Adults In High-income Countries Research Articles

Respiratory Syncytial Virus Sequelae Among Adults in High-Income Countries: A Systematic Literature Review and Meta-analysis.

Respiratory syncytial virus (RSV) can cause severe respiratory infections in adults; however, information on associated sequelae is limited. This systematic literature review aimed to identify sequelae in adults within 1year following RSV-related hospitalization or resolution of acute infection. Studies were identified from Embase, MEDLINE, LILACS, SciELO, and grey literature. Random-effects meta-analyses using restricted maximum likelihood were used to calculate the proportions and relative risks of sequelae in patients with RSV compared with controls (patients with RSV-negative influenza-like illness, influenza, and parainfluenza) per follow-up period, population, and treatment setting, where possible. Twenty-one relevant studies covering the period from 1990 to 2019 were included. Among the general population, the most frequent clinical sequela was sustained function loss (33.5% [95%CI 27.6-39.9]). Decline in lung function and cardiovascular event or congestive heart failure were also identified. Utilization sequelae were readmission (highest at > 6months after discharge) and placement in a skilled nursing facility. The only subpopulation with data regarding sequelae was transplant patients. Among lung transplant patients, the most frequently reported clinical sequelae were decline in lung function, followed by graft dysfunction and bronchiolitis obliterans syndrome. Pooled relative risks were calculated for the following sequela with controls (primarily influenza-positive patients): cardiovascular event (general population) and pulmonary impairment (hematogenic-transplant patients) both 1.4 (95%CI 1.0-2.0) and for readmission (general population) 1.2 (95%CI 1.1-1.3). Although less data are available for RSV than for influenza or other lower respiratory tract infections, RSV infection among adults is associated with medically important sequelae, with a prevalence similar to other respiratory pathogens. RSV sequelae should be included in disease burden estimates.

The link between social care deficiencies and healthcare pressures

In the UK, demand on the social care sector is rising, while a substantial reduction in funding makes meeting those demands a challenge. Exploring potential solutions to address the growing demands on health and social care, this commentary provides a critical evaluation of a systematic review that investigated the association between the availability and supply of social care services and the use of healthcare services among older adults in high-income countries. The commentary used the Rapid Conversion of Evidence Summaries methodology to critically appraise the study. There is some evidence for the benefits of care home support during hospital discharge, although research in the area is scarce. Increasing the supply of social care services may ease the pressures on the healthcare system, but the findings of this systematic review do not provide quantifiable evidence to support this. Nevertheless, it highlights the need for further investigation regarding the association between social care provision and healthcare service use.

Digital Health Interventions in Older Adult Populations Living With Chronic Disease in High-Income Countries: Protocol for a Scoping Review.

Globally, around 80% percent of adults aged 65 years or older are living with at least 1 chronic disease, and 68% percent have 2 or more chronic diseases. Older adults living with chronic diseases require greater health care services, but these health care services are not always easily accessible. Furthermore, the COVID-19 pandemic has resulted in unprecedented changes in the provision of health care services for older adults. During the COVID-19 pandemic, digital health interventions for chronic disease management were developed out of necessity, but the evidence regarding these and developed interventions is lacking. In this scoping review, we aim to identify available digital health interventions such as emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms for chronic disease management for older adults in high-income countries. We will follow the Arksey and O'Malley framework to conduct the scoping review. Our full search strategy was developed following a preliminary search on MEDLINE. We will include studies where older adults are at least 65 years of age, living with at least 1 chronic disease (eg, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and diabetes), and residing in high-income countries. Digital health interventions will be broadly defined to include emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms. This scoping review is currently ongoing. As of March 2023, our full search strategy has resulted in a total of 9901 records. We completed the screening of titles and abstracts and obtained 442 abstracts for full-text review. We are aiming to complete our full-text review in October 2024, data extraction in November 2024, and data synthesis in December 2024. This scoping review will generate evidence that will contribute to the further development of digital health interventions for future chronic disease management among older adults in high-income countries. More evidence-based research is needed to better understand the feasibility and limitations associated with the use of digital health interventions for this population. These evidence-based findings can then be disseminated to decision-makers and policy makers in other high-income countries. DERR1-10.2196/49130.

Social Factors Associated with Nutrition Risk in Community-Dwelling Older Adults in High-Income Countries: Protocol for a Scoping Review.

