Disease Prevention Interventions Research Articles

A Qualitative Assessment of a Worksite Nutrition Education Intervention

To assess the experience of participants who had previously completed a Community Chronic Disease Prevention intervention involving a micronutrient-dense plant-rich dietary intervention. Qualitative interviews were conducted individually or in groups of 2-3. There was a total of twelve participants who had completed a Community Chronic Disease Prevention intervention of 9- or 12-week duration. Questions were designed to be open-ended to maximize the diversity of responses and to allow exploration of a full range of participant views. Interviews were conducted at locations convenient to participants. Employees of a university or regional hospital who had completed a Community Chronic Disease Prevention dietary intervention 1.5-2 years previously. Audio-tape interviews were recorded, transcribed verbatim, and analyzed for common themes and thematic patterns. Participants reported their experiences and adherence to the dietary guidelines post-intervention. Common themes were identified, including a sense of well-being and increased mindfulness. Intervention features that facilitated adherence included regular contact, the educational component, and cooking demonstrations and tastings. Barriers to adhering to the intervention included life-long habits, as well as cultural and family issues. Identification of the experiences of individuals who have participated in a Community Chronic Disease Prevention will provide a basis for incorporating social, emotional, and psychological support into future studies.

Barriers and Facilitators to the Recruitment of Underrepresented Populations in Health Research: A Narrative Review

Aims: To identify barriers and facilitators to recruitment and retention of underrepresented populations into health research and propose evidence-based strategies to attenuate the barriers and foster the facilitators. Background: Health promotion research is designed to identify sustainable strategies that enable people to live a healthier lifestyle. To identify strategies that are effective for a diverse group of people, research must include a diverse sample that is representative of the population. Researchers frequently struggle with recruitment and retention of underrepresented populations in healthcare research, yet without adequate representation, identification of effective health promotion strategies is lacking. Methods: PubMed, CINAHL, and PsycINFO databases were searched to identify literature regarding recruitment and retention of underrepresented populations into health-related research. Results: A total of 13 quantitative and qualitative articles were reviewed. The primary barriers to recruitment and retention included mistrust of researchers, lack of communication, and inadequate representation of the underrepresented population among the research team. Facilitators included development of community partnerships, benefits for self and community, and involvement in planning of the research. Conclusions: Evidence-based strategies that address barriers and facilitators to underrepresented populations’ participation in health research should be addressed to promote recruitment and retention. Relevance to clinical practice: The findings guide the development of strategies as researchers plan health promotion and disease prevention interventions for underrepresented populations.

ADULT INFECTIONS ARE ASSOCIATED WITH HIGHER RISK OF ALZHEIMER’S DISEASE BUT LOWER RISK OF CANCER

Abstract Growing evidence suggests that infections may promote Alzheimer’s disease (AD). Chronic infections have also been linked to several cancers. However, there is evidence that acute febrile infections may treat some cancers, suggesting that anti-pathogen immune response could help fight off transformed cells. To explore potentially ambivalent role of infections in cancer and AD, we estimated associations between history of infection and subsequent risks of AD, cancer (all sites combined), and all-cause mortality, in sample of 270K participants of the UK Biobank. We found that prior infection is associated with 29% higher risk of AD (RR=1.29, 95% CI[1.02,1.63], both sexes). In contrast, the overall cancer risk was 49% lower in people with history of infection, compared to individuals without such history (RR=0.49, 95% CI[0.46,0.52], both sexes). History of infections was also associated with 7% reduced total survival at ages 70+ (RR=0.93, 95% CI[0.92,0.94]); however, the negative effect was less evident at younger ages. Results of our study suggest that infections may antagonistically influence chances of AD and cancer. They also show that impact of infections on survival depends on age and is more detrimental at older ages, which may reflect general decline in immune resilience due to aging, as well as the fact that cancer becomes a major contributor to mortality risk at younger ages than AD. Understanding the trade-offs between major diseases is essential for optimizing disease prevention and pro-longevity interventions, since measures aiming to prevent one disease may sometimes increase risks of other major conditions and/or all-cause mortality.

