Mapa de evidências - Doenças Crônicas Não Transmissíveis

Este mapa de evidências apresenta estratégias para o cuidado de pessoas com as seguintes Doenças Crônicas Não Transmissíveis (DCNT): Diabetes Mellitus Tipo 2, Hipertensão Arterial sistêmica e Obesidade. A partir de uma ampla busca bibliográfica realizada para o desenvolvimento de 7 revisões rápidas, 93 estudos de revisão foram incluídos no mapa (62 revisões sistemáticas, 31 revisões sistemáticas com meta-análise). Com base na ferramenta AMSTAR2, foi avaliado o nível de confiabilidade para a evidência reportada nestes estudos, resultando em 2 revisões de nível alto, 5 revisões de nível moderado, 10 revisões de nível baixo e 76 revisões de nível criticamente baixo. Todos os estudos foram avaliados, caracterizados, categorizados por uma equipe multiprofissional organizada em pares, composta por pesquisadores que atuam nas áreas de Saúde Coletiva e Políticas Informadas por Evidências. Principais Achados: ● As revisões avaliaram o efeito de 26 intervenções distribuídas em 5 grupos: Teleconsulta/eHealth, Tratamento farmacológico, Automonitoramento/autogerenciamento, Educação, e Serviço de saúde; ● As intervenções foram associadas a 22 desfechos relacionados às DCNT distribuídos em 3 grupos: resultados clínicos, resultados não clínicos e segurança; ● No total foram encontradas 196 associações entre intervenções, desfechos e efeitos nos estudos selecionados. A maior parte das associações foi com intervenções de cuidado assistencial (32 associações) e intervenções combinadas (24 associações); ● Os desfechos que receberam maior número de associações foram: Pressão Arterial (36 associações), Peso corporal (34 associações), Adesão ao tratamento farmacológico (29 associações) e Satisfação do paciente (21 associações).

The projected economic burden of non-communicable diseases attributable to overweight in Brazil by 2030.

OBJECTIVES: The prevalence of overweight increases the risk of several non-communicable diseases (NCDs) and, consequently, the costs of health care systems. In this study, we aimed to project the economic burden of NCDs attributable to overweight in Brazil between 2021 and 2030. METHODS: A cohort simulation of adults (17-117 years) using multistate lifetable modeling was used to estimate the costs of NCDs attributable to overweight in Brazil. The projections of direct health care costs (outpatient and inpatient expenses in the Unified Health System) and indirect costs (years of productive life lost) considered different trajectories of the prevalence of overweight between 2021 and 2030. RESULTS: In 2019, the prevalence of overweight was 55.4% in the adult Brazilian population. We estimate that around 1.8 billion international dollars (Int$) would be spent on the direct health care cost of NCDs between 2021 and 2030, through the continued increase in overweight prevalence observed between 2006 and 2020. The indirect costs over the same time would be approximately 20.1 billion Int$. We estimate that halving the annual increase in body mass index slope from the beginning of 2021 until 2030 would save 20.2 million Int$ direct and indirect costs by 2030. In the scenario of keeping the prevalence of overweight observed in 2019 constant until 2030, the savings would be 40.8 million Int$. Finally, in the scenario of a 6.7% reduction in the prevalence of overweight observed in 2019 (to be achieved gradually until 2030), 74.1 million Int$ would be saved. CONCLUSIONS: These results highlight the high economic burden of overweight in the Brazilian adult population.

On-site detection of infectious disease based on CaCO3-based magnetic micromotor integrated with graphene field effect transistor.

A new detection platform based on CaCO3-based magnetic micromotor (CaCO3@Fe3O4) integrated with graphene field effect transistor (GFET) was construct and used for on-site SARS-CoV-2 coronavirus pathogen detection. The CaCO3@Fe3O4 micromotor, which was modified with anti-SARS-CoV-2 (labelled antibody, AntiE1), can self-moved in the solution containing hydrochloric acid (HCl) and effective to capture the SARS-CoV-2 coronavirus pathogens. After magnetic field separation, the capture micromotor was detected by GFET, exhibiting a good linear relationship within the range of 1 ag/mL to 100 ng/mL and low detection limit (0.39 ag/mL). Furthermore, the detection platform was also successfully applied to detection of SARS-CoV-2 coronavirus pathogens in soil solution, indicating the potential use in on-site application.

