Prediction of disability-adjusted life years for diseases due to low fruit intake in 2017-2040 in Japan.

OBJECTIVE: The current study aimed to predict disability-adjusted life years (DALY) rate in Japan through 2040 with plausible future scenarios of fruit intake for neoplasms, cardiovascular diseases (CVD) and diabetes and kidney diseases (DKD). DESIGN: Data from National Health and Nutrition Surveys and the Global Burden of Diseases study in 2017 were used. We developed an autoregressive integrated moving average model with four future scenarios. Reference scenario maintains the current trend. Best scenario assumes that the goal defined in Health Japan 21 is achieved in 2023 and is kept constant afterwards. Moderate scenario assumes that the goal is achieved in 2040. Constant scenario applies the same proportion of 2016 for the period between 2017 and 2040. SETTING: DALY rates in Japan were predicted for the period between 2017 and 2040. PARTICIPANTS: Population aged more than than 20 years old. RESULTS: In our reference forecast, the DALY rates in all-ages group were projected to be stable for CVD and continue increasing for neoplasms and DKD. Age group-specific DALY rates for these three disease groups were forecasted to decrease, with some exceptions. Among men aged 20-49 years, DALY attributable to CVD differed substantially between the scenarios, implying that there is a significant potential for reducing the burden of CVD by increasing fruit intake at the population level. CONCLUSIONS: Our scenario analysis shows that higher fruit intake is associated with lower disease burden in Japan. Further research is required to assess which policies and interventions can be used to achieve an increase in fruit intake as modelled in the scenarios of the current study.

Age-appropriate vaccination coverage and its determinants in children aged 12-36 months in Nepal: a national and subnational assessment.

BACKGROUND: Vaccination is one of the effective ways to develop immunity against potential life-threatening diseases in children in early age. This study is focused on analysing the age-appropriate vaccination coverage at national and subnational levels and identify the factors associated with age-appropriate coverage in Nepal. METHODS: 460 children aged 12-36 months were included in the study. The data was obtained from Nepal Demographic and Health Survey (NDHS) 2016-17. Age-appropriate coverage of Bacillus Calmette-Guerin vaccine (BCG), oral polio vaccine (OPV) doses 1-3, pentavalent vaccine (PE) doses 1-3, and first dose of measles, mumps, and rubella vaccine (MMR) were estimated using Kaplan Meier method. Multilevel logistic regression with random intercept was used to identify the factors associated with age-appropriate vaccination. RESULTS: The crude coverage of the vaccines included in the study ranged from 91.5% (95% CI, 88.5-93.7) for PE3 to 97.8% (95.8-98.7) for BCG. Although the crude coverage of all the vaccines was above 90%, the age-appropriate coverage was significantly low, ranging from 41.5% (36.5-46.6) for PE3 to 73.9% (69.2-78.1) for PE1. Furthermore, high disparity in timely vaccination coverage was observed at regional level. Compared to the age-appropriate vaccination coverage in other provinces, Province 2 had the lowest coverage of all, followed by that in Province 6. The timeliness of vaccination was significantly associated with subnational regions i.e., provinces and the season of childbirth. CONCLUSION: Although the immunization program in Nepal has achieved the target of 90% crude coverage of all the childhood vaccines, the age-appropriate coverage is significantly low which undermines the effectiveness of the vaccines administered. Thus, along with crude coverage, timeliness of the vaccines administered should be taken into consideration and thoroughly monitored at national and subnational levels. Provincial government should formulate tailored strategies to ensure the timely administration of the childhood vaccines.

Analysis of the relationship between the HbA1c screening results and the development and worsening of diabetes among adults aged over 40 years: a 4-year follow-up study of 140,000 people in Japan - the Shizuoka study.

