Preventive Care Research Articles

Validation of digital cardiovascular risk score (DiCAVA) in the United States All of Us dataset

Abstract Introduction The cardiovascular disease (CVD) risk score DiCAVA was developed in 2021 using UK Biobank data with the aim to be used for population health screening by deriving its predictions only from variables readily available to every individual, omitting difficult-to-obtain measurements such as blood pressure and invasive blood tests for metrics like cholesterol or HbA1c, which are commonly used in clinical CVD risk assessment tools. The original set of variables was reduced to 30 in the DiCAVA Lite score to further improve usability in a digital solution accessible to the general population, while maintaining its discrimination ability. Purpose Like many countries, the US has a large burden of CVD and would benefit from easily accessible screening tools. However, to ensure generalisability of the UK-developed score, it is necessary to evaluate its performance in a population where the score is intended to be used. Methods Data from a large real-world modern observational study in the US, All of Us, was used to evaluate discrimination and calibration metrics of the risk score. Participants with pre-existing CVD and without available electronic health records were excluded from the study. Variables from the All of Us dataset were matched to the original variables and any missing values were imputed using multiple imputation. Results 216,985 participants with a median follow-up time of 3.44 years were included in the study. The median age was 51 years and 63% of the population were female. Discrimination ability in the All of Us dataset (C-index 0.76) slightly surpassed the discrimination achieved at training with UK Biobank (C-index 0.73), and that of Framingham risk score calculated for the All of Us population (C-index 0.72), demonstrating the score’s usability in the US. The score showed very good discrimination in both males (C-index 0.74) and females (C-index 0.77), all ethnic groups and age groups, with the exception of the population over 65 years of age, where the C-index dropped to 0.65 as expected (similar to that observed in the UK Biobank). Calibration of the original model was assessed at 3 years and showed under-estimation of the predicted risk (calibration-in-the-large of 2.37%). Following re-calibration, the algorithm demonstrated excellent results with the average predicted 3-year risk showing 0.59% difference from the observed CVD rate (calibration plot in Figure). Conclusions Overall, the DiCAVA Lite score has shown very good discrimination in the US, showing its generalisability in different demographic populations. Its re-calibrated form is now validated for use in the US population and because of its ability to be utilised outside clinical settings, it can be deployed widely in the general population as an initial screening tool and potentially boost awareness of cardiovascular health in an effort to drive preventative care of CVD.Re-calibration of the DiCAVA Lite score

An Innovative Public Health Solution with European Features for an American Problem

Abstract Problem The Eastern Shore of Maryland is a beautiful region that boasts a multicultural community of 455,000 year-round residents. Despite its rural location, the coastal lifestyle attracts retirees, making it the state’s oldest population. Unfortunately, the region also has the highest socioeconomic disparities in the state, which creates difficulties in accessing healthcare. This is a significant public health issue that results in costly barriers to preventive care and timely, accounting for $320 billion in unnecessary healthcare spending. Description of the problem Maryland’s healthcare funding formulas favor larger health systems in urban areas, leading to health inequities. To address this, we propose an innovative scenario analysis model partially based on European public health approaches. This model will adjust funding formulas based on each region’s specific needs and challenges, promoting fairness and equity in healthcare funding. Results Adopting this population health management approach would have built-in efficiencies: In the United States, healthcare spending tends to be higher among underserved populations due to delayed care, access challenges, missed diagnoses, and limited access to the latest scientific advances as well as proper preventive services. Lessons The proposed scenario-based public health funding approach targeting the needs of the underserved population on the Eastern Shore of Maryland could yield significant positive health outcomes and health savings generating a ripple effect across the state, and perhaps even the country. The lessons learned in how other countries handle public health funding could lead to global collaboration. Key messages • Our approach aims to provide a practical solution to unnecessary healthcare spending. • We must adapt to the changing tides to stay on course.

1.B. Round table: Artificial Intelligence in Mobile Health Apps: Ethical, Legal, and Regulatory Challenges