Presentation of SLE after COVID vaccination in a pediatric patient

BackgroundThe outbreak of severe acute respiratory syndrome coronavirus 2 has had an enormous impact on global health. Vaccination remains one of the most effective interventions for disease prevention. Clinically significant vaccine side effects are uncommon, though autoimmune-mediated disease occurs in a small percentage of vaccine recipients. Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that is associated with significant morbidity and mortality. Childhood-onset SLE tends to have more severe disease manifestations than adult-onset SLE. In adults, there are a few reported cases of SLE developing soon after coronavirus disease 2019 (COVID-19) mRNA vaccination.Case presentationA 14-year-old previously healthy male developed laboratory and clinical evidence of SLE, including maculopapular malar rash, arthritis, pleuritic chest pain, and class V (membranous) lupus nephritis, 2 days after his third dose of the Pfizer-BioNTech COVID-19 vaccine. The patient’s symptoms improved after initiation of prednisone and mycophenolate mofetil. We also summarize eleven prior case reports describing SLE after COVID-19 vaccine in adults.ConclusionTo our knowledge, this is the first reported pediatric patient with new onset SLE following COVID-19 mRNA vaccination. While potential mechanistic links exist between COVID-19 vaccination and SLE development, additional studies are necessary to elucidate the exact nature of this relationship.

Determining optimal strategies for primary prevention of cardiovascular disease: systematic review of cost-effectiveness analyses in the United Kingdom.

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. The aim of the study was to guide researchers and commissioners of cardiovascular disease preventative services towards possible cost-effective interventions by reviewing published economic analyses of interventions for the primary prevention of cardiovascular disease, conducted for or within the UK NHS. In January 2021, electronic searches of MEDLINE and Embase were carried out to find economic evaluations of cardiovascular disease preventative services. We included fully published economic evaluations (including economic models) conducted alongside randomised controlled trials of any form of intervention that was aimed at the primary prevention of cardiovascular disease, including, but not limited to, drugs, diet, physical activity and public health. Full systematic review methods were used with predetermined inclusion/exclusion criteria, data extraction and formal quality appraisal [using the Consolidated Health Economic Evaluation Reporting Standards checklist and the framework for the quality assessment of decision analytic modelling by Philips et al. (Philips Z, Ginnelly L, Sculpher M, Claxton K, Golder S, Riemsma R, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess 2004;8(36)]. Of 4351 non-duplicate citations, eight articles met the review's inclusion criteria. The eight articles focused on health promotion (n = 3), lipid-lowering medicine (n = 4) and blood pressure-lowering medication (n = 1). The majority of the populations in each study had at least one risk factor for cardiovascular disease or were at high risk of cardiovascular disease. For the primary prevention of cardiovascular disease, all strategies were cost-effective at a threshold of £25,000 per quality-adjusted life-year, except increasing motivational interviewing in addition to other behaviour change strategies. Where the cost per quality-adjusted life-year gained was reported, interventions varied from dominant (i.e. less expensive and more effective than the comparator intervention) to £55,000 per quality-adjusted life-year gained. We found few health economic analyses of interventions for primary cardiovascular disease prevention conducted within the last decade. Future economic assessments should be undertaken and presented in accordance with best practices so that future reviews may make clear recommendations to improve health policy. It is difficult to establish direct comparisons or draw firm conclusions because of the uncertainty and heterogeneity among studies. However, interventions conducted for or within the UK NHS were likely to be cost-effective in people at increased risk of cardiovascular disease when compared with usual care or no intervention. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in Health Technology Assessment. See the NIHR Journals Library website for further project information.

