceive discomfort than their rural counterparts, whereas men (IRR: 0.93) reported more significant discomfort than women (IRR: 0.88) in the urban area. Literate patients [Up to class 10 (IRR: 0.87), (p = 0.013) and 11-above (IRR: 0.85), (p = 0.022) categories] were significantly less likely to perceive discomfort. In all education categories, women professed more significant discomfort than men.

Conclusion

Given the differences in symptoms between the two genders, this paper will help comprehend the disease development process and limit the possibilities of misdiagnosis. This study will assist in identifying the order of the symptoms among both genders.

The importance, benefits, and future of nanobiosensors for infectious diseases

Infectious diseases, caused by pathogenic microorganisms such as bacteria, viruses, parasites, or fungi, are crucial for efficient disease management, reducing morbidity and mortality rates and controlling disease spread. Traditional laboratory-based diagnostic methods face challenges such as high costs, time consumption, and a lack of trained personnel in resource-poor settings. Diagnostic biosensors have gained momentum as a potential solution, offering advantages such as low cost, high sensitivity, ease of use, and portability. Nanobiosensors are a promising tool for detecting and diagnosing infectious diseases such as coronavirus disease, human immunodeficiency virus, and hepatitis. These sensors use nanostructured carbon nanotubes, graphene, and nanoparticles to detect specific biomarkers or pathogens. They operate through mechanisms like the lateral flow test platform, where a sample containing the biomarker or pathogen is applied to a test strip. If present, the sample binds to specific recognition probes on the strip, indicating a positive result. This binding event is visualized through a colored line. This review discusses the importance, benefits, and potential of nanobiosensors in detecting infectious diseases.

Socio-environmental predictors of diabetes incidence disparities in Tanzania mainland: a comparison of regression models for count data

BACKGROUND

Diabetes is one of the top four non-communicable diseases that cause death and illness to many people around the world. This study aims to use an efficient count data model to estimate socio-environmental factors associated with diabetes incidences in Tanzania mainland, addressing lack of evidence on the efficient count data model for estimating factors associated with disease incidences disparities.

METHODS

This study analyzed diabetes counts in 184 Tanzania mainland councils collected in 2020. The study applied generalized Poisson, negative binomial, and Poisson count data models and evaluated their adequacy using information criteria and Pearson chi-square values.

RESULTS

The data were over-dispersed, as evidenced by the mean and variance values and the positively skewed histograms. The results revealed uneven distribution of diabetes incidence across geographical locations, with northern and urban councils having more cases. Factors like population, GDP, and hospital numbers were associated with diabetes counts. The GP model performed better than NB and Poisson models.

CONCLUSION

The occurrence of diabetes can be attributed to geographical locations. To address this public health issue, environmental interventions can be implemented. Additionally, the generalized Poisson model is an effective tool for analyzing health information system count data across different population subgroups.

Green and blue space exposure and non-communicable disease related hospitalizations: A systematic review

The global increase in non-communicable diseases (NCDs) presents a critical public health concern. Emerging evidence suggests that exposure to natural environments may reduce the risk of developing NCDs through multiple pathways. The present systematic review aims to synthesize and evaluate the observational evidence regarding associations between exposure to green and blue spaces and hospital admissions related to NCDs. A comprehensive literature search strategy was conducted in Embase (Ovid), PubMed, and Web of Science. The risk of bias and quality of the evidence were assessed using The Navigation Guide methodology, an approach specifically designed for environmental health research. Of 3060 search results, 17 articles were included. Notably, the majority of the studies (n = 14; 82.4%) were published from 2020 onwards. Most studies were conducted in the United States (n = 6; 35.3%) and China (n = 4; 23.5%). Exposure to green spaces was assessed through all studies, while only three included blue spaces. In terms of study design, cohort design was employed in nearly half of the studies (n = 8; 47.1%), followed by case-crossover design (n = 3, 17.6%). Over 75% of the included studies (n = 13) had a high or probably high rating in the risk of bias assessment. The studies encompassed diverse NCD outcome domains; cardiovascular diseases (CVDs) (n = 10), respiratory diseases (RSDs) (n = 2), heat-related diseases (n = 1), metabolic diseases (n = 2), cancer (n = 1), neurodegenerative diseases (NDDs) (n = 2), and mental health disorders (n = 2). The present review suggests that a clear link between blue space exposure and NCD hospital admissions is not evident. However, exposure to green spaces appears to predominantly have a protective effect, although the direction of the association varies across different outcome domains. The heterogeneity among the outcome domains together with the limited number of studies, emphasizes the need for more robust evidence.

The interaction between general or abdominal obesity and hypertension on the risk of type 2 diabetes mellitus: a cross-sectional analysis in Iranian adults from the RaNCD cohort study

BACKGROUND

Interactions between risk factors may influence disease severity. Knowing this relationship is important for preventive interventions and disease control. The purpose of this study was to determine the interactions effects of obesity and hypertension on the risk of type 2 diabetes mellitus (T2DM).

METHODS

The data of 9,283 adults 35 to 65 years were examined from the cohort study of Ravansar Non-Communicable Disease (RaNCD). Waist circumference (WC) was used to identify both general and abdominal obesity based on body mass index (BMI). To assess the interaction between hypertension and obesity (general/abdominal) and the risk of T2DM, the additive interaction was calculated.

