Burden Of Chronic Disease Research Articles

Costs and healthcare use of patients with chronic kidney disease in the Northern Territory, Australia

BackgroundThe burden of chronic kidney disease (CKD) is high in the Northern Territory (NT), Australia. This study aims to describe the healthcare use and associated costs of people at risk of CKD (e.g. acute kidney injury, diabetes, hypertension, and cardiovascular disease) or living with CKD in the NT, from a healthcare funder perspective.MethodsWe included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model.ResultsAmong 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p < 0.001) compared to people in the at risk group without CKD.ConclusionThe total healthcare costs in advanced stages of CKD is high, even when patients are not on dialysis. There remains a need for effective primary prevention and early intervention strategies targeting CKD and related chronic conditions.

Effects of smoking on clinical treatment outcomes amongst patients with chronic inflammatory diseases initiating biologics: secondary analyses of the prospective BELIEVE cohort study.

The prevalence and disease burden of chronic inflammatory diseases (CIDs) are predicted to rise. Patients are commonly treated with biological agents, but the individual treatment responses vary, warranting further research into optimizing treatment strategies. This study aimed to compare the clinical treatment responses in patients with CIDs initiating biologic therapy based on smoking status, a notorious risk factor in CIDs. In this multicentre cohort study including 233 patients with a diagnosis of Crohn's disease, ulcerative colitis, rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis or psoriasis initiating biologic therapy, we compared treatment response rates after 14 to 16 weeks and secondary outcomes between smokers and non-smokers. We evaluated the contrast between groups using logistic regression models: (i) a "crude" model, only adjusted for the CID type, and (ii) an adjusted model (including sex and age). Among the 205 patients eligible for this study, 53 (26%) were smokers. The treatment response rate among smokers (n = 23 [43%]) was lower compared to the non-smoking CID population (n = 92 [61%]), corresponding to a "crude" OR of 0.51 (95% CI: [0.26;1.01]) while adjusting for sex and age resulted in consistent findings: 0.51 [0.26;1.02]. The contrast was apparently most prominent among the 38 RA patients, with significantly lower treatment response rates for smokers in both the "crude" and adjusted models (adjusted OR 0.13, [0.02;0.81]). Despite a significant risk of residual confounding, patients with CIDs (rheumatoid arthritis in particular) should be informed that smoking probably lowers the odds of responding sufficiently to biological therapy. Registration: Clinical.Trials.gov NCT03173144.

Distribution of neuropsychiatric profiles and comorbid diseases in dementia subtypes

Objectives: Alzheimer’s disease (AH) is the most prevalent cause of dementia, followed closely by vascular dementia. Mixed vascular-Alzheimer’s dementia (MVAD) is more evident in individuals aged 80 and above. Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia after AH. Vascular risk factors play important role in the pathogenesis of dementia syndromes. Behavioral and psychological symptoms represent a significant portion of the non-cognitive manifestations in dementia patients. This study aimed to evaluate the distribution of chronic diseases, behavioral disorders, psychiatric findings, and medication use in patients followed with different dementia diagnoses. Methods: Prevalance of chronic diseases, behavioral disorders, psychiatric findings as well as the usage of antidepressant and antipsychotic medications among patients followed up in dementia outpatient clinics with the diagnosis of AD, mild cognitive impairment (MCI), vascular dementia (VaD), FTD, and MVAD were investigated. Neuropsychiatric inventory (NPI) was applied to the patients. Results: Four hundred and fifty-five patients were accepted in the study. The patients were distributed as follows: AD (n=303, female/male: 187/115, age = 78±8 years), MCI (n=53, female/male: 31/22, age = 69±10 years), VaD (n=31, female/male: 18/13, age = 68±9 years), FTD (n=32, female/male: 17/15, age = 68±9 years), and MVAD (n=36, female/male: 16/20, age = 76±10 years). Both AD and MVAD groups were significantly older than the other groups (F = 23.2, P&amp;lt;0.0001). The ratio of comorbid chronic diseases was 80% in the AD group, 72% in the MCI group, 91% in the VaD group, 59% in the FTD group, and 93% in the MVAD group. In the whole group, antipsychotic drug use was 27.5% and antidepressant drug use was 28.9%. The mean NPI score was 32.9±28 in antipsychotic users and 16±19 in non-users (P&amp;lt;0.0001). The mean NPI of antidepressant users was 17.6±19 and 21.9±25 (P=0.055) in non-users. Conclusion: There is a comorbid chronic disease burden in all dementia subtypes, although at varying intensities, and as the chronic disease burden increases, behavioral disorders and psychotic findings increase, and accordingly, the use of antipsychotics also increases.