The effects of yoga on cardiovascular risk factors

Cardiovascular diseases is a group of disorders of the heart and blood vessels, including coronary heart disease, cerebrovascular disease, rheumatic heart disease, peripheral artery disease, congenital heart disease, deep vein thrombosis, and pulmonary embolism. The most important behavioral risk factors for heart disease and stroke are poor diet, physical inactivity, smoking, and harmful alcohol use. The impact of behavioral risk factors may manifest in each individual as high blood pressure, hyperglycemia, hyperlipidemia, overweight, and obesity. The purpose of this study was to give a thorough scientific analysis of yoga’s contribution to the management and prevention of cardiovascular diseases and related risk factors. The records are collected from several databases. We performed an extensive search of the PubMed/Medline electronic database. However, it is believed that the risk of cardiovascular disease can be reduced by adjusting for several risk factors, such as increasing physical activity and using relaxation to reduce stress, both of which are elements of yoga. As yoga has become an increasingly popular form of exercise, it could be an important intervention for primary and secondary cardiovascular disease prevention. Evidence suggests that regular exercise can reduce the risk of death from cardiovascular disease, and it is beneficial when included in primary and secondary prevention strategies. This review assessed the effectiveness of yoga in reducing various cardiovascular risk factors (blood pressure, weight, body mass index, lipid profile, blood sugar). There is promising evidence that the practice of yoga improves cardiovascular health. Yoga practice length has a beneficial relationship with reducing the risk of сardiovascular diseases. Numerous studies used limited sample numbers, varied the forms and lengths of their yoga treatments, and omitted information on the processes behind change. The prevention and management of cardiovascular illnesses and associated risk factors, however, might be greatly aided by yoga. To even further understand the numerous possible mechanisms behind yoga’s effects, more research is necessary.

Reform of the Health Insurance Funding Model to Improve the Care of Noncommunicable Diseases Patients in Saudi Arabia.

Health insurance models are being considered as part of health system reforms in Saudi Arabia. This paper assesses the attributes of health funding models that support better control of non-communicable diseases (NCDs) and perspectives on health insurance as a model from the perspective of patients, clinicians, and managers. The study employed a mixed-methods research design that included quantitative and qualitative data gathering and analysis. Study findings indicated concerns that the current health funding mechanism is financially unsustainable and, as a result, there will be a greater reliance on personal health insurance to support government spending on healthcare. Essential elements of any health insurance model to support effective NCD management identified from a review of the literature and interviews include the following: ensuring continuity of care and equity; funding chronic disease prevention interventions; prioritising primary healthcare; and maintaining the principle of community rating to prevent insurers from discriminating against members. Other desirable attributes for the funding model includes collaboration across primary, secondary, and tertiary care. Healthcare finance reform aimed at adopting and increasing personal health insurance coverage may play a critical role in extending access to healthcare, eliminating health inequities, enhancing population health, and reducing government spending on healthcare if appropriately considered.

Risk Factors of Coronary Artery Disease: A Hospital-Based Study.

Coronary artery disease is among the leading cause of morbidity and mortality worldwide. There are limited scientific evidence on the risk factors for coronary artery disease specific to the Nepalese context. This study aimed to determine the association of various modifiable cardiovascular risk factors with coronary artery disease in Nepal. It is a hospital-based case-control study conducted among 300 participants. Case group comprised of 150 newly diagnosed coronary artery disease patients attending Manmohan Cardiothoracic Vascular and Transplant Centre while the Age and sex matched non-cardiac patients (n=150) from the outpatient department of the Department of General Practice and Emergency Medicine of Tribhuvan University Teaching Hospital were recruited as controls. Adjusted odds ratios (AOR) were calculated using multivariable logistic regression. Of the 300 participants, 208 (69.3%) were males and 92 (30.7%) were females. The mean age was 59.8 years ± 11 years (standard deviation). In multivariable analysis, current smoking (AOR=3.05, 95% CI: 1.61-5.78), hypertension (AOR=1.82, 95% CI: 1.08-3.09), diabetes (AOR=3.78, 95% CI: 1.91-7.47), family history of coronary artery disease (AOR=2.92, 95% CI: 1.27-6.71), and low high density lipoprotein (AOR= 2.0, 95% CI: 1.17-3.42) were significantly associated with coronary artery disease. Current alcohol use (AOR=0.51, 95% CI: 0.29-0.89) was identified as a protective factor for coronary artery disease. Among the modifiable cardiovascular risk factors, smoking, hypertension, diabetes, and low level of high density lipoprotein were significantly associated with coronary artery disease, which should be considered while developing public health interventions for cardiovascular disease prevention in Nepal in future.