Prevalence of Sexually Transmitted Infections and Predictors for Loss to Follow Up among Marginalized Homeless and Migrant Communities: a Cross-Sectional Study.

Background: In Europe and Italy, marginalized communities have a higher risk for both contracting sexually transmitted infections (STI) and progressing towards adverse outcomes. Objectives: This study focuses on the screening of HIV, HBV, HCV, and syphilis among homeless individuals and agricultural migrant workers living in Apulia, Italy. It aims to assess STI prevalence and investigate factors that might hinder return to collect test results. In addition, it explores STI knowledge, attitudes, and practices among these vulnerable populations. Methods: A cross-sectional study was conducted from September 1, 2022, to September 30, 2023. Participants were recruited from community health centers and migrant camps. Blood tests for HBV, HCV, HIV, and syphilis were performed, and Knowledge, Attitude, and Practices (KAP) survey were conducted via face-to-face interviews. Descriptive and logistic regression analyses were used to assess factors influencing the return for test results. Results: A total of 149 persons were recruited, including 64 agricultural migrant workers and 85 homeless people. Overall, 24.8% (n = 37) tested positive for at least one infection, and only 50.3% (n = 75) of the screened participants returned to collect their test results. Significant disparities in STI knowledge and healthcare access were observed between the two populations, with only 14.1% (n = 9) of migrants having access to primary healthcare. At multivariable analysis, the strongest predictor for not returning for test results was being positive for HCV. Conclusions: Among homeless people and agricultural migrant workers, STI prevalence was high, and only half of the population returned to collect test results. The study underscores the urgent need for targeted interventions and policy reevaluation to address healthcare disparities in marginalized communities.

Machine learning insights into PM2.5 changes during COVID-19 lockdown: LSTM and RF analysis in Mashhad.

This study seeks to investigate the impact of COVID-19 lockdown measures on air quality in the city of Mashhad employing two strategies. We initiated our research using basic statistical methods such as paired sample t-tests to compare hourly PM2.5 data in two scenarios: before and during quarantine, and pre- and post-lockdown. This initial analysis provided a broad understanding of potential changes in air quality. Notably, a low reduction of 2.40% in PM2.5 was recorded when compared to air quality prior to the lockdown period. This finding highlights the wide range of factors that impact the levels of particulate matter in urban settings, with the transportation sector often being widely recognized as one of the principal causes of this issue. Nevertheless, throughout the period after the quarantine, a remarkable decrease in air quality was observed characterized by distinct seasonal patterns, in contrast to previous years. This finding demonstrates a significant correlation between changes in human mobility patterns and their influence on the air quality of urban areas. It also emphasizes the need to use air pollution modeling as a fundamental tool to evaluate and understand these linkages to support long-term plans for reducing air pollution. To obtain a more quantitative understanding, we then employed cutting-edge machine learning methods, such as random forest and long short-term memory algorithms, to accurately determine the effect of the lockdown on PM2.5 levels. Our models' results demonstrated remarkable efficacy in assessing the pollutant concentration in Mashhad during lockdown measures. The test set yielded an R-squared value of 0.82 for the long short-term memory network model, whereas the random forest model showed a calculated cross-validation R-squared of 0.78. The required computational cost for training the LSTM and the RF models across all data was 25 min and 3 s, respectively. In summary, through the integration of statistical methods and machine learning, this research attempts to provide a comprehensive understanding of the impact of human interventions on air quality dynamics.

Understanding dynamics and overlapping epidemiologies of HIV, HSV-2, chlamydia, gonorrhea, and syphilis in sexual networks of men who have sex with men.

