Double Burden Research Articles

Combined effect of inflammation and malnutrition for long-term prognosis in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a cohort study

BackgroundInflammation is a key driver of atherosclerotic diseases and is often accompanied by disease-related malnutrition. However, the long-term burden of dysregulated inflammation with superimposed undernutrition in patients with acute coronary syndrome (ACS) remains unclear. This study sought to investigate the double burden and interplay of inflammation and malnutrition in patients with ACS undergoing percutaneous Coronary Intervention (PCI).MethodsWe retrospectively included 1,743 ACS patients undergoing PCI from June 2016 through November 2017 and grouped them according to their baseline nutritional and inflammatory status. Malnutrition was determined using the nutritional risk index (NRI) with a score lower than 100 and a high-inflamed condition defined as hs-CRP over 2 mg/L. The primary outcome was major adverse cardiovascular events (MACEs), compositing of cardiac mortality, non-fatal myocardial infarction, non-fatal stroke, and unplanned revascularization. Long-term outcomes were examined using the Kaplan-Meier method and compared with the log-rank test. Multivariable Cox proportional hazards regression analysis was applied to adjust for confounding. The reclassification index (NRI)/integrated discrimination index (IDI) statistics estimated the incremental prognostic impact of NRI and hs-CRP in addition to the Global Registry of Acute Coronary Events (GRACE) risk score.ResultsDuring a median follow-up of 30 months (ranges 30–36 months), 351 (20.1%) MACEs occurred. Compared with the nourished and uninflamed group, the malnourished and high-inflamed group displayed a significantly increased risk of MACEs with an adjusted hazard ratio of 2.446 (95% CI: 1.464–4.089; P < 0.001). The prognostic implications of NRI were influenced by patients’ baseline inflammatory status, as it was only associated with MACEs among those high-inflamed (P for interaction = 0.005). Incorporating NRI and hs-CRP into the GRACE risk score significantly improved its predictive ability for MACEs (NRI: 0.210, P < 0.001; integrated discrimination index; IDI: 0.010, P < 0.001) and cardiac death (NRI: 0.666, P < 0.001; IDI: 0.023, P = 0.002).ConclusionsAmong patients with ACS undergoing PCI, the double burden of inflammation and malnutrition signifies poorer outcomes. Their prognostic implications may be amplified by each other and jointly improve the GRACE risk score’s risk prediction performance.

High Gastric Cancer Mortality and Years of Life Lost in Nicaragua: A Population-Based Study 1997 to 2012.

Gastric adenocarcinoma is the fourth leading cause of cancer-related mortality and leading infection-associated cancer. Gastric adenocarcinoma has striking geographic variability, with high incidence in East Asia and mountainous Latin America. Reliable cancer data and population-based cancer registries are lacking for the majority of low- and middle-income countries, including the Central American Four region (CA-4, Nicaragua, El Salvador, Honduras, and Guatemala). Mortality data for Nicaragua were obtained from the highly rated Ministry of Health death registry. All the patients were diagnosed with gastric cancer between 1997 and 2012 (ICD-10 codes, C16.0-C16.9) and death due to any cause were included in the study. Data on variables such as sex, age (stratified by 5-year age groups), municipality, urban/rural, altitude, and year of death were analyzed. A total of 3,886 stomach cancer deaths were reported in Nicaragua between 1997 and 2012, of which 2,214 (56.9%) were male. The age-standardized mortality rates were 13.1 and 8.7 per 100,000 habitants for males and females, respectively, and without significant change during the study period (annual percentage change = -0.7, P = 0.2). An average of 17.9 years were lost per death, accounting for 67,964 years of life lost (YLL). The burden of gastric cancer mortality is high in Nicaragua with a significantly elevated age-standardized mortality rate, YYL, and average YLL. The projected increase in mortality portends the double cancer burden in northern Central America, with persistent infection-associated cancers and growing transition cancers (e.g., breast and colon cancers), which has implications for cancer control in Mesoamerica and US Latino populations. See related commentary by Riquelme and Abnet, p. 1550.