An Academic-Community Engagement: A Roadmap for Developing a Culturally Relevant Diabetes Self-Management Program among Vietnamese Americans

Recognizing and addressing culture-specific differences concerning diabetes self-management education and support (DSMES) programs can potentially increase participation among Vietnamese Americans with type 2 diabetes and improve health outcomes. This paper describes the academic-community engagement process used to seek input from the Vietnamese community of Oklahoma to tailor a DSMES program. The Community Engagement Continuum (CEC) (CDC, 2011) was utilized as a conceptual framework to engage with the Vietnamese community. The academic team assembled a community advisory board (CAB) of stakeholders, who were selected to advise the team on intervention development; elicited community feedback; and integrated recommendations to tailor the DSMES program. Twenty-three CAB members participated in a minimum of three community engagement meetings over six months. Meetings were structured to elicit feedback and suggestions to ensure that the tailored program was embedded in Vietnamese cultural practices and accounted for community resources and needs. CAB members identified that education and resources must be provided in the Vietnamese language with special attention to culturally relevant adaptations concerning healthy eating and medication adherence. Application of the CEC framework facilitated the inclusion of Vietnamese community perspectives and beliefs, the identification of potential collaborators, the establishment of trust and relationships, and the development of a culturally relevant DSMES program. This engagement process may serve as a model for other underserved minority populations to develop culturally appropriate health promotion and disease prevention interventions.

Bridging Epidemiological Data with Features of the Urban Context: An experience of Urban Public Health within the City of Milan, Italy

Abstract Referring to the Research Project “Enhancing Healthcare and Well-Being Through the Potential of Big Data: An Integration of Survey, Administrative, and Open Data to Assess Health Risk in the City of Milan with Data Science” the Authors present preliminary results regarding a survey distributed to a sample of citizens across all neighborhoods of Milano city. This survey sought to collect data regarding health risk factors of this population, including both individual (e.g. socio-demographic characteristics, behaviors, etc.) and community (e.g. environmental/morphological features, available social services, etc.) data. A digital survey was designed to collect information on the health conditions, risk factors, and lifestyle characteristics of a representative sample of the Milanese population at the neighborhood level, with reference to the census tracts and Local Identity Units (NIL). Collected survey data are entered into a system containing corresponding individual health information acquired from the Local Health Authority databases, creating a synthesized information profile with each respondent's state of health, including existing conditions, health services used, and drug therapies. The disseminated survey was developed from comparisons with similar experiences at the national/international level and divided into 60 multiple choice questions (6 for Sociodemographic profile; 8 for Context of residence; 12 for Functional limitations; 25 for Behaviors and lifestyles; 9 for Access to health services). The data from urban analysis conducted on the NIL of the City of Milan are assessed with particular reference to the theme of bicycle-pedestrian accessibility (Walkability) in the urban context and repercussions on the adoption of Healthy Lifestyles. The models developed through this research are expected to provide critical insight for designing health promotion, health protection, and disease prevention interventions aimed both at individual and community level.

Prognostic impact of coronary artery calcifications in patients with newly diagnosed prostate cancer