Introduction: We aimed to investigate the overlapping epidemiologies of human immunodeficiency virus (HIV), herpes simplex virus type 2 (HSV-2), chlamydia, gonorrhea, and syphilis in sexual networks of men who have sex with men (MSM), and to explore to what extent the epidemiology of one sexually transmitted infection (STI) relates to or differs from that of another STI. Methods: An individual-based Monte Carlo simulation model was employed to simulate the concurrent transmission of STIs within diverse sexual networks of MSM. The model simulated sexual partnering, birth, death, and STI transmission within each specific sexual network. The model parameters were chosen based on the current knowledge and understanding of the natural history, transmission, and epidemiology of each considered STI. Associations were measured using the Spearman's rank correlation coefficient (SRCC) and maximal information coefficient (MIC). Results: A total of 500 sexual networks were simulated by varying the mean and variance of the number of partners for both short-term and all partnerships, degree correlation, and clustering coefficient. HSV-2 had the highest current infection prevalence across the simulations, followed by HIV, chlamydia, syphilis, and gonorrhea. Threshold and saturation effects emerged in the relationship between STIs across the simulated networks, and all STIs demonstrated moderate to strong associations. The strongest current infection prevalence association was between HIV and gonorrhea, with an SRCC of 0.84 (95% CI: 0.80-0.87) and an MIC of 0.81 (95% CI: 0.74-0.88). The weakest association was between HSV-2 and syphilis, with an SRCC of 0.54 (95% CI: 0.48-0.59) and an MIC of 0.57 (95% CI, 0.49-0.65). Gonorrhea exhibited the strongest associations with the other STIs while syphilis had the weakest associations. Across the simulated networks, proportions of the population with zero, one, two, three, four, and five concurrent STI infections were 48.6, 37.7, 11.1, 2.4, 0.3, and < 0.1%, respectively. For lifetime exposure to these infections, these proportions were 13.6, 21.0, 22.9, 24.3, 13.4, and 4.8%, respectively. Conclusion: STI epidemiologies demonstrate substantial overlap and associations, alongside nuanced differences that shape a unique pattern for each STI. Gonorrhea exhibits an "intermediate STI epidemiology," reflected by the highest average correlation coefficient with other STIs.

Special Issue "Mitochondrial Dysfunction: A Common Trigger in Neurodegenerative and Metabolic Non-Communicable Diseases".

Non-communicable diseases (NCDs) are non-infectious and non-transmissible chronic disorders [...].

Ultra-Processed Foods-Dietary Foe or Potential Ally?

The prevalence of non-communicable diseases (NCDs) has steadily increased in the United States. Health experts attribute the increasing prevalence of NCDs, in part, to the consumption of ultra-processed foods (UPFs) based on epidemiological observations. However, no definitive evidence of causality has been established. Consequently, there is an ongoing debate over whether adverse health outcomes may be due to the low nutrient density per kilocalorie, the processing techniques used during the production of UPFs, taste preference-driven overconsumption of calories, or unidentified factors. Recognizing that "the science is not settled," we propose an investigative process in this narrative review to move the field beyond current controversies and potentially identify the basis of causality. Since many consumers depend on UPFs due to their shelf stability, affordability, availability, ease of use, and safety from pathogens, we also suggest a paradigm for guiding both the formulation of UPFs by food designers and the selection of UPFs by consumers.

Gender and non-communicable diseases in Mexico: a political mapping and stakeholder analysis.

BACKGROUND: Mexico and other low- and middle-income countries (LMICs) present a growing burden of non-communicable diseases (NCDs), with gender-differentiated risk factors and access to prevention, diagnosis and care. However, the political agenda in LMICs as it relates to health and gender is primarily focused on sexual and reproductive health rights and preventing violence against women. This research article analyses public policies related to gender and NCDs, identifying political challenges in the current response to women's health needs, and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care in Mexico. METHODS: We carried out a political mapping and stakeholder analysis during July-October of 2022, based on structured desk research and interviews with eighteen key stakeholders related to healthcare, gender and NCDs in Mexico. We used the PolicyMaker V5 software to identify obstacles and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care, from the perspective of the political stakeholders interviewed. RESULTS: We found as a political obstacle that policies and stakeholders addressing NCDs do not take a gender perspective, while policies and stakeholders addressing gender equality do not adequately consider NCDs. The gendered social and economic aspects of the NCD burden are not widely understood, and the multi-sectoral approach needed to address these aspects is lacking. Economic obstacles show that budget cuts exacerbated by the pandemic are a significant obstacle to social protection mechanisms to support those caring for people living with NCDs. CONCLUSIONS: Moving towards an effective, equity-promoting health and social protection system requires the government to adopt an intersectoral, gender-based approach to the prevention and control of NCDs and the burden of NCD care. Despite significant resource constraints, policy innovation may be possible given the willingness among some stakeholders to collaborate, particularly in the labour and legal sectors. However, care will be needed to ensure the implementation of new policies has a positive impact on both gender equity and health outcomes. Research on successful approaches in other contexts can help to identify relevant learnings for Mexico.