In high-income countries, between 65 and 70 percent of community-dwelling adults aged 65 and older are at high nutrition risk. Nutrition risk is the risk of poor dietary intake and nutritional status. Consequences of high nutrition risk include frailty, hospitalization, death, and reduced quality of life. Social factors (such as social support and commensality) are known to influence eating behavior in later life; however, to the authors' knowledge, no reviews have been conducted examining how these social factors are associated with nutrition risk specifically. The objective of this scoping review is to understand the extent and type of evidence concerning the relationship between social factors and nutrition risk among community-dwelling older adults in high-income countries (HIC) and to identify social interventions that address nutrition risk in community-dwelling older adults in HIC. This review will follow the scoping review methodology as outlined by the JBI Manual for Evidence Synthesis, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search will include MEDLINE, CINAHL, PsychInfo, and Web of Science. There will be no date limits placed on the search. However, only resources available in English will be included. EndNote and Covidence will be used for reference management and removal of duplicate studies. Articles will be screened, and data extracted by at least 2 independent reviewers using Covidence. Data to be extracted will include study characteristics (country, methods, aims, design, dates), participant characteristics (population description, inclusion and exclusion criteria, recruitment method, total number of participants, demographics), how nutrition risk was measured (including the tool used to measure nutrition risk), social factors or interventions examined (including how these were measured or determined), the relationship between nutrition risk and the social factors examined, and details of social interventions designed to address nutrition risk. The scoping review was started in October 2023 and will be finalized by August 2024. Findings will describe the social factors commonly examined in the nutrition risk literature, the relationship between these social factors and nutrition risk, the social factors that have an impact on nutrition risk, and social interventions designed to address nutrition risk. The results of the extracted data will be presented in the form of a narrative summary with accompanying tables. Given the high prevalence of nutrition risk in community-dwelling older adults in high-income countries and the negative consequences of nutrition risk, it is essential to understand the social factors associated with nutrition risk. The results of the review are anticipated to aid in identifying individuals who should be screened proactively for nutrition risk and inform programs, policies, and interventions designed to reduce the prevalence of nutrition risk.

A systematic review of binge drinking interventions and bias assessment among college students and young adults in high-income countries.

Alcohol is the number one substance used by young people and people of college age. Binge drinking (BD) in this age group is considered one of the most important global health issues, as much harm accrues from it and even lives are lost. This study aimed to review the interventions to curb BD or encourage responsible drinking among college students and young adults. MEDLINE (PubMed), ERIC and APA PsycINFO were searched. The selected articles were published in English and had to evaluate a BD reduction program through a randomized control trial (RCT) among college students or young adults between the ages of 17-24years. The exclusion criteria included research not published in English, systematic review articles, qualitative studies, designs other than RCTs and discussion articles on college students drinking with no findings. The three reviewers independently screened and extracted the data using the PRISMA guidelines. The overall quality of the studies was assessed. Then, 10 of the 12 interventions studied were found to be successful in reducing BD among college students, though the effect sizes were small to medium. A minority of the studies used behavior change theories. Effective interventions for reducing BD among college students and young adults should include robust behavior change theories, longer follow-up time and the operationalization of multiple outcomes. Process evaluation is needed to be conducted in these studies.

OGBN P20 A Clinician Delivered pH Manometry Service

Abstract Background Gastroesophageal reflux disease (GORD) has an influence on patients’ health related quality of life, affecting 20% of adults in high income countries (1)(2). Despite first line therapy, proton pump inhibitors, approximately 20-30% of patients have persistent symptoms (3). Anti-reflux surgery is by its very nature a lifestyle related procedure, thus there must be a robust and duplicatable method for assessment of the severity of symptoms to facilitate patient selection. We launched a clinician delivered high-resolution pH oesophageal manometry and ambulatory pH impedance service in January 2021 at our Specialist Anti-Reflux Centre. Here we present our preliminary data. Methods This is a retrospective analysis of patients who underwent ambulatory pH manometry within our department between January 2021 and June 2023. Analysis to date was undertaken of patient’s outcomes from their pH manometry. Patients with previous anti-reflux surgery were excluded. We reviewed those who were offered surgery versus those who were not. Each group had further analysis of the DeMeester score, Symptom Index (SI) and Symptom Association Probability (SAP). A two sample T-test was performed, with p<0.05 considered statistically significant. Results Of the 141 patients that underwent ambulatory pH manometry, 62% (n=88) had sufficient data for analysis. 33% (n=29) of these were subsequently offered surgical intervention; 14 underwent fundoplication (48%) and 12 LINX procedures (41%); the remaining patients, 1 referred for POEM, 1 awaited surgical planning and 1 required Gastroenterology review. Those who progressed to surgery had a greater DeMeester score than those who were not offered surgery (45.2 vs 28.5). Patients in the surgical group also had a higher mean SI than those in the non-surgical group (57.0% vs 38.6%, p=0.01), and higher SAP (94.1% vs 80.3%, p=0.03). Conclusions This clinician-led in-house clinic has had significant impact upon our service. It has enabled collation of quantitative data to facilitate the decision-making process in the provision of anti-reflux surgery, thus aiding appropriate patient selection. Going forward, further work is being undertaken into quality of life questionnaires post anti-reflux surgery, both before and after introduction of our new service.