Abstract Globally, governments and public health authorities are integrating Artificial Intelligence (AI) techniques in mobile apps to improve public health. For example, during the COVID-19 outbreak, AI-driven chatbots were deployed to provide immediate health information and advice. AI-based mobile apps are also used to support mental health or for preventive healthcare, such as personalized dietary recommendations. Moreover, the use of generative AI for public health purposes is rapidly increasing. In 2024, the WHO launched S.A.R.A.H - a generative AI chatbot designed to provide information on major health topics such as healthy lifestyles and mental health. By integrating AI, public institutions could potentially achieve better health outcomes, improve efficiency, and enhance access to healthcare. However, the rapid adoption of AI public health apps also raises significant ethical, legal, and regulatory challenges. The large amounts of sensitive personal data collected and processed by such apps may create issues for privacy, data protection, and cybersecurity. At the same time, the tendency of AI to exhibit biases may deepen existing health inequities. The new EU ‘digital’ legal framework does not directly address these challenges. This workshop aims to convene leading experts working on AI in health to address these issues. We bring together scholars from different disciplines (health law, health policy, bioethics, biosciences). The workshop objectives are twofold: (1) to critically assess the current landscape of AI in public health apps from a legal, ethical, and regulatory point of view, and (2) to lay the groundwork for policy recommendations on how to ensure the deployment of AI apps for public health in compliance with ethical principles and fundamental rights. First, the panel explores the differences in the data protection regulation of AI public health apps in the EU and the US (speaker: James Hazel). Second, it discusses how these apps are regulated under the new EU Artificial Intelligence Act (speaker: Hannah van Kolfschooten). Third, it investigates the consequences of the European Health Data Space regulation on how health data can be processed through public health apps (speaker: Mahsa Shabani). Finally, as the cross-border use of apps complicates regulatory efforts, it discusses the need for international cooperation in establishing and enforcing guidelines (speaker: Vasiliki Rahimzadeh). The workshop will be conducted as a round table discussion with 4 short presentations of 5 minutes each. Speakers first present a key challenge posed by AI in mobile health apps, and then suggest a potential regulatory solution. This will be followed by a dialogue between panelists and the audience to share best practices on how to regulate AI in mobile public health apps from a legal, ethical, and regulatory perspective. The input will be used to develop a submission for the Call for papers of BMC Bioinformatics. Key messages • As public institutions are increasingly integrating AI technologies into their mobile public health solutions, it is crucial to evaluate the ethical, legal, and regulatory implications. • In light of current gaps in the EU legal framework, we convene scholars from different disciplines and legal systems to design guidelines on the ethical use of AI mobile apps for public health. Speakers/Panelists James Hazel University of Amsterdam, Amsterdam, Netherlands Mahsa Shabani University of Amsterdam, Ghent University, Amsterdam, Netherlands Hannah van Kolfschooten University of Amsterdam, Amsterdam, Netherlands Vasiliki Rahimzadeh Baylor College of Medicine, Houston, USA Pramiti Parwani University of Amsterdam, Amsterdam, Netherlands

Machine learning and traditional analysis of the interaction between cardiovascular diseases and hematological malignancies

Abstract Background Cardiovascular diseases and clonal hematopoiesis of indetermine potential (CHIP), the premalignant state of hematological cancers, exhibit reciprocal interactions. While the presence of CHIP confer a risk for heart failure, it is unclear if cardiovascular diseases are associated with elevated risk hematological cancers. Purpose To determine the association between cardiovascular diseases (CVD) and cardiovascular risk, and hematological cancer. Methods We evaluated 27,231 adults, free of CVD and cancer, who participated in preventive healthcare program between 2000-2018. Each participant underwent a complete physical evaluation, blood test and exercise stress test at baseline. CVD was defines as ischemic heart disease, stroke, atrial fibrillation or hypertension. Then, we used machine learning and traditional survival analysis to evaluate the association between CVD and hematological cancer. For machine learning, we used the random forest method using Curat package in r, and incorporated all continuous variables gathered into the model (70% training, 30% test). For survival analysis, we first matches each CVD patient to a control patient by propensity scores to balance for age, sex, smoking, diabeles mellitus, renal function, body mass index and length of follow-up. Then, we compared the CVD and non-CVD patients using cox proportional hazard regression. Results Using machine learning, we found that the strongest predictors for hematological cancer in our cohort are low eGFR, age, high atherosclerosis cardiovascular disease score (ASCVD) and BMI. Of note, systolic and diastolic blood pressure were also strong predictors of hematological cancer (Figure A). Then, we matched 5500 CVD patients to controls with median follow-up of 9.2 years (Interquartile range 5-15 years). During follow-up, 1380 developed cancer. Of them, 186 developed hematological cancer. We used cox proportional hazard regression and Kaplan Mayer method to determine the risk and hazard ratio of developing hematological cancer (Figure B-C). Compared with subjected without CVD, patients with CVD were 91% more likely to develop cancer during follow-up, and 62% more likely to develop hematological cancer (Figure C, HR=1.61. 95%CI 1.21-2.16). Moreover, the 10-year risk to develop hematological cancer was 1.9% for patients with CVD and 1.0% for individuals without CVD (Figure D). Notably, the increased incidence of hematological cancers included 38% increase in cases of leukemia but only 11% increase in cases of lymphoma. Conclusions Using machine learning and traditional analysis we show that CVD risk and CVD were associated with increased incidence of hematological cancer. Understanding this relationship could lead to advances in cardiovascular and cancer treatment and could ultimately help to improve patient outcomes.