Double burden of malnutrition among young adult female (18-25 years) of West Bengal, India

Globally, malnutrition affects approximately one-third of the population, manifesting in various forms of undernutrition and overnutrition. This issue is particularly prevalent in developing countries, posing significant health concerns for female. To address this, the present study was undertaken to evaluate the nutritional status and related factors among female in Paschim Medinipur District and North 24 Pargana District of West Bengal, India. This cross-sectional study was conducted involving 337 females selected through a simple random sampling technique with proportional allocation. Data collection utilized a self-administered questionnaire. Nutritional status was determined based on the World Health Organization (WHO) cut off points for underweight and overweight. Statistical significance was set at a p&lt;0.05. The study revealed that 16.91% of participants were underweight and 17.80% were classified as overweight or obesity. A significant association (χ2=28.400; p&lt;0.01) was noted between monthly family income (MFI) group and nutritional status among the participants. The BMI of the participants were significantly different (F= 5.791; p&lt;0.001) in varied MFI group. It was observed that age of the participants was significantly correlated with weight (r=0.360; p&lt;0.01), height (r=0.294; p&lt;0.01) and BMI (r=0.257; p&lt;0.01). The present study clearly documented that age of the female and family income had significant influence on the nutritional status of the young adult female and more than one-third of participants were suffering from double burden of malnutrition.

Breast cancer in women by HIV status: A report from the South African National Cancer Registry.

Breast cancer (BC) is the leading cause of cancer-related morbidity and mortality in women living in South Africa, a country with a high HIV burden. However, characteristics of the double burden of HIV and BC in South Africa have not been properly investigated. We described characteristics of BC cases by HIV status in South Africa. In this nationwide South African study, we obtained BC records for women aged ≥15 years diagnosed in the public health sector between January 2004 and December 2014. We included records from the National Cancer Registry that had been linked to HIV-related laboratory records from the National Health Laboratory Service. We assessed the odds of being HIV positive versus HIV negative in relation to patient-, cancer-, and municipality-related characteristics. From 2004-2014, 40 520 BC cases were diagnosed in women aged ≥15 years. Of these, 73.5% had unknown HIV status, 18.7% were HIV negative, and 7.7% were HIV positive. The median age at BC diagnosis was 43 years (interquartile range [IQR]: 37-52) in HIV positive and 57 years (IQR: 46-68) in HIV negative women, respectively. The odds of being HIV positive was higher for women who were aged 30-34 years compared to women aged 35-39 years at cancer diagnosis (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.10-1.71), Black versus non-Black (OR 6.41, 95% CI 5.68-7.23), diagnosed with cancer in rural versus urban areas (OR 1.59, 95% CI 1.40-1.82) and diagnosed in municipalities with low and middle (OR 3.46, 95% CI 2.48-4.82) versus high socioeconomic position (OR 2.69, 95% CI 2.11-3.42). HIV status was unknown for the majority of BC patients. Among those with known HIV status, being HIV positive was associated with a younger age at cancer diagnosis, being Black and receiving care in municipalities of poor socioeconomic position. Future studies should examine opportunities to integrate HIV and BC control programs.

Sociodemographic, nutritional and anthropometric factors determining overweight and obesity in an adult moroccan population

BACKGROUND: Knowledge of the determinants of the weight status of a population is important to be considered in actions aimed at improving public health. OBJECTIVE: The aim was to study the sociodemographic, nutritional and anthropometric factors associated with overweight and obesity in an adult Moroccan population. METHODS: This study focused on 507 adult subjects from the Rabat-Salé-Kénitra region in Morocco, according to a validated conceptual and methodological framework. Sociodemographic data were collected using a questionnaire, physical activity (PA) was assessed by the Marshal questionnaire, dietary intakes were estimated by a “dietary history” type survey. Anthropometric parameters were also measured using impedancemetry and a tape measure. RESULTS: The majority of the study population was 20 to 29 years old, females, urban and had an medium socio-economic level (SEL). The population’s dietary intake was high in calories, proteins, carbohydrates, fats, sugars, and sodium; and low in vitamin C, vitamin A, vitamin E, folic acid, iron, calcium and zinc. Univariate analysis revealed that overweight and obesity are associated with the 30–39 yrs age group, average SEL, insufficient PA, high intakes of calories, proteins, carbohydrates and lipids, as well as with high waist circumference and excessive body fat percentage. CONCLUSION: Factors associated with overweight and obesity were identified in the study population, revealing a coexistence of high intakes of energy and macronutrient and low intake of several micronutrients. The prevalence of deficiencies and excesses of these intakes testifys of a double burden of malnutrition in this population. The results are very relevant for guiding nutritional education actions among this population.

