Global Burden Of Non-communicable Diseases Research Articles

Pharmacovigilance monitoring and treatment adherence in patients on antihypertensive drugs at a tertiary care centre.

Hypertension is one of the main factors contributing to the global burden of non-communicable diseases. Previous research has revealed that stress, bad lifestyle choices and a lack of knowledge about the disease are the main causes of hypertension that can be controlled. The key cause behind the prevalence of the condition is the lack of medication adherence by patients. This study aims to evaluate medication adherence in patients with hypertension through the Morisky Medication Adherence Scale (MMAS) and to observe any adverse drug reaction leading to non-adherence of medications. A descriptive, cross-sectional study was conducted on 124 patients who attended the outpatient department of medicine. The descriptive tools were MMAS and causality scales for adverse drug reactions. The mean MMAS score was 5.20±1.29. Amongst the demographic profile, age, sex, comorbidities and duration of disease were significantly associated with decreased mean MMAS scores. Forty-two patients experienced drug reactions and only four patients were adherent to their medications. Our study suggests that patients were poorly adherent to their medications. Effective interventions should be considered to improve adherence in patients. Monitoring for adverse drug reactions can lead to improved patient outcomes, whilst interventions to improve adherence can lead to better blood pressure control and reduced risk of cardiovascular events.

Dietary Practices of Cancer Outpatients at Nyeri County Referral Hospital, Kenya; A Cross Sectional Survey

The global burden of non-communicable diseases remains unacceptably high and Kenya is among the countries experiencing an epidemiological transition from the communicable to non-communicable diseases. In Kenya, cancer is the second leading cause of non-communicable disease related mortalities after the cardiovascular diseases and Nyeri County is among the counties that are leading in this burden of non-communicable diseases. This study sought to assess the dietary practices of the cancer patients on chemotherapy at Nyeri County and Referral Hospital in comparison with the recommended dietary practices. Analytical cross-sectional study design was employed and the data on the dietary practices was collected using a 24-hour recall and a Food Frequency Questionnaire (FFQ). Sixty one percent of the respondents were female while 39% were male. Sixty one percent had acquired primary school education and half of the respondents survive on a monthly income of between 0-10,000. Breast cancer was the most common cancer type in the population (39%), followed by esophageal and throat cancer at 14.5% and gastric cancer at 14%. Prostate cancer was the most prevalent among the male respondents at 11%. The mean energy intake of the respondents was 1068+- 520 Kcals which was not meeting the requirements as per the ESPEN clinical guidelines on cancer. The dietary patterns identified from the research were, excessive consumption of foods from the starchy foods and the fats category (65.1%) and less than half (41.9%) were not attaining the minimum daily requirements of the fruit’s servings recommended by the World Health Organization (WHO). Nutrition education and counselling is key in improving the dietary practices among the cancer patients. However, 44.19% had not received nutrition education and counselling regarding the appropriate diet to consume in the course of their treatment. This study found out that the dietary practices of the cancer patients do not meet the recommended clinical guidelines on cancer nutrition and almost half of the population had not received nutrition education and counselling services. Social and behavior change is one of the possible strategies that could be adopted to deliver nutrition information to the population, to improve the knowledge, attitude and dietary practices of cancer patients in Kenya, which in turn will improve their nutrition outcomes.

The Impact of Flavonoid Supplementation on Serum Oxidative Stress Levels Measured via D-ROMs Test in the General Population: The PREVES-FLAVON Retrospective Observational Study.

Oxidative stress has emerged as a key contributor to numerous NCDs (non-communicable diseases), including cardiovascular diseases, cancer, and diabetes. This study aims to explore the potential of targeted interventions to mitigate oxidative stress as part of a primary prevention strategy. The study included 32 healthy participants (11 men, 21 women) aged 45-65 who completed both the initial and follow-up assessments of the Healthy Days Initiative, a community-based wellness program organized by the non-profit Associazione O.R.A. ETS. Through blood analysis, vital sign assessment, lifestyle questionnaires, and individualized recommendations, participants received guidance on improving their health and reducing disease risk. The initiative also offered the opportunity for participants to consume a flavonoid supplement containing quercitrin, rutin, and hesperidin, with the goal of reducing oxidative stress. Participants who opted for supplementation were instructed to take 1-2 tablets daily for two weeks. Data collected included demographic information, anthropometric measurements, vital signs, dietary and lifestyle habits, medical history, WHO-5 Well-Being Index scores, and blood parameters. Significant reductions were observed in glucose levels (from 82 to 74.5 mg/dL), reactive oxygen metabolites (d-ROMs) (from 394.5 to 365.5 U.CARR), and systolic blood pressure (from 133 to 122 mmHg) after the two-week flavonoid intervention. Most participants (26/31) reported no side effects, and the majority (30/31) expressed a willingness to continue using a product combination of quercitrin, rutin, and hesperidin or a similar product long-term. While limited in scope and duration, the PREVES-FLAVON study contributes valuable insights to the growing body of evidence suggesting that flavonoid supplementation may play a significant role in reducing risk factors associated with NCDs in primary prevention settings. By targeting novel risk factors such as oxidative stress, this intervention holds promise for mitigating the global burden of NCDs and promoting healthy aging.