The cardiovascular polypill strategy (acetyl salicylic acid, atorvastatin, ramipril) as baseline treatment after a cardiovascular event supported by compelling evidence: a global expert consensus

Abstract Background The SECURE trial demonstrated that the CV-polypill strategy (acetylsalicylic acid [ASA]+atorvastatin+ramipril) reduces CV mortality by 33% in patients with acute myocardial infarction (MI) compared to standard care over 3 years (median). The 2023 ACS ESC Guidelines recommend the polypill strategy to improve outcomes and treatment adherence. The CV-polypill inclusion in the 2023 World Health Organization's essential medicines list signifies its effective and affordable response to a global secondary prevention healthcare requirement. Purpose To reach consensus among medical experts from various countries regarding key implementation aspects of the CV-polypill strategy (ASA+atorvastatin+ramipril) as baseline preventive treatment after a CV event (CVe) in routine clinical practice. Methods A two-round modified Delphi method was employed. A questionnaire consisting of 30 evidence-based statements was developed and validated with input from 8 distinguished cardiologists. The Delphi panel, 50 physicians from 19 countries across Europe, Latin America, and Asia, used a three-point Likert scale to establish their agreement and perceived importance of the statements. Consensus was reached when ≥80% agreed or deemed statements 'very important' or 'important. Statements without consensus in the first round underwent refinement based on evidence and panellists’ feedback in the second round. Persistent disagreements were resolved in a face-to-face meeting with experts. Descriptive statistics were applied. Results 38/50 panellists participated in round 1, and 37/50 in round 2. 31/38 were cardiologists. 28/38 routinely prescribed the CV-polypill strategy. 97.4% of panellists believed that the 24% relative risk reduction in major CVe over 3 years (median), attained with the CV-polypill strategy (ASA+atorvastatin+ramipril) compared to standard care could replicate in clinical practice while maintaining equal safety (97.4%). Unanimous consensus (100%) supported initiating the CV-polypill strategy as baseline preventive treatment upon hospital discharge or at first follow-up. Its efficacy and safety were also acknowledged for stroke (94.7%), peripheral artery disease (92.1%), and both genders (84.2%). 89.5% supported CV-polypill affordability for preventing CHD events and strokes. Algorithms for initiation (97.3%) and transition (97.4%) to the CV-polypill strategy from cardioprotective drugs, considering patient preferences (97.5%), were confirmed. A unanimous consensus (100%) affirmed the positive impact of the simplified CV-polypill treatment on patient satisfaction, with 94.7% recognizing its convenience (Figure 1). Conclusions Skilled medical experts across continents reached consensus on critical implementation aspects and strongly endorse the early use of the CV-polypill strategy (ASA+atorvastatin+ramipril). This adoption aims to reduce CVD recurrence, improve prognosis, and potentially enhance affordability in CVD treatment after a CVe.Consensus on CV polypill implementation

Forecasting cognitive functioning: an artificial intelligence approach with Dynamic Bayesian Networks

Abstract Background Several potentially modifiable risk factors are associated with subjective cognitive decline (SCD). However, developmental patterns of these risk factors have not been used before to forecast later SCD. Practical tools for the prevention of cognitive decline are needed. We examined multifactorial trajectories of risk factors, and their associations with SCD using an artificial intelligence approach to build a score that forecasts later SCD. Methods Five repeated surveys (2000-2022) of the Helsinki Health Study (n = 8960, 79% women, aged 40-60 at Phase 1) were used to build dynamic Bayesian networks (DBN) for estimating the odds of SCD. A score-based approach was implemented for learning DBN using the quotient normalized maximum likelihood criterion. The model was used to predict SCD based on the history of consumption of fruit and vegetables, smoking, alcohol consumption, leisure-time physical activity, body mass index, and insomnia symptoms, adjusting for sociodemographic covariates. Results Of the participants, 31-48% reported decline in memory, learning, and concentration in 2022. Physical activity was the strongest predictor of SCD in a 5-year interval, with an odds ratio of 0.76 (95% Bayesian credible interval 0.59-0.99) for physically active compared to inactive participants. Alcohol consumption showed a U-shaped relationship with SCD. Other risk factors had minor effects. Conclusions A new online risk score tool was developed that enables individuals to inspect their own risk profiles, as well as explore potential targets for interventions and their estimated contributions to later SCD. Dynamic decision heatmap was presented as a communication tool to be used at healthcare consultations. Key messages • Potentially modifiable health-related behaviours such as physical activity can contribute to subjective cognitive decline. • Artificial intelligence can be applied to discover the complex interactions between risk factors and subjective cognitive decline, to support preventive healthcare at individual and population levels.