Finerenone: Who should prescribe it for CKD? The physician associate's perspective.

Diabetic kidney disease (DKD) affects 30-40% of all patients with diabetes and contributes significantly to the cardiovascular burden of chronic kidney disease (CKD). Despite the availability of evidence-based medications like finerenone and simple screening tests such as Urinary Albumin-to-Creatinine Ratio (UACR), more resources are still needed to care for DKD patients. Physician Associates (PAs) play a crucial role in the multidisciplinary team responsible for DKD diagnosis, monitoring, and management. A nonsteroidal mineralocorticoid receptor antagonist, namely finerenone, was approved by the FDA in adults with CKD associated with type 2 diabetes to reduce the risk of renal and cardiovascular outcomes. Finerenone is considered among the pillars of care for DKD, furthermore, the addition of finerenone in combination with renin-angiotensin system inhibitors and/or other renal protective medications may offer additional benefits. Primary care providers prescribe finerenone less frequently than specialized care providers, indicating a need to empower physician associates in medication prescription and other renal protection strategies. As part of a multidisciplinary team, physician associates can play an important role in evaluating risk factors that contribute to heart disease and metabolic health. They can also monitor not only kidney function by ordering tests, such as serum creatinine and urinary albumin-to-creatinine ratio every 3-12months, but also serum potassium levels. Additionally, physician associates can encourage patients to take responsibility for their health by regularly monitoring their blood pressure, blood glucose levels, and body weight. With early detection and management, kidney failure and cardiovascular events may be preventable. Specialized physician associates also play a significant role in the comprehensive care of DKD patients, especially in the later stages. DKD care can be hindered by numerous factors such as lack of patient engagement during counseling, cost disparities, and a complex referral system that requires multidisciplinary guidelines to improve professional communication. It is necessary to re-envision the physician associates' role in primary care and empower them in goal-directed therapies.

Four-year longitudinal culinary and lifestyle medicine track for undergraduate medical students: development and implementation

ABSTRACT The importance of culinary and lifestyle medicine education to combat the growing burden of chronic disease is gaining recognition in the United States. However, few medical schools offer in-depth training with a 4-year longitudinal track. The Culinary and Lifestyle Medicine Track (CLMT) is a 4-year curriculum thread created at West Virginia University School of Medicine to address the need for comprehensive culinary and lifestyle medicine education. CLMT teaches concepts of healthy nutrition, physical activity, stress management, and restorative sleep. CLMT students complete approximately 300 h of in-person and virtual culinary and lifestyle medicine education, including hands-on teaching kitchens, distributed over the preclinical and clinical years. Students are selected into the track prior to matriculation after an application and interview process. The students have exceeded expectations for scholarly and community activity. Track graduates have entered into primary care as well as specialty and surgical residencies, demonstrating that lifestyle education plays a role for students interested in a wide range of careers. Exit survey responses from learners reflected tangible and intangible benefits of participation and offered constructive feedback for improvement. Presented here are the components of the curricular design, implementation, and initial outcomes.

Economic burden of chronic obstructive pulmonary disease and post-tuberculosis sequelae in low- and middle-income countries: a database compiled from a systematic review and meta-analysis

BackgroundChronic obstructive pulmonary disease (COPD) and tuberculosis (TB) impose a substantial economic burden globally. This systematic review summarised the evidence on the costs of COPD, including post-TB diseases in low-...

Chronic respiratory disease observatory for Africa (CHEST-Africa): study protocol for the prevalence, determinants and economic impacts of asthma and COPD in Africa

IntroductionContemporary data on the burden of chronic respiratory diseases in sub-Saharan Africa is limited. More so, their economic burden is not well described. This study aims to establish a chronic...

EUFOREUM Berlin 2023: Optimizing care for type 2 inflammatory diseases from clinic to AI: A pediatric focus.