Barriers and facilitators for strengthening physiotherapy services in Nepal: perspectives from physiotherapists and health providers

BackgroundPhysiotherapy provides non-invasive and non-pharmaceutical intervention for curative, rehabilitation and preventative purposes. Physiotherapy is also a central provider of health promotion. As the global burden of non-communicable diseases and chronic health conditions is rising, the importance of physiotherapy services increases. Unfortunately, physiotherapy services in low- and middle-income countries (LMICs) are generally unsatisfactory. In Nepal, the earthquake in 2015 and the COVID pandemic have clearly illuminated the importance of physiotherapy.ObjectiveThis qualitative study aimed to identify barriers and facilitators at different system levels for strengthening physiotherapy services in Nepal.MethodsForty semi-structured individual interviews were performed with different health providers. Transcribed interviews were assessed with thematic analysis. A five-level socioecological framework conceptualised multilevel determinants of barriers and facilitators.ResultsThe study revealed various factors that were potential barriers and facilitators across five different levels, namely individual (taking the lead, need for advocacy), interpersonal (lack of recognition and autonomy, networking for referrals and coordination), community (lack of knowledge and awareness, social and family support), organisational (accessibility, workplace and clinical practice, educational opportunities, role of organisations and rehabilitation centres), and public policy level (planning and implementation of policies and programs, medical hegemony, priorities). Government officials, local leaders, and clinicians, half of whom were physiotherapists, agreed on many of the same issues, where a lack of awareness of what physiotherapy is and knowledge about what physiotherapists do was central.ConclusionsThe results provide information for the development of physiotherapy by pointing out key elements that need attention. Our broad and structured investigation strategy is applicable to others for a comprehensive analysis of barriers and facilitators for physiotherapy services.

Highlighting the South Asian Heart Failure Epidemic.

Heart failure (HF) remains a progressive syndrome with high morbidity and mortality, and accounts for many hospitalisations globally with a downstream impact of increasing healthcare costs. South Asian individuals account for most of the global burden of non-communicable diseases. In this systematic review, a literature search was performed for all studies focusing on South Asians and HF using PubMed as the primary research tool and citations were included from relevant MEDLINE-indexed journals. Upon identification of relevant studies, pertinent data points were extracted systematically from each eligible study. South Asians have an earlier age of onset of many non-communicable diseases compared to other ethnic groups worldwide, including cardiovascular disease (CVD). Given the large number of South Asians impacted by CVD and both traditional and non-traditional risk factors for CVD, HF has the potential to become an epidemic among South Asians across the world. Individuals of South Asian origin are at elevated risk for CVD compared to many other populations and should be followed closely for the potential development of HF. This review describes what is unique to South Asian individuals at risk for and with established HF, as well as management and prognostic considerations. Future directions and potential policy changes are highlighted that can reduce the HF burden among South Asians globally.

Addressing emerging public health threats: the Noncommunicable Disease Capacity Assessment and Planning (N-CAP) Process.

The global epidemic of noncommunicable diseases (NCDs) is increasing. Current assessments that monitor capacity to address NCDs are often externally led and do not facilitate country planning. The Noncommunicable Disease Capacity Assessment and Planning (N-CAP) Process assists ministries of health and other governmental and non-governmental stakeholders to assess, prioritize, and plan how to address NCDs and other public health threats. This paper describes the development of this tool. Driven by ministries of health, the N-CAP Process engages new and existing stakeholders in three activities: Stakeholder Mapping; Strengths, Weaknesses, Opportunities, and Threats Workshop; and N-CAP Workshop that uses Discussion Guides to lead in-depth assessment and planning. Standard Operating Procedures, a library of Discussion Guides based on common NCD themes, and an open-access e-learning course are available. The N-CAP Process outcome is a prioritized plan of how to improve the country's public health functions. Adaptations to the tool were made after piloting in Jordan and Iraq. The N-CAP Process helps countries engage various stakeholders to identify gaps and create collaborative, country-specific strategies to effectively respond to NCDs, a leading public health threat. The pilots sparked interest from other countries and underscored its potential for broader implementation to combat the rising global burden of NCDs.