Knowledge of non-communicable diseases and access to healthcare services among adults before and during COVID-19 pandemic in rural Tanzania.

Background: The COVID-19 pandemic significantly affected access to healthcare services, particularly among individuals living with Non-Communicable Diseases (NCDs) who require regular healthcare visits. Studies suggest that knowledge about a specific disease is closely linked to the ability to access services for that condition. In preparation for the future, we conducted the study to assess knowledge of NCDs and access to healthcare services among adults residing in rural areas before and during the COVID-19 pandemic. Methods: We conducted a community-based cross-sectional study in rural Tanzania in October 2022, a few months after the end of the third wave of the COVID-19 pandemic. A total of 689 community residents participated in the study. The level of knowledge of NCDs was assessed using an 11-item Likert questionnaire, which was later dichotomized into adequate and inadequate levels of knowledge. In addition, access to healthcare was assessed before and during the pandemic. We summarized the results using descriptive statistics and logistic regression was applied to determine factors associated with adequate levels of knowledge of NCDs. All statistical tests were two-sided; a p-value <0.05 was considered statistically significant. All data analyses were performed using SPSS. Results: Among 689 participants, more than half 369 (55%) had adequate knowledge of whether a disease is NCD or not; specifically, 495 (73.8%), 465 (69.3%), and 349 (52%) knew that hypertension, diabetes mellitus, and stroke are NCDs while 424 (63.2%) know that UTI is not NCD. Of the interviewed participants, 75 (11.2%) had at least one NCD. During the COVID-19 pandemic the majority 57 (72.2%) accessed healthcare services from nearby health facilities followed by traditional healers 10 (12.7%) and community drug outlets 8 (10.1%). Residence and education level were found to be significantly associated with knowledge of NCDs among participants. Conclusion: The study revealed that the community has a moderate level of knowledge of NCDs, and during the COVID-19 pandemic outbreaks, people living with NCD (s) relied on nearby health facilities to obtain healthcare services. Health system preparedness and response to pandemics should take into account empowering the community members to understand that NCD care is continuously needed even during pandemic times. We further advocate for a qualitative study to explore contextual factors influencing the knowledge of NCDs and access to healthcare services beyond the big domains of education and residence.

Impact of a carrageenan gel on viral load of genital human papillomavirus infections in sexually active women: Findings from the Carrageenan-gel Against Transmission of Cervical Human papillomavirus (CATCH) trial.

Previous research has shown that women's use of a carrageenan gel reduces the risk of acquiring genital human papillomavirus (HPV) infections but does not help to clear existing ones. Although gel use may not result in complete clearance, it may decrease the viral load of HPV infections. We tested this hypothesis in the Carrageenan-gel Against Transmission of Cervical Human papillomavirus (CATCH) randomized controlled trial. Participants of the CATCH study were selected for viral load testing if they had completed the first four study visits and tested positive for HPV42 or HPV51 in at least one of these visits. HPV42 and HPV51 were chosen as they were among the most abundant low- and high-risk types, respectively, in the study sample. We measured viral load with a type-specific real-time polymerase chain reaction. Results were displayed using summary statistics. Of 461 enrolled participants, 39 were included in the HPV42 analysis set and 56 in the HPV51 analysis set. The median time between visits 1 and 4 was 3.7 months. The viral load (copies/cell) of HPV42 ranged from <0.001 to 13 434.1, and that of HPV51 from <0.001 to 967.1. The net median change in HPV42 viral load over all four visits was -1.04 copies/cell in the carrageenan and -147 copies/cell in the placebo arm (Wilcoxon rank sum test, p = 0.26). There was no net median change in HPV51 viral load over all four visits in either arm (p = 0.45). The use of a carrageenan-based gel is unlikely to reduce the viral load of HPVs 42 or 51.