The European Forum for Research and Education in Allergy and Airways diseases (EUFOREA) organized its bi-annual forum EUFOREUM in Berlin in November 2023. The aim of EUFOREUM 2023 was to highlight pediatric action plans for prevention and optimizing care for type 2 inflammatory conditions starting in childhood, with a focus on early-stage diagnosis, ensuring neither under- nor overdiagnosis, optimal care, and suggestions for improvement of care. EUFOREA is an international not-for-profit organization forming an alliance of all stakeholders dedicated to reducing the prevalence and burden of chronic respiratory diseases through the implementation of optimal patient care via educational, research, and advocacy activities. The inclusive and multidisciplinary approach of EUFOREA was reflected in the keynote lectures and faculty of the virtual EUFOREUM 2023 (www.euforea.eu/euforeum) coming from the pediatric, allergology, pulmonology, ENT, dermatology, primary health care fields and patients around the central theme of type 2 inflammation. As most type 2 inflammatory conditions may start in childhood or adolescence, and most children have type 2 inflammation when suffering from a respiratory or skin disease, the moment has come to raise the bar of ambitions of care, including prevention, remission and disease modification at an early stage. The current report provides a comprehensive overview of key statements by the faculty of the EUFOREUM 2023 and the ambitions of EUFOREA allowing all stakeholders in the respiratory field to be updated and ready to join forces in Europe and beyond.

Health system performance assessment and reforms, Oman.

To prioritize key areas of action and investment for the next strategic cycle of national development plans (2026-2031) in Oman, we needed a holistic view of the country's health system and its main deficiencies and inefficiencies. Informed by the World Health Organization framework, our team of seven national health ministry staff and two international experts conducted a rapid health system performance assessment. We used already available data to identify system bottlenecks and their potential root causes, verifying our findings with key informant interviews. Oman's 4.9 million population is relatively young (average age 28years) but ageing, with a mounting burden of chronic diseases. While health-care services are free for Omani nationals, more than 1.5 million expatriates rely on out-of-pocket payments for health-care services. Strengthening primary health care, improving the quality of care, providing financial protection, and ensuring that public and private health-care providers operate within the same legal and procedural framework are recognized as key national priorities. Our assessment highlighted the need to extend health service coverage to the whole population, strengthen private health-care sector governance, improve health education, increase financial investment, and expand the country's capacity for data collection and analysis. The assessment framework allowed us to identify areas where information is lacking and use already available data to analyse multiple health outcomes. As well as identifying issues that need to be addressed during the next policy development cycle, our findings have contributed towards the preparation of a more extensive assessment.

Digital health interventions in primary care in low- and middle-income countries: a systematic scoping review protocol

Background The integration of digital health (eHealth) interventions into primary healthcare systems has gained recognition lately in Low- and Middle-Income Countries (LMICs) to enhance healthcare quality, accessibility, and efficiency. These interventions may offer effective strategies in mitigating the burden of chronic diseases by facilitating access to remote healthcare and optimising its processes. This scoping review aims to identify and assess eHealth interventions implemented in primary care settings in LMICs for further development and adaptation. Methods and analysis We will search two electronic databases, such as Scopus and Embase, to identify peer-reviewed studies reporting on eHealth interventions implemented in primary care settings within LMICs. This review will encompass evidence published in the English language without a time frame restriction. We will remove duplicates from the search, and two reviewers will independently assess all articles for eligibility by first screening the title and abstract, followed by a full-text review. Eligible articles will be extracted, and data will be charted according to types of intervention and settings using a standardised form. Ethics and dissemination There is no ethical review required for this scoping review. We plan to disseminate the findings by presentations at conferences and publishing in open-access journal.

The Global Burden of Chronic Obstructive Pulmonary Disease: Exploring the Social and Psychological Dimensions

Millions worldwide suffer from chronic obstructive pulmonary disease (COPD), a progressive and debilitating respiratory condition. Beyond its physical symptoms, COPD has significant social and psychological repercussions. This research examines the connections between smoking, depression, suicidal ideation, and the quality of life (QOL) in COPD patients. By analyzing these variables, we aim to enhance the understanding of the challenges faced by individuals with COPD and inform healthcare strategies and public policy. Using a purposive sampling technique, the study employed the PHQ-9 (Patient Health Questionnaire-9), Suicidal Ideation Attribute Scale, and WHOQOL-BREF (World Health Organization Quality of Life-BREF) to collect data. The results revealed a significant negative correlation between depression and quality of life (r = -.475**). Smoking was positively correlated with the severity of COPD as diagnosed by doctors (r = .542**). A longer duration of COPD was associated with a lower quality of life (r = -.268*). The study also found that males (m = 23.15, Sd = 9.5) exhibited a higher prevalence of suicidal ideation compared to females (t = 3.38, p = .001, m = 16.06, Sd = 9.26). Additionally, the age of individuals with COPD positively correlated with disease severity (r = .268) and duration of illness (r = .457**). These findings highlight the need for comprehensive healthcare approaches addressing both the physical and psychosocial dimensions of COPD, guiding public policy and healthcare regulations to better support affected individuals.