Characteristics of programmes designed to link community-dwelling older adults in high-income countries from community to clinical sectors: a scoping review protocol

IntroductionResearch on effectively navigating older adults into primary care is urgently needed. Community–clinic linkage models (CCLMs) aim to improve population health by linking the health and community sectors in order...

Using Twitter to Understand COVID-19 Vaccine-Related Ageism During the Pandemic.

During the rollout of coronavirus 2019 (COVID-19) vaccines, older adults in high-income countries were often prioritized for inoculation in efforts to reduce COVID-19-related mortality. However, this prioritization may have contributed to intergenerational tensions and ageism, particularly with the limited supply of COVID-19 vaccines. This study examines Twitter discourse to understand vaccine-related ageism during the COVID-19 pandemic to inform future vaccination policies and practices to reduce ageism. We collected 1,369 relevant tweets on Twitter using the Twint application in Python from December 8, 2020, to December 31, 2021. Tweets were analyzed using thematic analysis, and steps were taken to ensure rigor. Our research identified four main themes including (a) blame and hostility: "It's all their fault"; (b) incompetence and misinformation: "clueless boomer"; (c) ageist political slander; and (d) combatting ageism: advocacy and accessibility. Our findings exposed issues of victim-blaming, hate speech, pejorative content, and ageist political slander that is deepening the divide of intergenerational conflict. Although a subset of tweets countered negative outcomes and demonstrated intergenerational solidarity, our findings suggest that ageism may have contributed to COVID-19 vaccine hesitancy among older adults. Consequently, urgent action is needed to counter vaccine misinformation, prohibit aggressive messaging, and promote intergenerational unity during the COVID-19 pandemic and beyond.

Adjusting for Case Under-Ascertainment in Estimating RSV Hospitalisation Burden of Older Adults in High-Income Countries: a Systematic Review and Modelling Study.

Previous studies suggest diagnostic testing characteristics (i.e. variations in clinical specimens and diagnostic tests) can contribute to underestimation of RSV disease burden. We aimed to improve the understanding of RSV hospitalisation burden in older adults (aged ≥ 65years) in high-income countries through adjusting for case under-ascertainment. We conducted a systematic review to include data on RSV-associated acute respiratory infection (ARI) hospitalisation burden in older adults in high-income countries. To adjust for case under-ascertainment, we developed a two-step framework that incorporated empirical data on the RSV detection proportion of different clinical specimens and testing approaches as well as their statistical uncertainty. We estimated the unadjusted and adjusted RSV-associated hospitalisation burden through multilevel random-effects meta-analysis. We further explored RSV-associated in-hospital mortality burden. We included 12 studies with eligible RSV hospitalisation burden data. We estimated that pooled unadjusted hospitalisation rate was 157 per 100,000 (95%CI 98-252) for adults aged ≥ 65years; the rate was adjusted to 347 per 100,000 (203-595) after accounting for under-ascertainment. The adjusted rate could be translated into 787,000 (460,000-1,347,000) RSV-associated hospitalisations in high-income countries in 2019, which was about 2.2 times the unadjusted estimate. Stratified analysis by age group showed that the adjusted rate increased with age, from 231 per 100,000 in adults aged 65-74years to 692 per 100,000 in adults aged > 85years. The in-hospital case fatality ratio of RSV was 6.1% (3.3-11.0) and the total RSV-associated in-hospital deaths in high-income countries in 2019 could be between 22,000 and 47,000. This study improves the understanding of RSV-associated hospitalisation burden in older adults and shows that the true RSV-associated hospitalisation burden could be 2.2 times what was reported in existing studies. This study has implications for calculating the benefit of interventions to treat and prevent RSV-associated disease.