Sexual and reproductive health among forcibly displaced persons in urban environments in low and middle-income countries: scoping review findings.

BACKGROUND: Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most refugees and nearly half of internally displaced persons live in urban areas. This scoping review assesses the sexual and reproductive health (SRH) needs, outcomes, and priorities among forcibly displaced persons living in urban LMIC. METHODS: Following The Joanna Briggs Institute scoping review methodology we searched eight databases for literature published between 1998 and 2023 on SRH needs among urban refugees in LMIC. SHR was operationalized as any dimension of sexual health (comprehensive sexuality education [CSE]; sexual and gender based violence [GBV]; HIV and STI prevention and control; sexual function and psychosexual counseling) and/or reproductive health (antental, intrapartum, and postnatal care; contraception; fertility care; safe abortion care). Searches included peer-reviewed and grey literature studies across quantitative, qualitative, or mixed-methods designs. FINDINGS: The review included 92 studies spanning 100 countries: 55 peer-reviewed publications and 37 grey literature reports. Most peer-reviewed articles (n = 38) discussed sexual health domains including: GBV (n = 23); HIV/STI (n = 19); and CSE (n = 12). Over one-third (n = 20) discussed reproductive health, including: antenatal, intrapartum and postnatal care (n = 13); contraception (n = 13); fertility (n = 1); and safe abortion (n = 1). Eight included both reproductive and sexual health. Most grey literature (n = 29) examined GBV vulnerabilities. Themes across studies revealed social-ecological barriers to realizing optimal SRH and accessing SRH services, including factors spanning structural (e.g., livelihood loss), health institution (e.g., lack of health insurance), community (e.g., reduced social support), interpersonal (e.g., gender inequitable relationships), and intrapersonal (e.g., low literacy) levels. CONCLUSIONS: This review identified displacement processes, resource insecurities, and multiple forms of stigma as factors contributing to poor SRH outcomes, as well as producing SRH access barriers for forcibly displaced individuals in urban LMIC. Findings have implications for mobilizing innovative approaches such as self-care strategies for SRH (e.g., HIV self-testing) to address these gaps. Regions such as Africa, Latin America, and the Caribbean are underrepresented in research in this review. Our findings can guide SRH providers, policymakers, and researchers to develop programming to address the diverse SRH needs of urban forcibly displaced persons in LMIC. Most forcibly displaced individuals live in low- and middle-income countries (LMICs), with a significant number residing in urban areas. This scoping review examines the sexual and reproductive health (SRH) outcomes of forcibly displaced individuals in urban LMICs. We searched eight databases for relevant literature published between 1998 and 2023. Inclusion criteria encompassed peer-reviewed articles and grey literature. SRH was defined to include various dimensions of sexual health (comprehensive sexuality education; sexual and gender-based violence; HIV/ STI prevention; sexual function, and psychosexual counseling) and reproductive health (antenatal, intrapartum, and postnatal care; contraception; fertility care; and safe abortion care). We included 90 documents (53 peer-reviewed articles, 37 grey literature reports) spanning 100 countries. Most peer-reviewed articles addressed sexual health and approximately one-third centered reproductive health. The grey literature primarily explored sexual and gender-based violence vulnerabilities. Identified SRH barriers encompassed challenges across structural (livelihood loss), health institution (lack of insurance), community (reduced social support), interpersonal (gender inequities), and individual (low literacy) levels. Findings underscore gaps in addressing SRH needs among urban refugees in LMICs specifically regarding sexual function, fertility care, and safe abortion, as well as regional knowledge gaps regarding urban refugees in Africa, Latin America, and the Caribbean. Self-care strategies for SRH (e.g., HIV self-testing, long-acting self-injectable contraception, abortion self-management) hold significant promise to address SRH barriers experienced by urban refugees and warrant further exploration with this population. Urgent research efforts are necessary to bridge these knowledge gaps and develop tailored interventions aimed at supporting urban refugees in LMICs.