Abstract Background Patients diagnosed with prostate cancer (PCa) are known to be at increased risk of cardiovascular events. Because of the ageing population and better cancer treatment, the number of these patients is increasing. A prostate-specific membrane antigen positron emission tomography (PSMA-PET) is guideline recommended as part of the diagnostic workup. This scan includes a non-ECG-gated computed tomography (CT) of the thorax, allowing assessment of coronary artery calcifications (CAC). It is not well-established, whether estimation of CAC based on this CT scan can identify patients with increased risk of major adverse cardiac events (MACE) and thus possibly improve therapy and prognosis. Purpose This study aims to assess CAC and evaluate whether high calcium scores predict the risk of MACE in patients newly diagnosed with PCa. Methods We identified 634 consecutive patients diagnosed with PCa and undergoing PSMA-PET from 2016 to 2019 in an area of 300.000 residents. In total, 63 patients were excluded due to prior revascularization. The remaining 571 patients (mean age 69.9±6.7 years) were included. Patients were followed until June 2021 or until an event occurred (mean follow-up 962±372 days). We used a standard cardiac CT software to assess CAC. Information on MACE defined as all-cause mortality, stroke and myocardial infarction were obtained from electronic patient files. We divided patients into five groups based on their coronary artery calcium score (CACS): 0–10, 11–99, 100–399, 400–999, and + 1000. Cox regression analysis was used to compute the hazard ratios (HR) for MACE with CACS 0–10 as reference while adjusting for age, hypertension diabetes, and treatment with aspirin and statins. Results We found a significantly increasing risk of MACE with increasing CACS after adjustment for risk factors. For CACS 100–399 (n=136): HR 2.10 (95% CI: 0.98–4.51, p=0.056), for CACS 400–999 (n=79): HR of 2.99 (95% CI: 1.35–6.59, p=0.007) and for CACS +1000 (n=150): HR 3.06 (95% CI: 1.37–6.85, p=0.006) (Figure 1). Cardiovascular disease prevention treatment with statins and aspirin was 53% and 16% in patients with CACS 400–999 and 52% and 19% in patients with CACS + 1000. Conclusion In patients with PCa, estimating coronary calcium score based on non-ECG-gated CT scans, which are performed as part of the diagnostic workup, predicts the occurrence of MACE. In the patient group with the highest CAC, a four-year event rate of 24% was found. In combination with the finding of infrequent use of statin and aspirin, this emphasizes the possibility of early detection of high CAC in patients with PCa and illustrates the potential for more extensive use of preventive treatment. Future studies should investigate the effect of preventive treatment being initiated in patients with PCa and high CAC. Funding Acknowledgement Type of funding sources: None.

Overview.

South Africa (SA) faces multiple health challenges. Quantifying the contribution of modifiable risk factors can be used to identify and prioritise areas of concern for population health and opportunities for health promotion and disease prevention interventions. To estimate the attributable burden of 18 modifiable risk factors for 2000, 2006 and 2012. Comparative risk assessment (CRA), a standardised and systematic approach, was used to estimate the attributable burden of 18 risk factors. Risk exposure estimates were sourced from local data, and meta-regressions were used to model the parameters, depending on the availability of data. Risk-outcome pairs meeting the criteria for convincing or probable evidence were assessed using relative risks against a theoretical minimum risk exposure level to calculate either a potential impact fraction or population attributable fraction (PAF). Relative risks were sourced from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study as well as published cohort and intervention studies. Attributable burden was calculated for each risk factor for 2000, 2006 and 2012 by applying the PAF to estimates of deaths and years of life lost from the Second South African National Burden of Disease Study (SANBD2). Uncertainty analyses were performed using Monte Carlo simulation, and age-standardised rates were calculated using the World Health Organization standard population. Unsafe sex was the leading risk factor across all years, accounting for one in four DALYs (26.6%) of the estimated 20.6 million DALYs in 2012. The top five leading risk factors for males and females remained the same between 2000 and 2012. For males, the leading risks were (in order of descending rank): unsafe sex; alcohol consumption; interpersonal violence; tobacco smoking; and high systolic blood pressure; while for females the leading risks were unsafe sex; interpersonal violence; high systolic blood pressure; high body mass index; and high fasting plasma glucose. Since 2000, the attributable age-standardised death rates decreased for most risk factors. The largest decrease was for household air pollution (-41.8%). However, there was a notable increase in the age-standardised death rate for high fasting plasma glucose (44.1%), followed by ambient air pollution (7%). This study reflects the continued dominance of unsafe sex and interpersonal violence during the study period, as well as the combined effects of poverty and underdevelopment with the emergence of cardiometabolic-related risk factors and ambient air pollution as key modifiable risk factors in SA. Despite reductions in the attributable burden of many risk factors, the study reveals significant scope for health promotion and disease prevention initiatives and provides an important tool for policy makers to influence policy and programme interventions in the country.

Demographic and cultural correlates of traditional eating among Alaska Native adults at risk for cardiovascular disease.