Probiotics Function in Preventing Atopic Dermatitis in Children.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by relapsing eczematous injuries and severe pruritus. In the last few years, the AD prevalence has been increasing, reaching 20% in children and 10% in adults in high-income countries. Recently, the potential role of probiotics in AD prevention has generated considerable interest. As many clinical studies show, the gut microbiota is able to modulate systemic inflammatory and immune responses influencing the development of sensitization and allergy. Probiotics are used increasingly against AD. However, the molecular mechanisms underlying the probiotics mediated anti-allergic effect remain unclear and there is controversy about their efficacy. In this narrative review, we examine the actual evidence on the effect of probiotic supplementation for AD prevention in the pediatric population, discussing also the potential biological mechanisms of action in this regard.

Why are anti-smoking health-information interventions less effective among low-socioeconomic status groups? A systematic scoping review.

This paper identifies and synthesises explanations proposed in the literature for the (in)effectiveness of institutional anti-smoking health-information interventions (HII) among low-socioeconomic status (SES) adults in high-income countries. We searched eight databases for relevant papers from various disciplines: Studies published in English since 2009, on the effectiveness among low-SES adults of anti-smoking HIIs, aimed at changing knowledge/behaviour, and conducted by official institutions, were included. Through a scoping review, we synthesised: study design, SES indicator, intervention type, intervention source, study population, outcomes, low-SES effects, equity effects, proposed explanations and whether these were studied empirically. Thirty-eight studies were included in this scoping review. Seventeen suggested explanations for the (in)effectiveness of the HIIs in low-SES adults, but only nine assessed them empirically. Thematic analysis yielded six themes: message engagement, material conditions, cognition, risk perception, social environment and self-efficacy. Explanations for intervention results are not always present, and empirical evidence for explanations is often not provided. Including such explanations and testing their empirical merits in future research can provide the crucial information needed for developing more effective anti-smoking HIIs for low-SES adults. To our knowledge, this is the first review to explore the explanations proposed for why anti-smoking HIIs are (in)effective among low-SES adults. It contains insights for future studies aiming to provide empirical evidence on the causes of this (in)effectiveness, and concludes that such research is yet largely missing, but crucial to the quest for more effective and equitable anti-smoking interventions.

Life satisfaction in emerging adults: The role of emotional and spiritual intelligences

Objectives. The present research had two main objectives. The first was to examine the impact of emotional intelligence and aspects of spiritual intelligence on life satisfaction among emerging adults in high-income countries. The second objective was to study the interactions between the variables. Methods. First, we used predictive analysis to examine the impact of emotional and spiritual intelligences on life satisfaction beyond that accounted for by gender and by anxiety and depression. Second, we studied the interactions between the variables measured by means of decision-tree analysis. Results. Personal meaning production emerged as the primary determining factor of life satisfaction. In addition, the participants with both personal meaning production and emotional intelligence above a certain threshold had the highest average scores on life satisfaction. Conclusions. The results suggest that further research on emerging adults should investigate the critical issue of identity development, specifically regarding the impact of spiritual and emotional intelligence.

Financial Toxicity Among Older Mexican Adults With Cancer and Their Families: A Mixed-Methods Study.

PURPOSEThe financial toxicity (FT) of cancer is common among older adults in high-income countries, but little is known about the financial hardships faced by older patients with cancer living in developing countries. The aim of this study was to explore the financial burden of cancer among older Mexican adults and their relatives, as well as factors that might mitigate such burden.METHODSThis mixed-methods study included patients age 65 years and older with the 10 most common malignancies in Mexico and 3-24 months from diagnosis at two cancer centers in Mexico City and their relatives. For the quantitative component, patients and relatives answered the Spanish version of the Consumer Financial Protection Bureau Financial Well-Being Scale. Patients completed the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) scale and a 3-month, self-reported cost diary. For the qualitative component, focused interviews were used to explore the individual experiences of patients and their relatives.RESULTSNinety-six patients and their relatives were included, of whom 45% had stage IV disease. On the COST-FACIT scale, 9% reported no FT, 52% mild FT, 39% moderate FT, and 0% severe FT. The mean Consumer Financial Protection Bureau Financial Well-Being Scale score was 45.2, with 78% reporting poor financial well-being (score ≤ 50). On cost diaries, most expenses were associated with purchasing medications, including chemotherapy. Focused interviews showed that most patients and relatives had to acquire debt to face costs of cancer care.CONCLUSIONA high proportion of Mexican older adults with cancer reported FT and poor financial well-being. Understanding experiences associated with FT and strategies to mitigate it represents an essential first step to design public policies aimed at protecting older adults with cancer and their families from catastrophic spending.