Indicators of the clinical utility of genetic or genomic testing: a scoping review

Abstract Background Genetic or genomic tests are the cornerstones of personalized prevention. Previous reviews primarily focused on theoretical frameworks rather than actual assessments and assessed dimensions rather than specific indicators within these dimensions. Our scoping review aimed to review the dimensions and the specific indicators measured in the published assessment reports of genetic or genomic tests. Methods We selected formal assessments of genetic and genomic test used for prevention through PubMed, Web of Science, Scopus, websites of 20 different organizations, Google, and Google Scholar. Also, through a separate analysis we identified ten comprehensive dimensions of clinical utility through an analysis of 30 theoretical frameworks for genetic and genomic tests. From the included assessments, we extracted all the indicators, clustering them based on the comprehensive dimensions. Results From 3054 unique references and 12000 grey literature search results, we collected 57 assessments, all from high income-countries (in Europe (53%) and North America (47%)). The assessment methods were HTA (42%), EGAPP (25%), ACCE (21%) and other (12%). 951 disease-specific indicators were extracted from the assessments. Analytic validity (60%), clinical validity (79%) clinical efficacy (79%), economic impact (58%) were the most common dimensions (had at least one indicator). However, only 12 assessments (21%) include indicators that compared health outcomes between tested and untested groups. Equity, acceptability, legitimacy, and personal value were evaluated in less than 15% of the documents. Conclusions Our study illustrate that, although dimensions such as equity and acceptability, are significantly emphasized in traditional evaluation frameworks, these are often not considered in the assessments. Additionally, our study has underscored a significant dearth of primary evidence concerning the clinical efficacy of these technologies. Key messages • Our study highlights the prevalence of evaluations lacking indicators for equity, acceptability, and legitimacy dimensions and a lack of direct evidence of clinical efficacy. • The catalog of indicators was openly provided as a resource for researchers and institutions working in evidence-based evaluations of personalized preventive healthcare.

Introducing vaccination services in prison settings: case study from Moldova

Abstract Introducing vaccination services within prison settings presents a multifaceted challenge and opportunity, particularly evident in the case of Moldova. This Eastern European nation grapples with various socio-economic and healthcare disparities, with its prison population often experiencing heightened health vulnerabilities. Amidst such complexities, the implementation of vaccination services emerges as a crucial strategy not only to safeguard the health of incarcerated individuals but also to contribute to broader public health goals. Moldova’s journey in this regard reflects a commitment to advancing preventive healthcare within its correctional facilities. The introduction of vaccination services in prisons necessitated a comprehensive approach, encompassing policy development, infrastructure enhancement, staff training, and community engagement. Infrastructure enhancement was imperative to ensure the provision of vaccination services in a safe, efficient, and dignified manner within prison settings. This involved the establishment of designated vaccination areas equipped with the necessary medical supplies and equipment. Staff training emerged as a cornerstone of the initiative, empowering healthcare professionals working within prisons with the knowledge, skills, and confidence to deliver vaccination services effectively. Training programs encompassed various aspects, including vaccine administration, adverse event management, and communication strategies tailored to the specific needs of incarcerated individuals. Collaboration with people living in prison facilitated the dissemination of accurate information, addressed concerns, and encouraged participation in vaccination programs. During the period 2021-2023 7454 doses of antiCOVID-19, 1298 doses of anti-Flu vaccine, 3083 doses of anti-HBV vaccines were administered.

Essential public health competencies in nursing during the COVID-19 pandemic: A Delphi study

Background & Aim: Nursing practice, characterized by its multifaceted nature, encompasses diverse settings and situations in public health, making it difficult to clearly define the role of nurses in this setting. The study aimed to determine the applicability and relevance of the Regional Core Competency Framework for Public Health in nursing practice during the COVID-19 pandemic. Methods & Materials: Study based on the Delphi methodology, a structured approach to the systematic collectión of expert opinions, to obtain group agreements. Twenty-one nurses working in public health areas during the pandemic participated. Results: The competencies most applied by the nurses were in the domain of health situation analysis and surveillance and risk and damage control. 95% of the nurses were involved in care actions to prevent contagion; 71% analyzed social determinants of health, 100% were involved in the domain of policies, planning, regulation, and control, and 86% in the domain of health promotion. 89% made decisions to favor access to preventive and health care services. 78% valued social participation actions and 76% implemented immediate responses to COVID-19. Conclusion: The main public health competencies used by nursing for dealing with the COVID-19 pandemic are the management of educational processes, health promotion, primary health care, analysis of social determinants, management of health policies, information analysis, and management of immediate responses to challenges generated by COVID-19.