BACKGROUND: Hemoglobin A1c (HbA1c) levels are routinely measured during health check-ups and are used as an indicator of glycemic control in Japan. However, only a few studies have followed up individuals to assess the risk of diabetes development and worsening based on HbA1c screening results. This study evaluated the relationship between HbA1c screening results and the risk of diabetes development and worsening. METHODS: Data were collected from the Shizuoka Kokuho Database, a Japanese administrative claims database of insured individuals aged > 40 years. We included individuals available for follow-up from April 2012 to March 2018 who had not received any diabetes treatment before March 2014. HbA1c screening results were categorized into 4 groups based on the HbA1c levels at the 2012 and 2013 health check-ups: group A, those whose HbA1c levels were < 6.5% in 2012 and 2013; group B, those whose HbA1c levels > 6.5% in 2012 but < 6.5% in 2013; group C, those whose HbA1c levels were > 6.5% in 2012 and 2013; and group D, those whose HbA1c levels were < 6.5% in 2012 and > 6.5% in 2013. Logistic regression models were used to analyze diabetes development and worsening, defined as the initiation of diabetes treatment by March 2018 and the use of injection drugs by participants who initiated diabetes treatment by March 2018. RESULTS: Overall, 137,852 individuals were analyzed. After adjusting for covariates, compared with group A, group B was more likely to initiate treatment within 4 years (odds ratio: 22.64; 95% confidence interval: 14.66-34.99). In patients who initiated diabetes treatment by March 2018, injection drugs were less likely used by group D than by group A (odds ratio: 0.28; 95% confidence interval: 0.12-0.61). CONCLUSIONS: Our study suggests that although HbA1c levels measured during health check-ups were correlated with the risk of diabetes development and worsening, HbA1c levels in a single year may not necessarily provide sufficient information to consider these future risks.

Inequalities and risk factors analysis in prevalence and management of hypertension in India and Nepal: a national and subnational study.

BACKGROUND: Hypertension is one of the leading risk factors for cardiovascular diseases in India and Nepal. Socio-economic disparity in these two countries has created wide gap in management of hypertension. However, inequalities in prevalence and management (awareness, treatment, and control) of hypertension is poorly assessed. This study analyzes the risk factors associated with prevalence and management of hypertension in India and Nepal and assesses the wealth-and education-based inequalities in them. METHODS: This study used data from the Demographic and Health Survey; a cross-sectional survey conducted between January 2015 to December 2016 in India and June 2016 to January 2017 in Nepal. A total of 787,713 individuals in India and 14,454 individuals in Nepal aged between 15 and 49 years were included in the study. Respondents were classified as being hypertensive if their systolic blood pressure (SBP) readings were at least 140 mmHg or diastolic blood pressure (DBP) readings were at least 90 mmHg, or if they reported currently taking anti-hypertensive medication. Multilevel logistic regression models with random intercepts at household-and community-levels were used to identify the risk factors associated with prevalence and management of hypertension. For inequality assessment, slope index and relative index of inequalities in prevalence and management of hypertension were estimated. RESULTS: Overall prevalence of hypertension in India and Nepal were 11.4% (95% confidence interval (CI), 11.4-11.5) and 19.6% (95% CI, 18.9-20.2), respectively. Less than one-third of the hypertensive population received treatment and below 20% among them had their blood pressure controlled. In both countries, wealth-and education-based inequalities in awareness, treatment, and control of hypertension were significantly high in urban and rural areas. CONCLUSION: Wealth- and education-based inequalities in prevalence and management of hypertension were high among different socio-economic groups at national and sub-national levels. Tailored strategies are required to effectively manage hypertension in different regions by considering socio-economic and demographic factors.

Projection of morbidity and mortality due to breast cancer between 2020 and 2050 across 42 low- and middle-income countries.

Objective: Aim of the study is to predict trends in morbidity and mortality due to breast cancer in 42 LMICs between 2020 and 2050. Design: and Setting: National level cross-sectional breast cancer related data between 1990 and 2019 were used. Recurrent Neural Network, Long-Short-Term Memory (RNN-LSTM) model was employed to forecast the trend in breast cancer burden. Main outcomes and measures: Age standardized breast cancer incidence, mortality, and disability adjusted life years (DALYs) rates. Results: By 2050, the age standardized breast cancer incidence rate is expected to increase in 38 LMICs with highest incidence rate in Namibia; 127.0 (78.0-176.0) followed by Nigeria 71.1 (53.9-88.3) and Papua New Guinea 70.6 (88.7-74.6). Similarly, the age standardized breast cancer mortality and DALYs rates in 2050 are expected to increase in 33 and 35 LMICs respectively. The highest mortality and DALYs rates in 2050 are expected to be 64.7 (42.6-86.7) in Namibia and 1543.6 (1463.1-1624.1) in Pakistan. The estimated annual percentage change (EAPC) is expected to increase uniformly in all the countries during the same period. Due to considerable variation in exposure risk, such as high plasma glucose level, high body mass index (BMI) and socio-demographic index (SDI), high regional disparity in burden of breast cancer is expected among the countries. Conclusion: and Relevance: Breast cancer burden is expected to increase in most of the LMICs with high regional disparity by 2050. Our study's finding focuses on LMICs with high breast cancer burden that require tailored strategies and effective action plans to ensure prevention from catastrophic consequences in the future. Minimizing the exposure to behavioral and metabolic risk factors such as high plasma glucose, high BMI, along with tackling the issue of low fertility rate would be important in managing breast cancer burden in LMICs.