Multiple Roles for Cytokines in Atopic Dermatitis: From Pathogenic Mediators to Endotype-Specific Biomarkers to Therapeutic Targets.

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases, which generally presents with intense itching and recurrent eczematous lesions. AD affects up to 20% of children and 10% of adults in high-income countries. The prevalence and incidence of AD have increased in recent years. The onset of AD mostly occurs in childhood, although in some cases AD may persist in adult life or even manifest in middle age (adult-onset AD). AD pathophysiology is made of a complex net, in which genetic background, skin barrier dysfunction, innate and adaptive immune responses, as well as itch contribute to disease development, progression, and chronicization. One of the most important features of AD is skin dehydration, which is mainly caused by filaggrin mutations that determine trans-epidermal water loss, pH alterations, and antigen penetration. In accordance with the “outside-inside” theory of AD pathogenesis, in a context of an altered epidermal barrier, antigens encounter epidermal antigen presentation cells (APCs), such as epidermal Langerhans cells and inflammatory epidermal dendritic cells, leading to their maturation and Th-2 cell-mediated inflammation. APCs also bear trimeric high-affinity receptors for immunoglobulin E (IgE), which induce IgE-mediated sensitizations as part of pathogenic mechanisms leading to AD. In this review, we discuss the role of cytokines in the pathogenesis of AD, considering patients with various clinical AD phenotypes. Moreover, we describe the cytokine patterns in patients with AD at different phases of the disease evolution, as well as in relation to different phenotypes/endotypes, including age, race, and intrinsic/extrinsic subtypes. We also discuss the outcomes of current biologics for AD, which corroborate the presence of multiple cytokine axes involved in the background of AD. A deep insight into the correlation between cytokine patterns and the related clinical forms of AD is a crucial step towards increasingly personalized, and therefore more efficient therapy.

Factors Influencing COVID-19 Vaccine Acceptance in High Income Countries Prior to Vaccine Approval and Rollout: A Narrative Review.

Objectives: Acceptance and high uptake of COVID-19 vaccines continues to be critical for controlling the COVID-19 pandemic. This narrative review aimed to summarise findings on factors influencing acceptance of COVID-19 vaccines in the period leading up to the approval and rollout. Methods: We conducted a narrative review of literature published in 2020 on factors influencing acceptance of hypothetical COVID-19 vaccines in adults in high income countries with well-established health systems. Results: Facilitators of acceptance included confidence in vaccine safety and effectiveness, high COVID-19 disease risk perception and trust in health authorities and other vaccine stakeholders, including government. Barriers included safety and effectiveness concerns, perceived scientific uncertainty, low disease risk perception, and low trust in authorities and other stakeholders. Conclusion: Evidence on facilitators and barriers to COVID-19 vaccine acceptance, at a time prior to vaccine rollout, can help health authorities address hesitancy and may inform approaches to support acceptance of novel pandemic vaccines in the future. Future research should include in-depth qualitative research to gather more nuanced evidence.

Monitoring Walking Activity with Wearable Technology in Rural-dwelling Older Adults in Tanzania: A Feasibility Study Nested within a Frailty Prevalence Study

ABSTRACT Background Older adults with lower levels of activity can be at risk of poor health outcomes. Wearable technology has improved the acceptability and objectivity of measuring activity for older adults in high-income countries. Nevertheless, the technology is under-utilized in low-to-middle income countries. The aim was to explore feasibility, acceptability and utility of wearable technology to measure walking activity in rural-dwelling, older Tanzanians. Methods A total of 65 participants (73.9 ± 11.2 years), 36 non-frail and 29 frail, were assessed. Free-living data were recorded for 7 days with an accelerometer on the lower back. Data were analyzed via an automatic cloud-based pipeline: volume, pattern and variability of walking were extracted. Acceptability questionnaires were completed. T-tests were used for comparison between the groups. Results 59/65 datasets were analyzed. Questionnaires indicated that 15/65 (23.0%) experienced some therapeutic benefit from the accelerometer, 15/65 (23.0%) expected diagnostic benefit; 16/65 (24.6%) experienced symptoms while wearing the accelerometer (e.g. itching). Frail adults walked significantly less, had less variable walking patterns, and had a greater proportion of shorter walking bouts compared to the non-frail. Conclusion This study suggests that important contextual and practical limitations withstanding wearable technology may be feasible for measuring walking activity in older rural-dwelling adults in low-income settings, identifying those with frailty.