Role of Chikitsa Sutrani to Formulation a Treatment Protocol

The "Role of Chikitsa Sutras in Formulating Treatment Protocols" bridges ancient Ayurvedic wisdom with modern medical practices. Ayurvedic Samhitas, foundational texts, offer therapeutic principles in Chikitsa Sutras. This abstract explores the integration of these guidelines into contemporary protocols, aiming to enhance therapeutic efficacy, optimize patient outcomes, and foster a holistic healthcare approach. MATERIALS AND METHODS: This study employs a multifaceted approach, drawing insights from Ayurvedic Samhitas and contemporary medical literature. The ancient texts, including Charaka Samhita, Sushruta Samhita, and Ashtanga Hridaya, are meticulously reviewed to extract Chikitsa Sutras relevant to various ailments. Additionally, modern medical databases are searched for evidence-based treatment protocols corresponding to these conditions. By juxtaposing Ayurvedic principles with modern therapeutic strategies, this study elucidates synergies and disparities, facilitating the formulation of integrated treatment protocols. RESULTS: The combination of Ayurvedic Chikitsa Sutras with modern treatment paradigms yields profound insights and practical implications. Analysis reveals congruencies in fundamental principles such as holistic patient assessment, personalized treatment approaches, and emphasis on preventive healthcare. Ayurvedic guidelines offer nuanced perspectives on disease aetiology, classification, and management, supplementing modern diagnostic and therapeutic modalities. Integration of Ayurvedic principles into treatment protocols enhances therapeutic efficacy, minimizes adverse effects, and promotes patient-centred care. Moreover, the holistic framework of Ayurveda fosters a comprehensive understanding of health and disease, encouraging lifestyle modifications and preventive measures to augment long-term wellness.

Determinants of oral health among Iranian soldiers: a structural equation modeling study

BackgroundMilitary personnel often face unique challenges in maintaining optimal oral health. This study investigated the oral health status, caries experience, and associated factors among a sample of Iranian soldiers, employing a structural equation modeling (SEM) approach to explore the complex interplay of socioeconomic and behavioral determinants.MethodsA cross-sectional study was conducted among 658 male soldiers aged 18–30 years from three military barracks in Fars province, Iran. Data were collected through a structured instrument and clinical oral examinations. The study employs the DMFT index, which measures caries experience based on decayed, missing, and filled teeth, along with the Simplified Oral Hygiene Index (OHI-S) to assess overall oral health status. Structural equation modeling was employed to analyze the complex relationships between socioeconomic factors, oral health behaviors, and oral health outcomes.ResultsThe mean DMFT score was 3.57 ± 5.91, and the mean OHIS score was 0.56 ± 1.42. SEM analysis revealed that socioeconomic status (SES) indirectly influenced DMFT and oral hygiene scores, mediated by drug use, oral hygiene practices, dietary sugar consumption, and dental visit frequency. Lower toothbrushing frequency was significantly associated with higher DMFT (Estimate = -0.064, p < 0.001) and OHIS scores (Estimate = -0.637, p < 0.001). Drug use (smoking, qalyan, alcohol) was linked to poorer oral health outcomes, while more frequent dental visits were associated with lower DMFT and OHIS scores.ConclusionThis study reveals the complex interplay between socioeconomic conditions, oral health behaviors, and oral health outcomes among Iranian soldiers. The findings highlight the need for targeted interventions to address modifiable risk factors and improve access to preventive dental care within military settings. Future longitudinal studies are warranted to elucidate further the causal pathways between these factors and oral health outcomes in military populations.

Empowering Maternal Choice: Exploring Factors Influencing Early Postpartum Contraceptive Adoption Intention Among Pregnant Women in Northeast Ethiopia.

Despite progress in access to family planning services in many sub-Saharan African countries in recent decades, advances in early postpartum contraceptive adoption remain low, and the unmet need for early postpartum contraceptives is high. According to the Ethiopia Demographic and Health Survey report, early postpartum modern contraceptive method uptake is still unacceptably low in Ethiopia. This study aimed to determine the magnitude of intention to adopt early postpartum modern contraceptive methods and its associated factors among pregnant women in Dessie and Kombolcha town zones, northeast Ethiopia. A community-based cross-sectional study was deployed from 15 January-15 February 2023, in the Dessie and Kombolcha zones, northeast Ethiopia, among pregnant women. The study involved 780 pregnant women using the cluster sampling technique. A census was conducted in 20 randomly selected clusters to identify eligible pregnant women. Actual data were collected home-to-home in the community through face-to-face interviews. Data were collected by Open Data Kit (ODK) and exported to STATA 17 for analysis. A multivariable logistic regression analysis was performed, and the goodness of the model was checked by Hosmer-Lemeshow's test statistic and rock curve. An adjusted odds ratio with a 95% confidence interval and p-value < 0.05 was considered statistically significant. The study revealed that 49.6% of pregnant women lack autonomy and 50% lack knowledge about early postpartum contraception, with participants' wealth index status ranging from rich (36.6%) to poor (33.2%). The study found that 75.8% of pregnant women intended to adopt early postpartum modern contraceptive methods early after childbirth. After controlling the potential confounders, mother's age (AOR = 6.2 [2.6-14.6], birth interval (AOR = 2.5 [1.6-3.7]), have paid work (AOR = 1.9 [1.3-2.8]), health facility from home (AOR = 2.6 [1.5-4.4]), last delivery Place (AOR = 2.4 [1.1-5.7]), knowledge on (AOR = 1.5 [1.1-2.1]), and antenatal care follow-up (AOR = 1.9 [1.2-3.3]) were significant associated factors of intention to uptake early postpartum modern contraceptive methods among pregnant women. The study found that 75% of the participants had the intention to adopt contraceptive methods during the early postpartum period. Identified factors influencing this intention were age, birth interval, women's employment status, area of residence, distance to health facilities, last delivery place, knowledge of early postpartum modern contraception, gravidity, and antenatal care follow-up. These findings highlight the need for targeted interventions to address these factors, framing the intended users and enabling access to early adoption of postpartum contraceptive methods.