Factors for the integration of prevention in primary care: an overview of reviews.

The global burden of non-communicable diseases is increasing and the need for prevention is huge. Policies have yet to produce results and prevention indicators remain low. Primary care (PC) represents an opportunity to optimise the practice of prevention, but GPs are coming up against barriers that are holding back their prevention practices. To identify the barriers and facilitators for the implementation of routine prevention practices in PC. This study is an international overview of reviews focusing on the integration of prevention in PC settings. The search was conducted in July 2022 using MEDLINE, Embase, Web of Science, and the Cochrane Database of Systematic Reviews. Included reviews are systematic reviews or scoping reviews adopting a systematic approach. The 35 reviews included identify multiple barriers and facilitators related to the integration of prevention in PC. These factors are heterogeneous with regard to their source (the patient, the professional, and the health system) and their level of action (individual, organisational, or contextual). The results show the need to organise PC at the professional level (for example, in training), at the local level (for example, the information system), and at the political level (for example, the unclear definition of the role of professionals). The factors influencing the integration of prevention in PC are multiple and act at different levels (individual, organisational, and health-system level). Organisation factors play a major role and seem to be a means of overcoming the difficulties encountered by healthcare professionals in developing preventive practices.

IJCM_124A: A cross sectional study to assess the prevalence, pattern and predictors of complementary and alternative medicine use among non – communicable disease patients in the urban field practise area of a Government Medical College, Bengaluru

Background: In the current century, a significant challenge is addressing the escalating global burden of Non-Communicable Diseases. Integrating Alternative and Complementary Medicine into the existing healthcare system is a major initiative to combat this issue. Despite increased access to free healthcare facilities, heightened disease awareness, and widespread exposure through electronic and print media, the popularity of unprescribed alternative medicine persists in India. Objectives: To assess the Prevalence, Patterns, and Predictors of Complementary and Alternative Medicine use among non-communicable disease patients in the urban field practice area of Bangalore Medical College and Research Institute, Bengaluru. Methodology: A cross-sectional study conducted among non-communicable disease patients residing in the urban field practice area of Bangalore Medical College and Research Institute, Bengaluru. A sample size of 250 was determined based on a pilot study and systematic random sampling used for participant recruitment. Data collection utilized a pre-tested structured questionnaire. Data analysed using SPSS 21.0 Results: Among the 250 participants, 55 (22%) used both Allopathic and Alternative medicines, only 11 (20%) exclusively relying on Alternative systems. Ayurveda was the most utilized alternative medicine 15(27.2%), followed by Sidda 8(14.5%). Statistically significant associations were observed between the usage of Alternative medicine and patients’ religion and education. Conclusion: A relatively small percentage of adults exclusively used Alternative systems of medicine in this study. Ayurveda emerged as the predominant alternative medicine, followed by Sidda. The prevalence of alternative medicine was higher among Hindus and participants with education below the primary level. These findings shed light on the complex dynamics of healthcare.

Toward a Universal Definition of Etiologies in Heart Failure: Categorizing Causes and Advancing Registry Science.

Heart failure (HF) is a well-described final common pathway for a broad range of diseases however substantial confusion exists regarding how to describe, study, and track these underlying etiologic conditions. We describe (1) the overlap in HF etiologies, comorbidities, and case definitions as currently used in HF registries led or managed by members of the global HF roundtable; (2) strategies to improve the quality of evidence on etiologies and modifiable risk factors of HF in registries; and (3) opportunities to use clinical HF registries as a platform for public health surveillance, implementation research, and randomized registry trials to reduce the global burden of noncommunicable diseases. Investment and collaboration among countries to improve the quality of evidence in global HF registries could contribute to achieving global health targets to reduce noncommunicable diseases and overall improvements in population health.