Processed food consumption and risk of non-communicable diseases (NCDs) in South Africa: evidence from Demographic and Health Survey (DHS) VII.

We aimed to analyse the association between processed food consumption and the risk of non-communicable diseases (NCDs) in South Africa. In this empirical study, we analysed nationally representative secondary data obtained from the South African Demographic and Health Survey (SADHS) VII. The survey included 13,288 occupied households, of which 11,083 were interviewed. In the interviewed households, 12,717 eligible adults aged 15 and older were identified and 10,336 were successfully interviewed. The study included four processed food groups (i.e. fried foods, takeaway foods/fast foods, salty snacks/packed chips, and processed meats) and eight NCDs (i.e. hypertension, cardiac arrest, cancer, stroke, hypercholesterolaemia, diabetes, chronic bronchitis, and asthma). As per the logistic regression results following adjustment, none of the disease states showed association with all four processed food groups. However, at least three processed food groups showed a significant positive association with hypertension, cardiac arrest, and diabetes. Two processed food groups showed significant positive association with stroke, and chronic bronchitis; one with hypercholesterolaemia and asthma; and cancer was not associated with any food groups. Processed meat and salted snacks/packed chips were each associated with five chronic conditions. In summary, we found that the consumption of any of the processed food groups increased the risk of NCDs in the South African population. Enabling policy and regulatory efforts in the production and distribution of processed foods, combined with improved awareness among the population need to be prioritised for immediate action. Facilitating the populations to choose traditional healthy diets would be a sustainable strategy for the prevention of NCDs.

Impact of COVID -19 on expanded programme on Immunisation in District Dir lower Khyber Pakhtunkhwa.

Objectives: To study the impact of coronavirus disease-2019 on Expanded Programme on Immunisation in a rural setting. METHODS: The descriptive, cross-sectional study was conducted in five union councils of District Dir Lower, in the Khyber Pakhtunkhwa province of Pakistan. Data was collected from March to August 2020, which was a period of lockdowns in the wake of the coronavirus disease-2019, and then from March to August 2021. The sample comprised children aged <2 years. Data was analysed using SPSS 25. RESULTS: Of the 330 children, 210(63.6%) were boys, and 120(36.4%) were girls, and all 330(100%) were located in rural areas. First-phase data showed that the maximum coverage rate of immunisation was 258(78.2%) noted in OPV1(Oral Polio Vaccine) Penta1(Pentavalent vaccine), PCV10-1 (Pneumococcal pneumonia) and Rota 1(Rota Vaccine), and the least vaccination rate was 68.2% for Measle-1. In the second phase, 23% incline was noted in Measles-2 vaccination, followed by 16.3% in OPV2, Penta 2, PCV10-2 and Rota 2, 16% in Measles-1, 14% in OPV-3, Penta-3, PCV10-3, Rota-3 and IPV, 11.5% in OPV-1, Penta-1, PCV10-1, and Rota-1, and 10.6% in OPV-0 and BCG-0. CONCLUSIONS: Immunisation programme was affected by lockdowns during the active phase of the coronavirus disease-2019 pandemic.

The evolution of household forgone essential care and its determinants during the COVID-19 pandemic in Nigeria: A longitudinal analysis.