Preventative dental practices and cardiometabolic health in adolescents.

The aim of this study was to identify the relationship between preventative dental practices and cardiometabolic health in adolescents. Analysis included children aged 13 to 17 years enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018 who completed an Oral Health Examination and Questionnaire. Deferred dental care was defined as not having a dental visit in the past year. Financial barriers to seeking dental care (vs no financial barriers) were assessed among those with deferred dental care in the past year. Primary cardiometabolic outcomes included obesity, elevated blood pressure, and hypertensive blood pressure. Secondary outcomes included dyslipidemia, glucose intolerance, uric acid, glomerular hyperfiltration, and albuminuria. Regression models adjusted for age, sex, race/ethnicity, household income, food insecurity, health insurance status, household education, and body mass index z-score examined associations using complex survey design procedures. Of 2,861 adolescents, 17.6% (SE 0.9%) did not receive dental care in the past year and 20.2% (SE 1.9%) had a financial barrier to accessing dental care. In adjusted regression models, adolescents with deferred dental care had higher odds of dyslipidemia (odds ratio [OR]= 1.51, 95% CI 1.07 to 2.11, P = .020). Having a financial barrier was associated with lower odds of dyslipidemia (OR = 0.35, 95% CI 0.14 to 0.89, P = .03). Financial barriers were associated with lower non-high-density lipoprotein cholesterol (b = -7.95, 95% CI -14.87 to -1.05, P = .03) and higher high-density lipoprotein cholesterol (b = 3.06, 95% CI 0.37 to 5.75, P = .03) in adjusted models. Deferred dental care and financial barriers were not associated with any other cardiometabolic parameters. In this nationally representative cohort of adolescents, there was an association between lack of preventative dental care and the cardiometabolic health marker of dyslipidemia. However, financial barriers to dental care were surprisingly associated with higher high-density lipoprotein cholesterol levels and lower odds of dyslipidemia.

Disability, poverty and health-service accessibility in the context of the COVID-19 pandemic: a population-based repeated cross-sectional study in Colombia

ObjectivesIn Colombia, 4.3% of the population 5 years or older lives with a disability. They face higher levels of poverty and social exclusion compared with persons without disabilities. This article...

Integrated Online-to-Offline Model of Care for HIV Prevention and Treatment Among Men Who Have Sex With Men in Malaysia: Protocol for an Intervention Development and a Multiphase Trial.