Characterization of cell cycle, inflammation, and oxidative stress signaling role in non-communicable diseases: Insights into genetic variants, microRNAs and pathways

Non-Communicable Diseases (NCDs) significantly impact global health, contributing to over 70% of premature deaths, as reported by the World Health Organization (WHO). These diseases have complex and multifactorial origins, involving genetic, epigenetic, environmental and lifestyle factors. While Genome-Wide Association Study (GWAS) is widely recognized as a valuable tool for identifying variants associated with complex phenotypes; the multifactorial nature of NCDs necessitates a more comprehensive exploration, encompassing not only the genetic but also the epigenetic aspect. For this purpose, we employed a bioinformatics-multiomics approach to examine the genetic and epigenetic characteristics of NCDs (i.e. colorectal cancer, coronary atherosclerosis, squamous cell lung cancer, psoriasis, type 2 diabetes, and multiple sclerosis), aiming to identify novel biomarkers for diagnosis and prognosis. Leveraging GWAS summary statistics, we pinpointed Single Nucleotide Polymorphisms (SNPs) independently associated with each NCD. Subsequently, we identified genes linked to cell cycle, inflammation and oxidative stress mechanisms, revealing shared genes across multiple diseases, suggesting common functional pathways. From an epigenetic perspective, we identified microRNAs (miRNAs) with regulatory functions targeting these genes of interest. Our findings underscore critical genetic pathways implicated in these diseases. In colorectal cancer, the dysregulation of the “Cytokine Signaling in Immune System” pathway, involving LAMA5 and SMAD7, regulated by Hsa-miR-21-5p, Hsa-miR-103a-3p, and Hsa-miR-195-5p, emerged as pivotal. In coronary atherosclerosis, the pathway associated with “binding of TCF/LEF:CTNNB1 to target gene promoters” displayed noteworthy implications, with the MYC factor controlled by Hsa-miR-16-5p as a potential regulatory factor. Squamous cell lung carcinoma analysis revealed significant pathways such as “PTK6 promotes HIF1A stabilization,” regulated by Hsa-let-7b-5p. In psoriasis, the “Endosomal/Vacuolar pathway,” involving HLA-C and Hsa-miR-148a-3p and Hsa-miR-148b-3p, was identified as crucial. Type 2 Diabetes implicated the “Regulation of TP53 Expression” pathway, controlled by Hsa-miR-106a-5p and Hsa-miR-106b-5p. In conclusion, our study elucidates the genetic framework and molecular mechanisms underlying NCDs, offering crucial insights into potential genetic/epigenetic biomarkers for diagnosis and prognosis. The specificity of pathways and related miRNAs in different pathologies highlights promising candidates for further clinical validation, with the potential to advance personalized treatments and alleviate the global burden of NCDs.

Prevalence and risk factors of hypertension and diabetes mellitus in riverine communities in Nigeria’s Niger delta: implications for community-based interventions

Background: The global burden of non-communicable diseases is enormous, especially in low- and middle-income countries. This study assessed the prevalence of hypertension and diabetes mellitus and associated factors among adult residents of riverine communities in Niger delta region of Nigeria. Methods: A community-based descriptive cross-sectional study. Adults aged 18 years and above residing in riverine communities who attended a free medical outreach programme were screened for hypertension and diabetes mellitus. Anthropometry and measurements were done using standard methods. Data was analysed using SPSS version 26. Results: Of the 1597 participants, 1066 (66.6%) were females, 470 (29.4%) overweight and 356 (22.3%) were obese. Their mean age was 41.0±14.5 years. The prevalence of hypertension diabetes mellitus and hypercholesterolemia was 37.6%, 3.9% and 65.6% respectively. Significant predictors of hypertension were age ≥40 years (OR =3.86, CI: 2.59-5.75, p<0.001), male sex (OR=1.78, CI: 1.19-2.65, p=0.005), overweight (OR=1.92, CI: 1.19-3.11, p=0.008) and obesity (OR=1.73, CI: 1.05-2.85, p=0.032). No statistically significant association between demographic characteristics and diabetes mellitus was observed. Conclusions: The high prevalence of hypertension and diabetes mellitus in the riverine communities calls for an urgent need to set up community based noncommunicable diseases prevention programmes and then develop and implement effective targeted interventions to help residents of the riverine communities diagnosed with these conditions to better manage the disease.

Cohort profile: rationale and design of the Resource Center for Health Science (RECHS) project – a study of health hazards and medical cost burden among the Japanese population

PurposeThe increased global burden of non-communicable diseases and mental disorders is an urgent health challenge for countries around the entire world, especially those experiencing super-ageing societies, where over 21% of...