Apart from the morbidity and mortality, the Coronavirus disease 2019 (COVID-19) pandemic has increased the predisposition of households in Nigeria to forgone care, thereby increasing their vulnerability to adverse health consequences. Since there is no previous study in Nigeria on the evolution of pandemic-related forgone care and its drivers, our study assess the evolution of the problem using descriptive and nationally representative panel data analyses. We found about a 30% prevalence of forgone care during the lockdown, which declined progressively afterwards, dropping by 69.50 percentage points between April 2020 and April 2022. This decline produced a surge in households needing care from about 35.00% in the early pandemic to greater than 50%, beginning in early 2021. The forgone care was primarily due to financial hindrances, movement restrictions, and supply-side disruptions. Household socioeconomic factors such as income loss had 2.74 [95%CI: 1.45-5.17] times higher odds of forgone care, job loss, food insecurity, and poverty were 87% (OR: 1.87 [95%CI: 1.25-2.79]), 60% (OR: 1.60 [95%CI: 1.12-2.31]) and 76% (OR: 1.76 [95%CI: 1.12-2.75]) more likely to predispose households to forgone care, respectively. Also, geographical location, such as the South-South zone, induced 1.98 [95%CI: 1.09-3.58] times higher odds of forgone care than North-Central. A married female household head increased the odds by 6.07 [95%CI: 1.72-21.47] times compared with an unmarried female head. However, having a married household head, social assistance, and North-East or North-West zone compared with North-Central increased the chance of accessing care by 69% (OR 0.31 [95%CI: 0.16-0.59]), 59%,(OR 0.41 [95%CI: 0.21-0.77]), 72% (OR 0.28 [95%CI: 0.15-0.53]) and 64% (OR 0.36 [95%CI: 0.20-0.65]), respectively. Non-communicable diseases, disability, old age, large household size and rural-urban location did not affect the forgone care. Our study highlights the need to strengthen Nigeria's health system, create policies to promote healthcare accessibility and prepare the country for future pandemic challenges.

Early age at menarche and history of sexually transmitted infections significantly predict cervical cancer screening uptake among women aged 25-49 years: evidence from the 2021 Côte d'Ivoire demographic and health survey.

INTRODUCTION: Cervical cancer is the second dominant type of cancer among Ivorian women with an estimated age-standardised incidence and mortality rate of 31.2 cases and 22.8 deaths per 100,000 women in 2020, respectively. The Ivorian government through its Ministry of Health implemented the National Cancer Control Programme (NCCP) in 2003 with the aim of improving the prevention, early detection and treatment of cancers in Côte d'Ivoire. Yet, there is a low uptake of CCS (1.2%). Thus, making CCS uptake an important public health concern in the country. Understanding of the extent to which reproductive factors predict CCS uptake is limited in literature. This study aimed to investigate reproductive factors as a predictor of women's uptake of CCS in Côte d'Ivoire. METHODS: Data from the 2021 Côte d'Ivoire Demographic and Health Survey. A sample of 9,078 women aged 25-49 years were analyzed. The outcome variable was CCS uptake while other variables considered included age at menarche, history of STI, sexual debut, parity, age, educational level, wealth index, health insurance, place of residence, and media exposure. A multivariable logistic regression model was fitted to examine the association between the outcome of interest and predictors at 95% confidence interval. RESULTS: Approximately, 7.52% of women aged 25-49 years had ever undergone testing for cervical cancer by a healthcare provider. Early menarche was associated with lower odds of CCS uptake [AOR = 0.78; CI = 0.65-0.95]. Compared to those who had no STI, women with a history of STI were more likely to screen for cervical cancer [AOR = 2.63; CI = 2.02-3.42]. Increasing age, higher educational attainment, having health insurance, and being exposed to media were significantly associated with CCS uptake. CONCLUSION: In Cote d'Ivoire, age at menarche and STI history constitute reproductive factors that were significantly associated with women's uptake of CCS. It is imperative for public policy to focus on increasing CCS in these higher-risk women (i.e., women who experienced early menarche, women with early sexual debut and higher parity) through increased sensitization on cervical cancer risk factors.

Prevalence of common risk factors of major noncommunicable diseases among sexual and gender minorities in Kathmandu valley, Nepal.