This cross-sectional study assessed how traditional eating relates to cultural and community factors. Alaska Native adults from the Norton Sound region were recruited and surveyed between 2015–2018 for a randomized clinical trial of multiple risk behavior change interventions for cardiovascular disease prevention. Participants (n = 291) were 49% female with a mean age of 47 years (SD = 14). A 34-item food frequency questionnaire assessed consumption of foods traditional and nontraditional to the regional Alaska Native diet. A novel measure, termed the “traditional foods index”, was computed as weekly servings of culturally traditional food consumption divided by total foods reported. Overall, the sample’s traditional foods index averaged 21%±16%, with higher values reported by participants assessed in summer (23%±17%) than winter (19%±15%, p<0.05); by women (22%±16%) than men (19%±16%, p < .05); and by residents of smaller communities (22%±17%) than the comparatively larger community of Nome (17%±14%, p<0.05). The traditional foods index was correlated with age (r = .26, p < .01), as well as the cultural variables of community connectedness (r = .19, p < .01), community standing (r = .15, p < .01), and traditional language comprehension (r = .19, p < .01). In a multivariate regression model, age, community connectedness, and community standing remained significantly associated with traditional diet. These findings may inform the design and evaluation of community-based, culturally-relevant dietary initiatives for heart health.

Pharmacogenetic Biomarkers and Personalized Medicine: Upcoming Concept in Pharmacotherapy

Pharmacogenomics is the study of an individual's response to drugs as a result of their genetic makeup. Pharmacogenomics has been merged with pharmacology and genomics to produce safe and effective drugs that are customized to the unique genetic profile of each individual. Drug prescribing focused on pharmacogenomics opens up a modern avenue for developing and prescribing safe and efficient drugs to specific patients. Patients that are prescribed medications that are more appropriate to them based on their physiology and lifestyle characteristics are referred to as obtaining personalized medicine. The medicinal use of molecularly targeted agents, which are commonly used for customized therapies, could aid in disease detection in a small number of patients. To assess the advantage of selected patients with genomic changes to a given treatment, clinical trial research designs for different diagnostics and therapeutics must aim for rate-limiting steps. Precision medicine techniques are used to classify specific patients' genetic flaws in the hopes of identifying new disease-prevention treatments. Precision medicine, on the other hand, is more precise in clinical practice, with an emphasis on identifying new therapeutic targets, recent advances in molecular testing trials, and a variety of advanced approaches are available for collecting biological samples in clinical practice to conduct genomic processing. Pharmacogenomics biomarkers use customized drugs to anticipate the incidence of diseases in the future. Individual precision medicine can overcome the limitations of traditional medicine in terms of disease prevention.

High impact health service interventions for attainment of UHC in Africa: A systematic review.

African countries have prioritized the attainment of targets relating to Universal Health Coverage (UHC), Health Security (HSE) and Coverage of Health Determinants (CHD)to attain their health goals. Given resource constraints, it is important to prioritize implementation of health service interventions with the highest impact. This is important to be identified across age cohorts and public health functions of health promotion, disease prevention, diagnostics, curative, rehabilitative and palliative interventions. We therefore explored the published evidence on the effectiveness of existing health service interventions addressing the diseases and conditions of concern in the Africa Region, for each age cohort and the public health functions. Six public health and economic evaluation databases, reports and grey literature were searched. A total of 151 studies and 357 interventions were identified across different health program areas, public health functions and age cohorts. Of the studies, most were carried out in the African region (43.5%), on communicable diseases (50.6%), and non-communicable diseases (36.4%). Majority of interventions are domiciled in the health promotion, disease prevention and curative functions, covering all age cohorts though the elderly cohort was least represented. Neonatal and communicable conditions dominated disease burden in the early years of life and non-communicable conditions in the later years. A menu of health interventions that are most effective at averting disease and conditions of concern across life course in the African region is therefore consolidated. These represent a comprehensive evidence-based set of interventions for prioritization by decision makers to attain desired health goals. At a country level, we also identify principles for identifying priority interventions, being the targeting of higher implementation coverage of existing interventions, combining interventions across all the public health functions-not focusing on a few functions, provision of subsidies or free interventions and prioritizing early identification of high-risk populations and communities represent these principles.