Prevalence, Perception and Awareness of Chronic Diseases (HIV, Diabetes, Hypertension and Typhoid Fever) Among Rural Dwellers in Nomeh-Unateze Community in Nkanu-East LGA of Enugu

Introduction: This study investigated the prevalence, perception, and awareness of chronic diseases—HIV, Diabetes, Hypertension, and Typhoid Fever—among rural dwellers in Nomeh-Unateze Community, located in Nkanu-East Local Government Area of Enugu. Methodology: A total of 200 participants were evaluated for this study. The mean age (standard deviation) of the participants was 48.9years (12.25) and 47% of the participants were within the age range of 55 and above. 83% of the participants were females while 17% were males. Utilizing a mixed-methods approach, data was collected through structured questionnaires, in-depth interviews and tests for these chronic diseases. Results: Out of the study participants, only 4% had tertiary education, 17% started secondary school, 49% had basic education and 30% had no formal education. There was a high level of awareness of the chronic diseases, HIV, Diabetes Mellitus, Hypertension and Typhoid fever; however, the high rate of low level education had a huge impact on their perception about them. A significant gap in the sources of information about these chronic diseases was also found. Only 15% of participants reported receiving information from healthcare personnel, while 30% relied on media sources, predominantly radio. Misconceptions about disease causation and prevention were also prevalent, particularly regarding HIV as a high level of stigma surrounding HIV was also observed. The findings from this study revealed that the prevalence rates of these chronic diseases are notably low among the study participants, with HIV having a prevalence of 0.0% among the study participants. Diabetes had a1.15% prevalence among the study participants and the only identified incidences were recorded in females within the age range of 35-44. Typhoid had a prevalence of 1.05% among the participants, and the only incidences were recorded in males. However, Hypertension had the highest prevalence; 32.5% for hypertensive SBP (outside the safe range of 100-140mmHg) and 27.5% for hypertensive Diastolic Blood Pressure (DBP) (outside the safe range of 60-90mmHg). All cases of hypertension were recorded in participants above 45years of age. This study underscores the urgent need for targeted health education interventions and improved access to healthcare services to enhance disease management and reduce the burden of chronic diseases in rural communities. Conclusion: Therefore, the study recommend that more research-oriented medical outreaches should be organized to both evaluate the level of stigmatization and fear associated with these chronic diseases and aim at drastically reducing them. Future researches should involve longitudinal studies that will check for the changes in the trends of the prevalence rates of these diseases over time, as well as their mortality rates. The community.

Reevaluating Biota Alteration: Reframing Environmental Influences on Chronic Immune Disorders and Exploring Novel Therapeutic Opportunities.

Environmental mismatches are defined as changes in the environment that induce public health crises. Well known mismatches leading to chronic disease include the availability of technologies that facilitate unhealthy diets and sedentary lifestyles, both factors that adversely affect cardiovascular health. This commentary puts these mismatches in context with biota alteration, an environmental mismatch involving hygiene-related technologies necessary for avoidance of infectious disease. Implementation of hygiene-related technologies causes a loss of symbiotic helminths and protists, profoundly affecting immune function and facilitating a variety of chronic conditions, including allergic disorders, autoimmune diseases, and several inflammation-associated neuropsychiatric conditions. Unfortunately, despite an established understanding of the biology underpinning this and other environmental mismatches, public health agencies have failed to stem the resulting tide of increased chronic disease burden. Both biomedical research and clinical practice continue to focus on an ineffective and reactive pharmaceutical-based paradigm. It is argued that the healthcare of the future could take into account the biology of today, effectively and proactively dealing with environmental mismatch and the resulting chronic disease burden.

A Systematic Review of Healthcare Providers Awareness of Medication Switching for Polypharmacy Patients in Saudi Arabia