Epidemiology of Escherichia coli Bacteremia: A Systematic Literature Review.

Escherichia coli is the most common cause of bacteremia in high-income countries. To enable the development and implementation of effective prevention strategies, a better understanding of the current epidemiology of invasive E. coli infections is needed. A systematic review of literature published between 1 January 2007 and 31 March 2018 on the burden and epidemiology of E. coli bacteremia in populations that include adults in high-income countries was conducted. Meta-analysis was performed for descriptive purposes. During the studied time interval, the estimated incidence rate of E. coli bacteremia was 48 per 100 000 person-years, but this increased considerably with age: rates per 100 000 person-years were >100 in 55-to-75-year-olds and >300 in 75-to-85-year-olds. Overall, E. coli accounted for 27% of documented bacteremia episodes: 18% if hospital acquired, 32% if community-onset healthcare associated, and 33% if community acquired. The estimated case fatality rate was 12%. Approximately 44% of episodes were community acquired, 27% community-onset healthcare associated, and 27% hospital acquired. Urinary tract infection (UTI) was the primary source for 53% of episodes. This systematic review confirms the substantial burden of E. coli bacteremia in older adults and justifies the implementation of community-level programs to prevent E. coli bacteremia and ideally UTI in this age group.

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective.

Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests that SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations.Highlights:– The burden of non-communicable diseases including cardiovascular diseases is rising in SSA.– Levels of hypertension diagnosis, treatment, and control are low at <40%, <35%, and 10–20%, respectively, and more than 40% of patients with diabetes are not aware of their diagnosis in SSA.– SSA has 23% of the world’s prevalent rheumatic heart disease cases.– The leading causes of heart failure in SSA are hypertensive heart disease, cardiomyopathy, and rheumatic heart disease, with ischemic heart disease accounting for <10% of cases compared to >50% in high-income countries.

A review of interventions to improve clinical outcomes following hospitalisation for heart failure.

Heart failure (HF) is a leading cause of hospitalisation and death among older adults in high-income countries. HF is often accompanied by comorbid conditions, and patients hospitalised for HF commonly die or are readmitted in the weeks follow- ing hospital discharge. The objectives of this paper are to discuss the burden of HF hospitalisations in healthcare systems and to review strategies that reduce hospitalisations and death in this condition.

Factors perceived to influence healthy eating: a systematic review and meta-ethnographic synthesis of the literature.

Dietary risks are leading contributors to global morbidity and mortality and disproportionately burden individuals of lower socioeconomic positions. The aim of this review is to understand, holistically, what factors are perceived to influence healthy eating and to determine whether perceived factors differ when comparing the general population with lower socioeconomic subgroups. Four academic databases (MEDLINE, CINAHL, PsycINFO, Cochrane Library) and 3 gray literature databases were searched systematically, along with reference lists. Studies were included if they were qualitative and were conducted with community-dwelling adults in high-income countries and if they focused specifically on healthy eating. Eligibility was determined through author consensus. Thirty-nine eligible studies (of 11 641 records screened) were identified. Study characteristics were extracted using a standard template, and quality appraisal was conducted using the Critical Appraisal Skills Program tool. Data synthesis was conducted using meta-ethnography, with themes categorized according to the socioecological model. Factors across the individual, social, lived, and food environments were perceived to influence healthy eating. Meta-ethnography revealed that multiple environmental and social factors were frequently reported as barriers to healthy eating. While factors were largely generalizable, diet affordability and the lower availability of stores offering healthy food appeared to be more salient barriers for lower socioeconomic groups. Actions to improve population diets should mitigate the barriers to healthy eating to create environments that support healthy eating across the socioeconomic gradient. Systematic Review Registration: PROSPERO registration number CRD42017065243.