Mixed methods study on latent tuberculosis among agate stone workers and advocacy for testing silica dust exposed individuals in India

The 2021 tuberculosis (TB) preventive treatment guidelines in India included silicosis as a screening group, yet latent TB infection (LTBI) testing for silica-dust-exposed individuals is underemphasized. Focusing on an estimated 52 million silica-dust-exposed workers, particularly agate-stone workers in Khambhat, Gujarat, our study aims to estimate LTBI prevalence, identify predictors, and gather insights from TB and silicosis experts. Employing a sequential explanatory mixed-methods approach, a cross-sectional study involved 463 agate-stone workers aged ≥ 20 years in Khambhat, using IGRA kits for LTBI testing. In-depth interviews with experts complemented quantitative findings. Among agate-stone workers, 58% tested positive for LTBI, with predictors including longer exposure, type of work, and BCG vaccination. Our findings reveal a nearly double burden of LTBI compared to the general population, particularly in occupations with higher silica dust exposure. Experts advocate for including silica-dust-exposed individuals in high-risk groups for LTBI testing, exploring cost-effective alternatives like improved skin sensitivity tests, and shorter TB preventive treatment regimens to enhance compliance. Future research should explore upfront TB preventive treatment for silica-dust-exposed individuals with high LTBI prevalence and optimal exposure duration. This study underscores the urgent need for policy changes and innovative approaches to TB prevention among silica-dust-exposed populations, impacting global occupational health strategies.

Analisis Sistem Pemilu Proporsional Dan Dampaknya Terhadap Representasi Politik Perempuan di Indonesia

This research highlights the importance of women's representation in the legislature as an indicator of the quality of democracy in Indonesia. Although regulations set a minimum quota of 30% women's representation, the realization is still low with a projection of only 22.1% of women elected in the 2024 DPR. The open proportional electoral system provides opportunities but also presents challenges, such as money politics and patriarchal culture. Internal factors such as lack of confidence and double burden, as well as external factors such as political violence and lack of support from parties, hinder women in politics. To increase this representation, strategies such as gender mainstreaming in political communication, effective affirmative action, and inclusive political education are needed. These efforts aim to create a more inclusive and gender-equal parliament, supporting women's role in public policy-making.

Association between meal skipping and the double burden of malnutrition among university students

Background: The study delves into the nuanced relationship between meal skipping and the double burden of malnutrition among university students. It addresses a critical gap in understanding how young adults' irregular dietary patterns contribute to undernutrition and overnutrition, phenomena typically studied in isolation. Aims: This research aimed to shed light on the broader implications of meal skipping within the context of student health and well-being. Subjects and Methods: The study surveyed a representative sample of undergraduate students from various academic disciplines at Lead City University in Ibadan, Nigeria, utilizing a descriptive cross-sectional approach. Detailed questionnaires were administered to assess the frequency of meal skipping, dietary habits, and associated lifestyle factors. Body mass index (BMI) and self-reported health data were also collected. Statistical analyses, including univariate and bivariate analysis, were employed to identify the nutritional status and meal patterns of the students, Principal component analysis was employed to identify the dietary patterns prevalent among the students from the food frequency questionnaire administered. Results: The findings reveal a significant correlation between meal skipping and the risk of undernutrition and overnutrition. Students who regularly skip meals are likely at an increased risk of undernutrition, characterized by lower BMI and potential micronutrient deficiencies, and overnutrition, indicated by higher BMI and associated health risks. This dual risk factor challenges existing perceptions of nutrition among young adults, suggesting that meal skipping can be a critical determinant of diverse and complex nutritional outcomes. Conclusion: The study highlights the urgent need for comprehensive nutritional strategies at university campuses, focusing on educating students about the risks associated with inconsistent eating patterns. It calls for implementing targeted interventions and policy changes to address the double burden of malnutrition, promoting healthier lifestyles, and preventing long-term health issues among university students. Keywords: Meal skipping, double burden of malnutrition, university students, nutritional status, dietary patterns, public health interventions, young adult health.