Scaling Interventions to Manage Chronic Disease: Innovative Methods at the Intersection of Health Policy Research and Implementation Science

Policy implementation is a key component of scaling effective chronic disease prevention and management interventions. Policy can support scale-up by mandating or incentivizing intervention adoption, but enacting a policy is only the first step. Fully implementing a policy designed to facilitate implementation of health interventions often requires a range of accompanying implementation structures, like health IT systems, and implementation strategies, like training. Decision makers need to know what policies can support intervention adoption and how to implement those policies, but to date research on policy implementation is limited and innovative methodological approaches are needed. In December 2021, the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness and the Johns Hopkins Center for Mental Health and Addiction Policy convened a forum of research experts to discuss approaches for studying policy implementation. In this report, we summarize the ideas that came out of the forum. First, we describe a motivating example focused on an Affordable Care Act Medicaid health home waiver policy used by some US states to support scale-up of an evidence-based integrated care model shown in clinical trials to improve cardiovascular care for people with serious mental illness. Second, we define key policy implementation components including structures, strategies, and outcomes. Third, we provide an overview of descriptive, predictive and associational, and causal approaches that can be used to study policy implementation. We conclude with discussion of priorities for methodological innovations in policy implementation research, with three key areas identified by forum experts: effect modification methods for making causal inferences about how policies’ effects on outcomes vary based on implementation structures/strategies; causal mediation approaches for studying policy implementation mechanisms; and characterizing uncertainty in systems science models. We conclude with discussion of overarching methods considerations for studying policy implementation, including measurement of policy implementation, strategies for studying the role of context in policy implementation, and the importance of considering when establishing causality is the goal of policy implementation research.

The Meaning of "Hygiene" and Its Linked Practices in a Low-Income Urban Community in Bangladesh.

Improving hygiene practices is considered to be the single most cost-effective means of reducing the global health burden of infectious diseases. Hygiene promotion and disease prevention interventions often portray and promote “hygiene” from a biomedical perspective, which may not be optimally effective for achieving their goal of changing people’s behaviors. This study aimed to educe the meaning of hygiene for the residents of a low-income community in Bangladesh and how that meaning shapes their personal hygiene practices. We conducted this study in the Tongi township in Dhaka, Bangladesh, from September 2014 to June 2016. The research team purposively selected 24 households. The team conducted day-long observations using the participant observation approach and in-depth interviews with specific members of the 24 households. The concept of “hygiene” had two separate meanings to the study participants: cleanliness and holiness. The participants reported that cleanliness was required to remove odors, grease, hot spices and dirt. The motivation for cleanliness was to feel fresh, avoid heavy feelings, feel light and feel comfortable. To maintain the holiness of the body, bathing and ablution needed to be performed following particular religious rules/rituals. The motivation of holiness was derived from their accountability to God. The participants also reported that the cleansing processes and methods for the body and the home for cleanliness reasons were also different from those for holiness reasons. The notion of “hygiene” was multidimensional for the residents of the low-income urban community in Bangladesh. Our study participants did not explicitly conceptualize a notion of hygiene that was based on the germ theory of diseases but rather a notion that was based on individual physical comfort and cultural belief systems. Future studies on the prevention of hygiene-related diseases should combine and link the biomedical aspect to religious and cultural rituals to promote improved hygiene practices.

Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review.

While the evidence for the clinical effectiveness of most noncommunicable disease (NCD) prevention and treatment interventions is well established, care delivery models and means of scaling these up in a variety of resource-constrained health systems are not. The objective of this review was to synthesize evidence on the current state of implementation research on priority NCD prevention and control interventions provided by health systems in low- and middle-income countries (LMICs). On January 20, 2021, we searched MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the World Health Organization (WHO) priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Given the focus on this review and the heterogeneity in aims and methodologies of included studies, risk of bias assessment to understand how effect size may have been compromised by bias is not applicable. We instead commented on the distribution of research designs and discussed about stronger/weaker designs. We synthesized extracted data using descriptive statistics and following the review protocol registered in PROSPERO (CRD42021252969). Of 9,683 potential studies and 7,419 unique records screened for inclusion, 222 eligible studies evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries). The number of studies published has been increasing over time. Nearly 40% of all the studies were on cervical cancer. With regards to intervention type, screening accounted for 49%, treatment for 39%, while prevention for 12% (with 80% of the latter focusing on prevention of the NCD behavior risk factors). Feasibility (38%) was the most studied implementation outcome followed by adoption (23%); few studies addressed sustainability. The implementation strategies were not specified well enough. Most studies used quantitative methods (86%). The weakest study design, preexperimental, and the strongest study design, experimental, were respectively employed in 25% and 24% of included studies. Approximately 72% of studies reported funding, with international funding being the predominant source. The majority of studies were proof of concept or pilot (88%) and targeted the micro level of health system (79%). Less than 5% of studies report using implementation research framework. Despite growth in implementation research on NCDs in LMICs, we found major gaps in the science. Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.