Background: Polypharmacy, the concurrent use of multiple medications by an individual, presents challenges in medication management, patient safety, and healthcare outcomes, particularly among older adults. In Saudi Arabia, the prevalence of polypharmacy is increasing due to the aging population and the burden of chronic diseases. Understanding healthcare providers' awareness and practices regarding medication switching is crucial for optimizing medication use and improving patient outcomes. Study Aim: This systematic review aims to synthesize and analyze existing literature on healthcare providers' awareness of medication switching for polypharmacy patients in Saudi Arabia. The study focuses on pharmacists and physicians, exploring their knowledge, attitudes, and practices related to medication management, deprescribing, pharmacovigilance, and Medication Therapy Management (MTM) services. Methodology: A systematic search was conducted across major databases, including PubMed, Scopus, and Google Scholar, using predefined search terms related to polypharmacy, medication switching, healthcare providers' awareness, and Saudi Arabia. Eligible studies were selected based on inclusion criteria, including study design, setting, participants, and relevance to the study aim. Data extraction and synthesis were performed to analyze key findings and themes related to healthcare providers' awareness of medication switching. Results: Six eligible studies were included in the systematic review, encompassing survey-based investigations, cross-sectional studies, and qualitative studies conducted in various healthcare settings across Saudi Arabia. The findings revealed gaps in pharmacists' and physicians' knowledge regarding Potentially Inappropriate Medications (PIMs), Drug-Drug Interactions (DDIs), pharmacovigilance practices, and deprescribing strategies. Recommendations for improving pharmacists' education, enhancing pharmacovigilance practices, and promoting collaborative care models were highlighted. Conclusion: Healthcare providers in Saudi Arabia demonstrate varying levels of awareness and practices regarding medication switching for polypharmacy patients. There is a need for targeted educational interventions, standardized pharmacovigilance practices, and collaborative efforts among healthcare providers to optimize medication use, reduce polypharmacy-related risks, and improve patient outcomes.

Integrated community-based management of HIV, diabetes, and hypertension in Tanzania and Uganda: protocol for a cluster-randomized trial

Background In response to the growing burden of chronic diseases in sub-Saharan Africa, where innovative and cost-effective health solutions are imperative, this study outlines a protocol for a cluster-randomized trial that compares integrated community-based care with integrated facility-based care to improve access and outcomes for patients with HIV, diabetes, or hypertension. Methods &amp; analysis We will conduct a pragmatic cluster-randomized trial comparing integrated community care with integrated facility care in Tanzania and Uganda. Patients living with HIV, diabetes, or hypertension, stable on treatment in health facilities, will be organised into groups of approximately 8–14 persons and randomly assigned to integrated community or facility-based care. The study has two co-primary endpoints: a composite endpoint of glycemia and blood pressure control among individuals with diabetes and/or hypertension and suppression of plasma viral load among people living with HIV. Participants will receive their drugs, adherence support, and monitoring at a community venue in the integrated community arm. Those randomised to the control arm will receive integrated facility-based care. All study participants will be followed up for 12 months. A sample size of 116 groups will provide over 80% power to detect an absolute difference in blood pressure and blood glucose control of 10% at the 5% two-sided significance level. For HIV viral suppression, the trial will have over 80% power to show non-inferiority with a delta margin = 8.5%, 7.5%, and 5.5% assuming viral suppression is 85%, 90% and 95% respectively. To allow for loss to follow-up, our target for enrolment is 124 groups, each comprising an average of 14 participants. An economic evaluation within the trial will be conducted to estimate the cost and cost-effectiveness of integrated community care compared with integrated facility care. This will be complemented by a built-in social science process evaluation. Ethics and dissemination Ethical approval was granted by the Research Ethics Committees of the University College London (UCL), the National Institute of Medical Research (Tanzania), and the Uganda Virus Research Institute (Uganda). The findings will be disseminated through journal publications and meetings with key stakeholders. Trial registration number ISRCTN Registry: ISRCTN15319595, registration date: 07 June 2022.

Clinical officers in Uganda: Training and workforce role.

The clinical role of a clinical officer in Uganda is very similar to that of a physician associate/assistant in the United States. This article describes the qualifications and workforce role of clinical officers in Uganda, as well as their use in two primary care programs that provide effective, low-cost medical care to a growing population with an increasing burden of chronic disease.

Association between Combined Metals and PFAS Exposure with Dietary Patterns: A Preliminary Study.