Overweight and obesity trends and associated factors among reproductive women in Ethiopia

ABSTRACT Background In low- and middle-income countries, the double burden of malnutrition is prevalent. Many countries in Africa are currently confronted with overweight and obesity, particularly among women, coupled with an increase in the prevalence of non-communicable diseases. Objective This study examines trends in overweight and obesity among Ethiopian women of reproductive age from 2005 to 2016, and identifies associated factors. Methods We used three consecutive datasets from 2005 (n = 14070), 2011 (n = 16515), and 2016 (n = 15683) demographic health survey years. Multilevel logistic regression was used to identify the determinant factors among individual- and cluster-level variables. Results The prevalence of overweight and obesity among reproductive women in Ethiopia increased steadily from 6.09% in 2005 to 8.54% in 2011, and 10.16% in 2016. However, mixed patterns were observed among the regions of the country. We found that age, education, living in urban areas, and living in a rich community are associated with becoming overweight and obese. For instance, the odds of becoming overweight and obese among women aged 35–49 were higher than those among women aged 15–24 (odds ratio [OR] = 3.62, 95% Confidence Interval [CI]:2.64–4.97). Women who completed secondary school have higher odds than those without formal education (OR = 1.64, 95% CI:1.19–2.26). Conclusion To our knowledge, this is the first study to investigate trends in the nationwide prevalence of overweight and obesity and the associated factors among Ethiopian women. This study warrants further follow-up research to identify the pathways between overweight and obesity and their probable factors.

Double loading of nickel phosphide surface for efficient hydrogen evolution reaction

Metal phosphide, as a highly conductive, chemically stable catalyst material, modulating its hydrogen adsorption is crucial to enhance hydrogen evolution reaction (HER) activity. In this study, we propose a double loading strategy to build Ag and AgP2 heterogeneous structures on Ni2P nanosheets (Ag-AgP2/Ni2P). This is the first application of AgP2 materials in HER. This innovative synthesis was achieved by liquid-phase adsorption of precursors and heat-treatment phosphorization, surface adsorbed AgNO3 is converted to Ag-AgP2 double loading at the same time as Ni2P formation. Density functional theory (DFT) calculations reveal that the double loading structure optimizes charge distribution and d-band center. Its hydrogen adsorption free energy is closer to electroneutrality than that of single loading and simple heterostructures. Benefiting from the special structure, Ag-AgP2/Ni2P exhibits excellent HER performance in alkaline media, requiring only 78 mV overpotential to reach 10 mA cm−2 and stability up to 200 h. This dual loading strategy broadens the perspective of heterogeneous electrocatalyst development.

Bentuk Ketidakadilan Gender dalam Novel Lebih Senyap dari Bisikan Karya Andina Dwifatma

The basis of this research is to analyze the forms of gender inequality and the main character's efforts to confront these inequalities in the novel Lebih Senyap dari Bisikan. This study employs a qualitative approach by analyzing narrative texts within the story. The data for this research consists of textual excerpts containing instances of gender inequality in the novel Lebih Senyap dari Bisikan. The primary data source is the novel Lebih Senyap dari Bisikan by Andina Dwifatma, which comprised 155 pages and was published by PT Gramedia Pustaka Utama Jakarta in June 2021. The data collection was conducted through library research and note-taking methods. Data analysis procedures for this research involved three phases: data reduction, data presentation, and conclusion. The results of this research indicated various forms of gender inequality in the novel Lebih Senyap dari Bisikan, including (1) marginalization, (2) subordination, (3) stereotypes, (4) violence, and (5) double burden, also the main character's efforts to confront gender inequality are carried-out through seeking power and acquiring strength.

Literature Review: Impact of the Double Burden Malnutrition

Double burden of nutrition is a nutritional problem where undernutrition and overnutrition occur together. It might happen at the level of the individual, the household, and the population. This article’s goal is to acertain how double burden of nutrition affects health, economy, and productivity. The literature review approach was used to construct this paper, results were sourced from the Google Scholar database and then selected and examined more deeply the findings. The findings of this literature review highlight the effects of the health aspect which include the emergence of infectious, chronic diseases, and cognitive impairment; the economic aspect which leads in poverty and difficulty in finding employment opportunities; and the aspect of the country's productivity will decrease.