Targeted faith-based and faith-placed interventions for noncommunicable disease prevention and control in low- and middle-income countries: a systematic review protocol

BackgroundLow- and middle-income countries (LMICs) bear a disproportionately high burden of noncommunicable diseases (NCDs) with severe socioeconomic consequences. Targeted interventions that are faith-based or take place in faith-based settings are historically viable for health promotion and disease prevention programmes. However, evidence of their effectiveness often comes from high-income countries. This paper outlines the protocol for the systematic review of faith-based and faith-placed interventions for NCDs in low- and middle-income countries.ObjectiveTo determine the effectiveness of faith-based and faith-placed interventions or interventions within faith-based settings targeted at NCDs and/or their risk factors in LMICs.MethodsWe will conduct a systematic search of PubMed, Embase, Scopus, WHO Library, and grey literature to locate published and unpublished studies. We will consider quantitative studies that report on interventions (a) with faith-based components or that take place in faith-based settings (b) for the prevention and control of one or more of the top ten NCDs listed in the Global Burden of Disease or their known risk factors (c) occurring among adults aged 18 and above (d) that take place in one or more LMICs.We will screen the titles, abstracts, and full text of articles for eligibility. Included articles will be critically appraised for quality and the inclusion of faith-based components by at least two independent reviewers. Data extraction will be performed for study characteristics and findings. A meta-analysis will be used to synthesize the results; if impossible, a narrative synthesis will be performed.DiscussionThis review will attempt to synthesize up-to-date evidence to guide effective decision-making, allocation of health resources, and the design of future trials to test the efficacy of NCD interventions in faith-based settings. The study will increase the understanding of the existing evidence, highlight the need for additional evidence, and guide possible directions for future collaborations between public health professionals and faith-based health service providers.Systematic review registrationPROSPERO CRD42020186299

Changes in the spectrum of kidney diseases: a survey of 2803 patients from 2010 to 2018 at a single center in southeastern China

Primary glomerular disease was the leading cause of chronic kidney disease (CKD) in China; however, changes in the economy and environment introduce variations in the spectrum of kidney diseases. This study aimed to analyze renal biopsy data to inform disease prevention and public health interventions. In this retrospective cohort study, data from 2,803 consecutive renal biopsies conducted at our center between January 2010 and December 2018 were analyzed. The sample was disaggregated by age and the date of biopsy to facilitate analysis. Primary glomerulonephritis (PGN) is the most frequent (81.84%) finding, followed by secondary glomerulonephritis (SGN; 15.38%), tubulointerstitial nephritis (15.38%), and others (1.57%). IgA nephropathy (IgAN), idiopathic membranous nephropathy (iMN), and minimal change disease were the primary causes of PGN. Among PGN cases, the incidence of iMN arose, especially among those aged ≥ 60 years old, during the observation period. Contrary to the case of iMN, the proportion of IgAN in PGN trended downward, continuously, and at length. Moreover, IgAN mainly affected those aged 25–44 years old and less so those aged ≥ 60 years old. Lupus nephritis, Henoch–Schönlein purpura nephritis, and diabetic nephropathy (DN) were key causes of SGN. A ratio reversal between infectious disease and chronic disease dramatically changed SGN patterns. In the past year, the incidence of hepatitis B–related nephritis has constantly declined; however, the proportion of DN among SGN had steadily increased. The incidence of iMN significantly increased during these years. Among SGN cases, the proportion of DN has increased.