Assessing Factors Associated with TB Awareness in Nepal: A National and Subnational Study.

Tuberculosis (TB) has still remained a serious global health threat in low- and middle-income countries in recent years. As of 2021, Nepal is one of the high TB burden countries, with an increasing prevalence of cases. This study evaluates factors associated with TB awareness in Nepal. This study uses data from the Nepal Demographic and Health Survey, a cross-sectional survey carried out from June 2016 to January 2017. Multilevel logistic regression is performed to examine the association of demographic and socioeconomic factors with TB awareness. Our findings show a high level of TB awareness in all seven provinces of Nepal. Province 5 has the highest level of awareness (98.1%) among all provinces, followed by provinces 3 and 4, while province 6 has the lowest awareness level (93.2%) compared to others. Socioeconomic factors such as wealth, education and owning a mobile phone are significantly associated with TB awareness. Socioeconomic determinants are influential factors associated with TB awareness in Nepal. The wide variation in the proportion of awareness at a regional level emphasizes the importance of formulating tailored strategies to increase TB awareness. For instance, the use of mobile phones could be an effective strategy to promote TB awareness at a regional level. This study provides valuable evidence to support further research on the contribution of information and communication technology (ICT) usage to improving TB awareness in Nepal.

Timeliness of routine vaccination among children and determinants associated with age-appropriate vaccination in Mongolia.

INTRODUCTION: Routine vaccination at the recommended age is crucial to minimize the risk of acquiring vaccine preventable diseases. This study aimed to assess the proportion of children receiving routine immunization at the recommended age and determinants of timely (age-appropriate) vaccination in Mongolia. MATERIAL AND METHOD: A total of 879 eligible children aged 12-23 months were included in this study. We investigated age-appropriate administration of Bacillus Calmette-Guerin vaccine (BCG); hepatitis B vaccine (Hep B); oral polio vaccine (OPV); pentavalent vaccine; and measles, mumps, and rubella vaccine (MMR) using Kaplan-Meier method. Multilevel logistic regression with random intercept at cluster level was used to assess the determinants of age-appropriate vaccination. RESULTS: Overall, the crude vaccination coverage for routine vaccinations were above 90% for all vaccines except MMR1 which was 86.0% (95% CI, 83.6-88.2). While the first dose of almost all the vaccines given at birth; BCG, Hep B, and OPV0, were administered in a timely manner, a substantial proportion of second and third doses of these vaccines were not given in a timely manner with age-appropriate vaccination coverage ranging from 35.9% (32.8-39.1%) for MMR1 to 67.7% (64.5-70.7%) for OPV1 respectively. Factors associated with age-appropriate administration of the investigated vaccines included socio-economic status of household, religion of household heads, area of residence, owning mobile phone, and season of childbirth. For instance, children belonging to households from richer wealth quintile had higher possibilities of getting age-appropriate OPV1-OPV3, PE1-PE3 and MMR1 vaccines compared to those from the poorest household wealth quintile. CONCLUSION: Our findings suggest that the commonly used indicator 'crude vaccination coverage' could be supplemented by 'age-appropriate vaccination' to help to identify gaps in timely vaccinations and stimulate interventions in Mongolia. Factors such as household wealth quintile, place of residence and religion associated with timely vaccination in our study could be considered to promote effective intervention aiming to improve adequate vaccination coverage.