Four noncommunicable diseases (NCDs): cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, account for 71% of global deaths. However, little is known about the NCDs risk profile of sexual and gender minorities (SGMs). This study aimed to determine the prevalence of NCDs risk factors among the SGMs of Kathmandu valley, Nepal. A cross-sectional study was conducted among SGMs in the Kathmandu valley, Nepal. We recruited 140 participants using the snowball sampling method. A face-to-face interview was done using a structured questionnaire adapted from World Health Organization Step Wise Approach to Surveillance (STEPS instruments V2.2 2019) along with blood pressure and anthropometric measurements. Data were analyzed using Statistical Package for Social Science (SPSS.v20). More than two-thirds of the participants, 96 (68.6%), had co-occurrence of NCDs risk factors. The prevalence of insufficient fruits and vegetables consumption, current smoking, harmful alcohol consumption, overweight/obesity, and hypertension were 95.7%, 40.0%, 32.9%, 28.5%, and 28.6%, respectively. There was a significant association between hypertension, harmful alcohol consumption, and overweight/obesity with the participants' age, employment status, and marital status, respectively. Study findings indicated a higher prevalence of NCDs risk factors among SGMs. National-level NCDs surveillance, policy planning, prevention, and targeted health interventions should prioritize the SGMs.

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.

A high density of ultra-processed food, alcohol & tobacco retail stores, and social inequalities are associated with higher mortality rates of non-communicable diseases in Mexican adults: 2005 to 2021.

BACKGROUND: Non-communicable diseases (NCDs) are the leading causes of mortality in Mexico. Factors contributing to NCDs-related deaths may vary across small geographic areas such as municipalities. We aimed to predict municipal-level factors associated with NCD mortality in Mexican adults from 2005 to 2021 using the small-area analysis (SSA) approach. METHODS: We gathered data on population sociodemographic, access to healthcare services, and mortality records at the municipal-level from census and public institutions from 2005 to 2021. We identified municipal predictors of NCDs mortality rates (MR) using negative binomial regression models. RESULTS: A total of 584,052 observations of Mexican adults were analyzed. The national expected NCDs MR per 100,000 inhabitants was 210.7 (95%CI: 196.1-226.7) in 2005 and increased to 322.4 (95%CI: 300.3-346.4) by 2021. Predictors of NCDs mortality (quintile 5 vs. quintile 1) included; indigeneity (IRR = 1.15, 95%CI: 1.12-1.19), poverty (IRR = 1.14, 95%CI: 1.13-1.15), affiliation with Mexican Social Security Institute (IRR = 1.11, 95%CI: 1.09-1.14), households with television (IRR = 1.14, 95%CI: 1.11-1.17), and high density of ultra-processed food, alcohol & tobacco retail stores (IRR = 1.15, 95%CI: 1.13-1.17). The greatest increases in MR were observed in municipalities from Oaxaca (>200% increments). CONCLUSION: There was an overall increase in NCDs MR from 2005 to 2021, with a significant geographic variation among Mexican municipalities. The results of this study highlight the importance of identifying priority areas in the country that urgently require public policies focused on local factors associated with deaths from NCDs, such as the regulation of the ultra-processed food, alcohol & tobacco retail stores, and efforts to reduce social inequalities.

Anti-prion drugs do not improve survival in novel knock-in models of inherited prion disease.

Prion diseases uniquely manifest in three distinct forms: inherited, sporadic, and infectious. Wild-type prions are responsible for the sporadic and infectious versions, while mutant prions cause inherited variants like fatal familial insomnia (FFI) and familial Creutzfeldt-Jakob disease (fCJD). Although some drugs can prolong prion incubation times up to four-fold in rodent models of infectious prion diseases, no effective treatments for FFI and fCJD have been found. In this study, we evaluated the efficacy of various anti-prion drugs on newly-developed knock-in mouse models for FFI and fCJD. These models express bank vole prion protein (PrP) with the pathogenic D178N and E200K mutations. We applied various drug regimens known to be highly effective against wild-type prions in vivo as well as a brain-penetrant compound that inhibits mutant PrPSc propagation in vitro. None of the regimens tested (Anle138b, IND24, Anle138b + IND24, cellulose ether, and PSCMA) significantly extended disease-free survival or prevented mutant PrPSc accumulation in either knock-in mouse model, despite their ability to induce strain adaptation of mutant prions. Our results show that anti-prion drugs originally developed to treat infectious prion diseases do not necessarily work for inherited prion diseases, and that the recombinant sPMCA is not a reliable platform for identifying compounds that target mutant prions. This work underscores the need to develop therapies and validate screening assays specifically for mutant prions, as well as anti-prion strategies that are not strain-dependent.