HIV continues to have a disproportionate impact on specific populations in Malaysia, particularly men who have sex with men (MSM). HIV self-testing (HIVST) is a strategy that has been shown to scale up HIV testing rates. However, it faces shortcomings because of concerns about self-efficacy, result interpretation, and lack of counseling and linkage to care. This underscores the need for an innovative approach that integrates HIVST with timely counseling, expert guidance, and referrals to enhance engagement in relevant HIV prevention or treatment. This study aims to describe the protocol used in developing and testing a web-based platform (ie, CINTAI) providing an HIVST kit and real-time e-counseling to support online-to-offline linkage to HIV care services for MSM in Malaysia. The methods are reported according to the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 guidelines. In phase I, we will adapt existing HIVST web-based platforms to create a new online-to-offline HIVST and counseling platform called "CINTAI" for Malaysian MSM. In phase II, we will use a type 1 hybrid implementation trial design to determine the feasibility, acceptability, and preliminary efficacy of "CINTAI" compared with treatment as usual among Malaysian MSM, with assessments conducted over 6 months. Multilevel implementation factors will also be collected to guide future adoption and scale-up. We will enroll 78 MSM in the pilot randomized controlled trial. Baseline characteristics will be tested for homogeneity between groups using appropriate statistical tests. A generalized linear mixed model with random subject effects will account for within-subject correlation. Treatment assignment, time, interaction, and confounders will be included. The proportion of MSM tested for HIV over 6 months and other outcomes (pre-exposure prophylaxis for HIV or antiretroviral therapy linkage, HIV risk behaviors, and chemsex harm reduction) will be compared using linear contrasts. We completed phase I of the proposed study in April 2024 and started phase II in May 2024, with 15 participants recruited (7 in the CINTAI and 8 in the treatment-as-usual groups). On the basis of a series of formative works completed during phase I, we developed a fully functional, web-based platform that provides a digital platform for MSM in Malaysia to order HIVST kits for free and to receive HIV counseling, followed by offline linkage to HIV prevention services (if HIV negative) or HIV treatment services (if HIV positive). Despite being at high risk for HIV transmission, MSM in Malaysia have alarmingly low testing and linkage to HIV care services, prompting the need for innovative approaches to support HIV prevention efforts. If found to be feasible and acceptable, CINTAI can be easily adapted for a range of health outcomes and health care delivery services for MSM, including adaptation to other low- and middle-income countries. DERR1-10.2196/60962.

Outcomes of a Community Cat Program Based on Sterilization of Owned, Semi-Owned and Unowned Cats in a Small Rural Town.

Free-roaming cats in urban and peri-urban areas and in rural towns pose significant challenges due to their nuisance behaviors, threats to wildlife, and potential disease transmission. Traditional management methods often involve trapping and euthanizing many of these cats, which is not only costly but also distressing for the shelter staff involved, and have failed to reduce numbers of impounded cats or cat-related complaints. Our study aimed to evaluate the effectiveness of a Community Cat Program that provided free sterilization, microchipping, and preventative veterinary care for all owned, semi-owned, and unowned cats in a small rural town with high cat impoundments in Ipswich, Queensland. The program was instigated by the Australian Pet Welfare Foundation in collaboration with the Royal Society for the Prevention of Cruelty to Animals, Queensland and the Animal Welfare League, Queensland, and it was funded by various organizations including Fondation Brigitte Bardot. Data from 2017 to 2023 were analyzed to assess the impact of the program on cat intake and outcomes in local shelters. A total of 308 cats were sterilized, representing 94 cats per 1000 residents over 3.4 years, and in the third year, this was associated with a 60% decrease in cat intake, an 85% reduction in numbers euthanized and 39% fewer cat-related calls to the local council. These findings suggest that high-intensity, targeted sterilization programs significantly decrease shelter intake and euthanasia, and thus alleviate the psychological burden on staff. These programs are a humane and effective alternative to traditional cat management, and benefit animal welfare as well as community wellbeing. This is aligned with a One Welfare approach, which enhances the well-being of animals, humans, and their environments. Legislative changes are required to support these programs to effectively decrease the numbers of free-roaming cats in cities and towns and the issues they cause, while protecting human wellbeing.

Primary Care Considerations for Individuals With Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is an uncommon genetic neuromuscular condition manifesting as progressive and irreversible muscular weakness. It is usually diagnosed in childhood, and, unfortunately, individuals living with DMD have a shortened lifespan. DMD has an effect on multiple body systems, leading to complications such as cardiomyopathy, respiratory infections, fragility fractures, and mood disorders. Nurse practitioners working in the primary care setting are in a key position to support the individual by approaching the disease from a multisystem lens, incorporating preventive care to maximize health and well-being at varying stages of the disease process.

74 Reducing unplanned extubations in a level 3 neonatal intensive care unit - the nuts and bolts of UE bundle implementation