Prevalence and associations between micronutrient deficiencies and growth indicators of 10-18-year-old female adolescents living in Vietnam

Although in recent decades progress has been made in reducing the global burden of micronutrient deficiencies (MNDs), nonetheless MNDs prevalence remains high in some populations(1). Among the micronutrients, deficiencies in iron, zinc and vitamin A are particularly prevalent, and causally associated with adverse health outcomes for children and adolescents. The aim of this study was to examine the prevalence and associations between MNDs and components of the double burden of malnutrition in female adolescents utilizing the nationally representative Vietnam General Nutrition Survey 2020.1,471 female adolescents were included and categorised into: pre-adolescent (10-12-year-old), middle-adolescent (13-15-year-old), and late-adolescent (16-18-year-old) groups. Biomarkers of micronutrients, anthropometry, and sociodemographic data were selected for analyses. WHO growth reference values were applied to define stunting (height-for-age z-score (HAZ) &lt; −2 SD), thinness (BMI-for-age z-score (BAZ) &lt; −2 SD) and overweight (BAZ &gt; 1). Iron deficiency was defined as serum ferritin&lt;15μg/L (&lt;70 μg/L for individuals with inflammation), vitamin A insufficiency (VAI) as serum retinol&lt;1.05 μmol/L, zinc deficiency was based on Zinc International Consultative Group Recommendation, and inflammation as C-reactive protein &gt;5 mg/L or α1-acid glycoprotein &gt;1 g/L. One or multiple MNDs were defined as individuals with ≥ 1 MNDs.Data were analysed by STATA 17 (STATA Corporation, US). Descriptive and logistic regression analyses were performed based on the sampling weight adjustments for the estimation at population level. Multivariate logistic regressions between MNDs and growth indicators were presented as crude (COR) and 95% confidence intervals or adjusted odds ratio (AOR), after adjusting for sociodemographic variables (age, ecological area, demographic, ethnicity, and wealth index) and inflammation.Compared to the pre-adolescent group, prevalence of stunting doubled in late adolescence (12.4% to 26.8%). Meanwhile, the prevalence of overweight and thinness decreased with age (29.7% to 22.0% and 9.4% to 2.7%, respectively). Overall, the prevalence of MNDs increased with age. Zinc deficiency occurred most often in the entire cohort (39.8% in 10-18) and contributed the most to multi-MNDs. Prevalence of one or multiple MNDs increased with age, from 58.1% in pre-adolescence to 80% in late adolescence. In logistic regression analyses adjusting for inflammation and sociodemographic factors, stunting increased the risk of having ≥1 MNDs (AOR: 1.94 (1.3, 2.88), p=0.002), but not individual MND alone. Thinness increased the risk of VAI (AOR: 2.38 (1.34, 4.22), p=0.005). No association was found between any MND and overweight, although overweight was protective against zinc deficiency (COR: 0.76 (0.59, 0.99), p=0.04) in the unadjusted model.Female late adolescents in Vietnam had a higher prevalence of stunting and MNDs, but lower prevalence of thinness and overweight in comparison to pre-adolescents. Stunting was a risk factor associated with having one or multiple MNDs. Thinness was associated with higher risk of VAI. No association was found between overweight and MNDs in this cohort.

Double Burden of Malnutrition among Women of Reproductive Age and Its Associated Factors in Makassar District

Double Burden of Malnutrition among Women of Reproductive Age and Its Associated Factors in Makassar District

The association between parenthood and health: A comparison of people in same-sex and different-sex relationships

Understanding social inequalities in parental health is crucial for family functioning and child development. Theoretically, the double burden of parenting and minority stress may lead to the negative association between parenthood and health outcomes being stronger for people in same-sex relationships. Moreover, drawn from the social control process and the compensation mechanism, the negative association between parenthood and health risk behaviors may become stronger for people in same-sex relationships. Yet, empirical evidence on parental health disparities between parents in same- and different-sex relationships is limited. Using linear and logistic regression models, coarsened exact matching, and entropy balancing on Dutch data between 2008 and 2021 (196 people in same-sex relationships and 6948 people in different-sex relationships), we investigate the relationship between parenthood and three health outcomes (self-rated health, physical health, and mental health) and two health risk behaviors (smoking and heavy episodic drinking). We find that parents on average are less likely to experience heavy episodic drinking than non-parents. The association between parenthood and health does not differ between people in same-sex and different-sex relationships.