RESULTS

The adjusted odds ratios for T2DM were 2.38 (1.67, 3.41) in men and 4.02 (2.47, 6.47) in women for the combinations of hypertension and abdominal obesity. The adjusted odds ratios for T2DM were 2.53 (1.63, 3.82) in men and 2.66 (1.92, 3.70) in women for the combinations of hypertension and general obesity. The results of the additive interaction indicators were inconsistent with gender. The relative excess risk due to interaction (interaction between hypertension and central obesity) (RERI), attributable proportion due to interaction (AP) and synergy index (SI) were0.27 (-1.01, 1.54), 0.11 (-0.41, 0.63) and 1.23 (0.41, 3.68) in male and were 0.61 (-1.12, 2.33), 0.23 (0.08, 0.37) and 1.26 (0.60, 2.61) in female, respectively.

CONCLUSION

General/abdominal obesity and hypertension have a synergistic effect on the risk of T2DM. The recommendation for preventing T2DM is lifestyle modification. Large longitudinal studies are necessary to investigate causal relationships.

Mixture effects of trace element levels on cardiovascular diseases and type 2 diabetes risk in adults using G-computation analysis

There is an increasing concern about the health effects of exposure to a mixture of pollutants. This study aimed to evaluate the associations between serum levels of heavy/essential metals ([Arsenic (As), Cadmium (Cd), Mercury (Hg), Lead (Pb), Nickel (Ni), Chromium (Cr), Copper (Cu), Iron (Fe), and Zinc (Zn)]) and the risk of developing cardiovascular diseases (CVDs) and type 2 diabetes mellitus (T2D). Data were collected from 450 participants (150 with CVDs, 150 with T2D, and 150 healthy subjects) randomly selected from the Ravansar Non-Communicable Disease (RaNCD) cohort in Western Iran, covering the years 2018-2023. Trace element levels in the serum samples were assayed using ICP-MS. Logistic regression was performed to estimate the adjusted risk of exposure to single and multi-metals and CVD/T2D. Odds ratios were adjusted for age, sex, education, residential areas, hypertension, and BMI. The mixture effect of exposure to multi-metals and CVD/T2D was obtained using Quantile G-computation (QGC). In the logistic regression model, chromium, nickel, and zinc levels were associated with CVD, and significant trends were observed for these chemical quartiles (P < 0.001). Arsenic, chromium, and copper levels were also associated with T2D. The weight quartile sum (WQS) index was significantly associated with both CVD (OR 4.17, 95% CI 2.16-7.69) and T2D (OR 11.96, 95% CI 5.65-18.26). Cd, Pb, and Ni were the most heavily weighed chemicals in these models.The Cd had the highest weight among the metals in the CVD model (weighted at 0.78), followed by Hg weighted at 0.197. For T2D, the serum Pb (weighted at 0.32), Ni (weighted at 0.19), Cr (weighted at 0.17), and Cd (weighted at 0.14) were the most weighted in the G-computation model. The results showed the significant role of toxic and essential elements in CVDs and T2D risk. This association may be driven primarily by cadmium and mercury for CVDs and Pb, Ni, Cr, and Cd for T2D, respectively. Prospective studies with higher sample sizes are necessary to confirm or refute our preliminary results as well as to determine other important elements.

Complementary Feeding: Tradition, Innovation and Pitfalls

According to WHO, "complementary feeding (CF) is the process starting when breast milk alone or infant formula alone is no longer sufficient to meet the nutritional requirements of infants, and therefore, other foods and liquids are needed, along with breast human milk or a breastmilk substitute". CF is one of the most important "critical and sensitive periods" in human life: indeed, timing and approaches to solid foods introduction in an infant's nutrition are of utmost importance as potential epigenetic factors from infancy to adulthood. CF is also deeply influenced by each country and single-family traditions, culture, and beliefs. The aim of our narrative review is to analyze traditional CF practices, including innovative and alternative ones that emerged in the last decades, such as baby-led weaning or plant-based weaning, and to evaluate their effects on the risk of developing non-communicable diseases. Moreover, we will discuss pitfalls and misunderstandings that pediatricians frequently have to face when dealing with complementary feeding. Health care professionals must not have prejudices against parents' wishes or traditions about CF; rather, they should support and educate them in case of any alternative CF choice, always pursuing the infant's adequate growth, neuro- and taste development, and the achievement of correct eating behavior as the primary goal.

Qualitative Analysis of Newborn Hearing Screening Program in Iran

Background

Early diagnosis of hearing loss and timely interventions are important to minimize the consequences of this condition, especially for children. This research was conducted to analyze the newborn hearing loss screening program in Iran.

Methods

This qualitative study was conducted using the content analysis method and based on the CIPP model in 2023. The snowball method was used to recruit a sample with maximum diversity. The criteria for selecting people for interviews included having at least three years of experience in the newborn hearing loss screening program and sufficient knowledge in the field. To ensure the reliability of the results, four criteria proposed by Lincoln and Guba were used. Data analysis was conducted by MAXQDA2022 software.

Results

In the current research, using content analysis in the form of the CIPP model, based on the viewpoints of the interviewees (40 people), the management requirements of the newborn hearing loss screening program were categorized into the four main categories of context (texture), input, process, and output. Eight subcategories were identified in the context dimension, four subcategories in the input dimension, seven subcategories in the process dimension, and four subcategories in the output dimension.

Conclusion

According to the findings of this research, in order to properly implement the newborn hearing loss screening program, there is a need to conduct pilot studies, need assessments, evidence-based programs, and epidemiological studies and to prioritize services and resources. Also, communication between service delivery levels needs to be improved, and attention should be paid to personnel motivation and screening programs.