The global burden of chronic diseases has been increasing, with evidence suggesting that diet and exposure to environmental pollutants, such as per- and polyfluoroalkyl substances (PFAS) and heavy metals, may contribute to their development. The Dietary Inflammatory Index (DII) assesses the inflammatory potential of an individual's diet. However, the complex interplay between PFAS, heavy metals, and DII remains largely unexplored. The goal of this cross-sectional study was to investigate the associations between diet operationalized as the DII with individual and combined lead, cadmium, mercury, perfluorooctanoic acid (PFOA), and perfluorooctanesulfonic acid (PFOS) exposures using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018. Descriptive statistics, a correlational analysis, and linear regression were initially used to assess the relationship between the variables of interest. We subsequently employed Bayesian kernel Machine regression (BKMR) to analyze the data to assess the non-linear, non-additive, exposure-response relationships and interactions between PFAS and metals with the DII. The multi-variable linear regression revealed significant associations between the DII and cadmium and mercury. Our BKMR analysis revealed a complex relationship between PFAS, metal exposures, and the DII. In our univariate exposure-response function plot, cadmium and mercury exhibited a positive and negative linear relationship, respectively, which indicated a positive and negative relationship across the spectrum of exposures with the DII. In addition, the bivariate exposure-response function between two exposures in a mixture revealed that cadmium had a robust positive relationship with the DII for different quantiles of lead, mercury, PFOA, and PFOS, indicating that increasing levels of cadmium are associated with the DII. Mercury's bivariate plot demonstrated a negative relationship across all quantiles for all pollutants. Furthermore, the posterior inclusion probability (PIP) results highlighted the consistent importance of cadmium and mercury with the inflammatory potential of an individual's diet, operationalized as the DII in our study, with both showing a PIP of 1.000. This was followed by PFOS with a PIP of 0.8524, PFOA at 0.5924, and lead, which had the lowest impact among the five environmental pollutants, with a PIP of 0.5596. Our study suggests that exposures to environmental metals and PFAS, particularly mercury and cadmium, are associated with DII. These findings also provide evidence of the intricate relationships between PFAS, heavy metals, and the DII. The findings underscore the importance of considering the cumulative effects of multi-pollutant exposures. Future research should focus on elucidating the mechanistic pathways and dose-response relationships underlying these associations in a study that examines causality, which will enable a deeper understanding of the dietary risks associated with environmental pollutants.

Strategic Alliances in Global Health: Innovative Perspectives in the Era of Sustainable Development.

This article discusses current challenges in the field of global health and the World Health Organization's (WHO) strategies to address them. It highlights the importance of measuring the health impacts of global recession and globalization and the need for human-centered approaches to sustainable development. Emphasis is placed on commitment to health equity and the use of strategic partnerships for health at global, national, and local levels. Improving the health and well-being of populations, as well as public health equity, are core principles of the 2030 Agenda for the Sustainable Development Goals (SDGs). These principles are expressed in SDG 3, which promotes universal access to health services and systems and recognizes global health as a basic human right. It highlights the importance of strategic partnerships to combat emerging health crises, improve public health indices, and address the burden of chronic disease. These partnerships are contemplated in SDG 17 and are manifested in different modalities, such as network governance, cross-sector collaboration, public-private partnership, and social participation. This diversity of alliances has played an important role in scaling up and strengthening universal health systems around the world, including in Latin America and the Caribbean. The text concludes by presenting the essential characteristics of these inter-organizational and inter-institutional alliances in the field of global health.

Chronic oral disease burden at the first 1000 days: Intergenerational risk factors, BRISA cohort

AbstractObjectiveTo analyze multiple‐causal models, including socioeconomic, obesity, sugar consumption, alcohol smoking, caries, and periodontitis variables in pregnant women with early sugar exposure, obesity, and the Chronic Oral Disease Burden in their offspring around the first 1000 days of life.MethodsThe BRISA cohort study, Brazil, had two assessments: at the 22nd–25th gestational weeks and during the child's second year (n = 1141). We proposed a theoretical model exploring the association between socioeconomic and pregnancy factors (age, smoking, alcohol, sugars, obesity, periodontitis, and caries) and child's variables (sugars and overweight) with the outcome, Chronic Oral Disease Burden (latent variable deduced from visible plaque, gingivitis, and tooth decay), using structural equation modeling.ResultsCaries and periodontitis were correlated in pregnant women. Addictive behaviors in the gestational period were correlated. Obesity (Standardized coefficient ‐ SC = 0.081; p = 0.047) and added sugar consumption (SC = 0.142; p = 0.041) were observed intergenerationally in the pregnant woman‐child dyads. Sugar consumption by the children (SC = 0.210; p = 0.041) increased the Chronic Oral Disease Burden.ConclusionsPoor caries and periodontal indicators were correlated in pregnant women and their offspring. Obesity and sugar consumption act intergenerationally. Oral health in early life may change life trajectory since the worst oral conditions predict main NCDs.

Increasing Burden of Chronic Diseases in the Ghanaian Population: Need for Behavioral Inteventions with Effective Implementation to support the WHO PEN program

Increasing Burden of Chronic Diseases in the Ghanaian Population: Need for Behavioral Inteventions with Effective Implementation to support the WHO PEN program