Cardiovascular Dynamics in HIV: The Influence of Adrenal Function and Nutritional Status.

This interdisciplinary review explores the intricate nexus between HIV infection, nutrition, adrenal gland function, and cardiovascular health, highlighting a critical aspect of HIV management often overlooked in current literature. With the advent of antiretroviral therapy, the life expectancy of people living with HIV has dramatically improved, transforming HIV into a manageable chronic condition. However, this success brings forth new challenges, notably an increased risk of cardiovascular diseases among people living with HIV. We examine the normal physiology of the adrenal gland, including its role in mineral metabolism, a crucial facet of nutrition. We discuss the evolution of knowledge tying adrenal pathology to cardiovascular disease. We explore the impact of HIV on adrenal gland findings from a gross pathology perspective, as well as the clinical impact of adrenal insufficiency in HIV. The review further elucidates the role of nutrition in this context, considering the double burden of undernutrition and obesity prevalent in regions heavily affected by HIV. By aggregating findings from longitudinal studies and recent clinical trials, the review presents compelling evidence of increased cardiovascular disease among people living with HIV compared with people without HIV. It highlights the critical role of the adrenal glands in regulating nutrient metabolism and its implications for cardiovascular health, drawing attention to the potential for dietary interventions and targeted therapies to mitigate these risks. This review urges a paradigm shift in the management of HIV, advocating for a holistic approach that incorporates nutritional assessment and interventions into routine HIV care to address the complex interplay between HIV, adrenal function, and cardiovascular health. Through this lens, we offer insights into novel therapeutic strategies aimed at reducing cardiovascular risk in people living with HIV, contributing to the ongoing efforts to enhance the quality of life and longevity in this population.

Prevalence of the Double Burden of Malnutrition among Adolescents: Associations with Lifestyle Behaviors and Clusters of Social Determinants.

The double burden of malnutrition (DBM) is a condition in which malnutrition coexists with overweight, reflecting a new layer of malnutrition. Our objectives were to assess prevalence; test associations between DBM and 24-hour movement behaviors; and investigate whether DBM is associated with clusters of social determinants. Methods: This multicenter cross-sectional study included 1152 adolescents (12 to 17 years old) from four Brazilian cities. Body mass index (BMI, kg/m2) was used to estimate overweight, and the adopted cutoff points took into account the curves established for age and sex: Z-score > 1 and ≤2 (overweight) and Z-score > 2 (obesity). The serum concentration of 25-hydroxyvitamin D [25(OH)D] was stratified into three levels: vitamin D deficiency ≤ 20 ng/mL; vitamin D insufficiency = 21-29 ng/mL; optimal vitamin D ≥ 30 ng/mL. We used multilevel Poisson regression models to estimate prevalence ratios (PRs) and their respective 95% confidence intervals (95%CI) and to analyze the association between DBM and covariates. A significance level of p < 0.05 was considered. Cluster analyses were performed by applying a combination of hierarchical and non-hierarchical methods. Results: A population prevalence of DBM of 7.3% (95% CI: 5.9-8.9) was revealed. A percentage of 19.2% (95% CI: 17.0-21.6) of adolescents were overweight, and 8.3% (95% CI: 6.8-10.1) were obese. A total of 41.5% (95% CI: 38.7-44.4) had vitamin D deficiency, and 25.8% (95% CI: 23.4-28.4) had vitamin D insufficiency. However, 24-hour movement behaviors were not associated with DBM. Adolescents living in the southern region of the country, from public schools whose mothers have higher education, have a 1.94 [PR = 2.94 (95% CI: 1.20-7.23)] times greater chance of developing DBM. These results highlight the importance of specific factors to improve the nutritional health of adolescents, considering the specific social determinants identified in this study.

Identifying priority double-duty actions to tackle the double burden of malnutrition in infants and young children in Peru: Assessment and prioritisation of government actions by national experts.