Abstract Background Unplanned extubations (UEs) are preventable adverse events that may lead to short term consequences (e.g. cardiopulmonary collapse) and long term sequelae (e.g. acquired airway injury, brain injury) for patients admitted to the Neonatal Intensive Care Unit (NICU). UE prevention care bundles have been demonstrated to reduce UE rates in NICUs; however, implementation of bundle elements is unit dependent. Objectives To describe the work of a UE Prevention Team in a Level 3 NICU with rising UE rates despite implementation of UE prevention bundle per Children’s Hospital Solutions for Patient Safety (SPS). Design/Methods A neonatologist / respiratory therapist pair was assembled in March 2022 to tackle rising UE rates in a 69 bed NICU. Contributing unit stressors included implementation of a new electronic health record, COVID-19 policies, and nursing shortages. Baseline UE rates were &amp;gt;3x the centerline for SPS network NICUs and likely underreported. Steps undertaken include: 1) daily audit to ensure reporting of all UEs, 2) structured post-event team debriefs, 3) unit education campaign to raise awareness of UE prevention and bundle elements, 4) prominent posting of last UE date and reporting on daily team huddle, 5) rapid UE case reviews and apparent cause analysis with reporting of findings unit-wide, 6) optimize endotracheal tube (ETT) securement methods, 6) enforce T2-T3 ETT tip position, 7) standardize x-ray frequencies and reporting, 8) trial of daily rounds ETT safety checklist. Results From rapid case reviews, apparent causes were determined to be incorrect ETT securement device sizing, taping method prone to loss of tape integrity in high humidity, high ETT positions, and inadequate ETT monitoring during high risk activities other than repositioning (invasive/painful procedures, diaper changes). Post-event structured debriefs and unit-wide vigilance increased reporting of UE events to 100%. UE rates fell from a peak of &amp;gt;4 UEs/month, &amp;gt;2.4/100 ventilation days to 1 UE/month, 0.465/100 ventilation days, a 80% reduction.(Figure 1) Most impactful interventions were standard x-ray reporting template in the electronic health record, reinforcing T2-T3 ETT tip positioning, correcting ETT holder sizing, and change in ETT method (Figure 2). Daily rounds checklist was not effective. UE reductions were achieved without changing patient ratios as nurse staffing shortages continued. Conclusion A nimble systems approach is needed to ensure success in implementation of UE prevention care bundles. Simple changes can be made to decrease UEs, guided by rapid case reviews.

Utilizing Citizen Generated Data to enhance Women's Access to Sexual and Reproductive Health Services in Somalia: Insights, Barriers, and Pathways Forward

Purpose: This study was undertaken to capture citizen’s insights on practical steps that individuals, families, communities, and institutions could take to support the improvement of Sexual and Reproductive Health (SRH) services in Somalia. This includes raising awareness of issues affecting women's access to SRH, such as Gender-Based Violence (GBV) and Female Genital Mutilation (FGM). Methodology: This research employed a qualitative research design, utilizing semi-structured radio questions distributed through various channels such as radio promos, mini-dramas, interactive radio shows, and Short Messaging Service (SMS) on mobile phones. To enhance and validate the findings from the radio series, thirty Focus Group Discussions (FGD) involving 270 'hard-to-reach' participants were conducted across all Federal Member States (FMS) of Somalia, excluding Somaliland. Collaborating with 20 radio stations, a total of 4,268 participants from across Somalia were involved in this study. The qualitative data obtained was categorized into themes, and the subsequent information was analyzed using content analysis methodology for qualitative data, as well as descriptive statistics and inferential analysis through statistical package for social science (SPSS) version 25 and excel for quantitative data. The presentation of the data included the use of tables and figures. Findings: This study outlined key challenges in accessing quality SRH services for women in Somalia. Priorities included enhancing healthcare infrastructure and availability of SRH professionals, along with emphasizing health education on reproductive health and family planning. Food insecurity's impact, especially among displaced populations, was noted. GBV and FGM were highlighted, calling for comprehensive survivor care and male involvement in prevention. Collaboration between schools and the private sector was proposed for menstrual hygiene. Men's support for SRH access was deemed crucial. Addressing stigma around SRH access, GBV, and FGM was stressed, urging comprehensive awareness campaigns and improved healthcare provision for survivors. Unique Contribution to Theory, Practice and Policy: Addressing women's SRH in Somalia involves investing in healthcare infrastructure, expanding health education programs, ensuring access to nutritious food, and engaging men as allies in promoting women's SRH rights. Moreover, efforts to combat stigma, GBV, and FGM must be culturally sensitive and inclusive, involving religious and community leaders, and addressing underlying socio-economic factors contributing to these issues.

Beyond the Heart: The Predictive Role of Coronary Artery Calcium Scoring in Non-Cardiovascular Disease Risk Stratification.

Coronary artery calcium scoring (CACS), a non-invasive measure of coronary atherosclerosis, has significantly enhanced cardiovascular (CV) risk assessment and stratification in asymptomatic individuals. More recently, a higher score for CAC has been associated with an increased risk of non-CV diseases and all-cause mortality. This review consolidated evidence supporting the role of CAC in assessing non-CV diseases, emphasizing its potential in early diagnosis and prognosis. We observed a strong association between CACS and non-CV diseases, viz., chronic obstructive pulmonary disease, pulmonary embolism, pneumonia, diabetes, chronic kidney disease, osteoporosis, metabolic dysfunction-associated steatotic liver disease, nephrolithiasis, stroke, dementia, malignancies, and several autoimmune diseases. Also, CAC may aid in evaluating the risk of CV conditions developing secondary to the non-CV diseases mentioned earlier. Further evidence from prospective studies, intervention trials, and population-based behavioral studies is needed to establish CAC cutoff values and explore preventative care applications, facilitating their broader integration into healthcare practices.