Multiple forms of malnutrition coexist in infants and young children (IYC) in Peru. The World Health Organization has proposed double-duty actions (DDAs) to simultaneously address undernutrition and overweight/obesity. We assessed current implementation of- and priority for- government-level actions to tackle multiple forms of malnutrition in IYC in Peru. Mapping of current policy activity was undertaken against 47 indicators of good practice for five DDAs (exclusive breastfeeding, complementary feeding, food marketing, maternal nutrition, preschool nutrition; assessed by 27 indicators) and for the enabling policy environment, i.e., 'infrastructure support' (health in all policies, platforms for interactions, financing, monitoring, governance, leadership; assessed by 20 indicators). Interviews with 16 national experts explored views on the level of and barriers to implementation of DDAs and infrastructure support, as well as their prioritisation based on likely impact and feasibility. The level of implementation of actions was categorised into two groups (agenda setting/formulation vs. implementation/evaluation). Mean scores were generated for prioritisation of DDAs and infrastructure support. Deductive qualitative analysis was undertaken to identify barriers that influence policy implementation. Only 5/27 DDA indicators were reported as fully implemented by all national experts (international code that regulates the marketing of breastmilk substitutes, iron supplementation for IYC, micronutrient powders in IYC, iron/folic acid supplementation in pregnant women, paid maternity leave). Only 1/20 infrastructure support indicator (access to nutrition information) was rated as fully implemented by all experts. Barriers to implementing DDAs and infrastructure support included: legal feasibility or lack of regulations, inadequate monitoring/evaluation to ensure enforcement, commercial influences on policymakers, insufficient resources, shifting public health priorities with the COVID-19 pandemic and political instability. The experts prioritised 12 indicators across all five DDAs and eight infrastructure support indicators. Experts highlighted the need to improve implementation of all DDAs and identified ways to strengthen the enabling policy environment.

Tuberculosis-diabetes comorbidities: Mechanistic insights for clinical considerations and treatment challenges.

Tuberculosis (TB) remains a leading cause of death among infectious diseases, particularly in poor countries. Viral infections, multidrug-resistant and ex-tensively drug-resistant TB strains, as well as the coexistence of chronic illnesses such as diabetes mellitus (DM) greatly aggravate TB morbidity and mortality. DM [particularly type 2 DM (T2DM)] and TB have converged making their control even more challenging. Two contemporary global epidemics, TB-DM behaves like a syndemic, a synergistic confluence of two highly prevalent diseases. T2DM is a risk factor for developing more severe forms of multi-drug resistant-TB and TB recurrence after preventive treatment. Since a bidirectional relationship exists between TB and DM, it is necessary to concurrently treat both, and promote recommendations for the joint management of both diseases. There are also some drug-drug interactions resulting in adverse treatment outcomes in TB-DM patients including treatment failure, and reinfection. In addition, autophagy may play a role in these comorbidities. Therefore, the TB-DM comorbidities present several health challenges, requiring a focus on multidisciplinary collaboration and integrated strategies, to effectively deal with this double burden. To effectively manage the comorbidity, further screening in affected countries, more suitable drugs, and better treatment strategies are required.

Paradigm Shifts in Gender Narratives of Tafsīr al-Ibrīz through Oral Exegesis on Youtube

This article examines the book Tafsīr al-Ibrīz, written by KH Bisri Mustofa, a prominent Javanese exegesis. The book has been re-read and interpreted orally by his son, Gus Mus (KH Ahmad Mustofa Bisri), on his YouTube channel. This study highlights a new tradition in the digital era where Qur'anic exegesis is transmitted and transformed through both written texts and oral interpretations. This research employs a qualitative approach, using primary data from the official YouTube Channel of Gus Mus and secondary data from relevant scholarly literature. Document analysis and descriptive-analytic methods reveal a significant paradigm shift between the written and oral exegesis. Specifically, gender issues such as polygamy and women's leadership, which are presented with a gender-biased perspective in the written Tafsīr al-Ibrīz, are reinterpreted by Gus Mus with a focus on gender equality. This transformation is influenced by the socio-cultural context, Gus Mus's educational background, and the changing audience of the oral exegesis. The study incorporates gender equality theory, highlighting forms of gender inequality like marginalization, subordination, stereotyping, violence, and double burden. The findings suggest that Gus Mus's oral exegesis reflects an egalitarian interpretation, contrasting with the traditional views in Tafsīr al-Ibrīz, thus promoting fair treatment for both women and men. This research contributes to the discourse on gender and Qur'anic exegesis by demonstrating the dynamic nature of oral interpretation in the Indonesian pesantren context and its impact on advancing gender equality in Islamic thought.