Global environmental changes and the epithelial barrier hypothesis

The global burden of noncommunicable diseases (NCD) has seen astrong increase in recent decades and attributable to the influence of environmental factors. For amultitude of diseases an association with epithelial barrier damage has been reported. This article provides an overview of the health effects of environmental pollution in the context of the epithelial barrier hypothesis of Cezmi Akdis. Additionally, exemplary mechanisms of abarrier damage are described. Finally, possible preventive and therapeutic consequences are discussed. The PubMed database was searched for the relevant topics and selected literature was reviewed. Awide variety of substances can damage the epithelial barriers of the skin, lungs and gastrointestinal tract. The rise in the prevalences of atopic diseases could (partly) be due to an increased exposure to barrier-damaging substances, such as particulate matter and laundry detergents. Apossible pathogenetic mechanism is the initiation and maintenance of an immune response by subepithelial penetration of microorganisms through damaged epithelia. Based on the epithelial barrier hypothesis new therapeutic and prevention strategies can be developed. The regulation of hazardous chemicals and the fight against environmental pollution and climate change are necessary to reduce the burden of disease.

Epidemiology and referral patterns of patients living with chronic kidney disease in Johannesburg, South Africa: A single centre experience.

Chronic kidney disease (CKD) is a significant contributor to the global burden of non-communicable disease. Early intervention may facilitate slowing down of progression of CKD; recognition of at-risk patient groups may improve detection through screening. We retrospectively reviewed the clinical records of 960 patients attending a specialist nephrology outpatient clinic during the period 1 January 2011-31 December 2021. A significant proportion (47.8%) of patients were referred with established CKD stage G4 or G5. Non-national immigration status, previous diagnosis with diabetes, and advancing age were associated with late referral; antecedent diagnosis with HIV reduced the odds of late referral. Black African patients comprised most of the sample cohort and were younger at referral and more frequently female than other ethnicities; non-nationals were younger at referral than South Africans. Hypertension-associated kidney disease was the leading ascribed aetiological factor for CKD (40.7% of cases), followed by diabetic kidney disease (DKD) (19%), glomerular disease (12.5%), and HIV-associated kidney disease (11.8%). Hypertension-related (25.9%) and diabetic (10.7%) kidney diseases were not uncommon in people living with HIV. Advancing age and male sex increased the likelihood of diagnosis with hypertensive nephropathy, DKD and obstructive uropathy; males were additionally at increased risk of HIV-associated kidney disease and nephrotoxin exposure, as were patients of Black African ethnicity. In summary, this data shows that hypertension, diabetes, and HIV remain important aetiological factors in CKD in the South African context. Despite the well-described risk of CKD in these disorders, referral to nephrology services occurs late. Interventions and policy actions targeting at-risk populations are required to improve referral practices.

Female community health volunteers' experience in navigating social context while providing basic diabetes services in western Nepal: Social capital and beyond from systems thinking.

The global burden of non-communicable diseases (NCDs) has led to an increased mobilization of community health workers (CHWs) in the prevention and management of NCDs, particularly in resource-poor settings. However, little is known about the experiences of CHWs as they navigate the complex social context while proving home-based NCD management. This study aims to explore the experiences of female community health volunteers (FCHVs) in a community-based pilot project in western Nepal, specially regarding the social challenges they face while delivering basic type 2 diabetes (T2D) services. Using a qualitative phenomenological approach, the study conducted two focus group discussions and nine in-depth interviews with a total of 14 and 9 FCHVs, respectively. Social Capital theory was employed to understand the sociological aspects. The findings shed light on the challenges encountered by FCHVs in expanding their social networks, building trust, and fostering reciprocity among T2D intervention recepients. Notably, social trust was a significant challenge, compounded by power dynamics related to gender and socioeconomic status. FCHVs managed to overcome these challenges through their perseverance, self-motivation, and leaveraging their strong bonding and linking social capital. The recognition they received from the community played a crucial role in sustaining their motivation. The study highlights the importance of FCHVs' strong social capital, supported by available resources and personal motivation, in overcoming social obstacles. It is imperative for community health interventions to anticipate challenges across various elements of social capital to ensure the long-term retention and motivation of CHWs. Establishing appropriate support systems that address personal motivating factors and the strengthen social capital is essential.

A Study to Assess the Knowledge about Disposal of Biomedical Waste among the Hospital Staff in a Multi-Specialty Hospital in Vadodara, Gujarat

Abstract: Introduction: Workplace hazards and health hazards are major public health concerns worldwide, contributing to the global burden of non-communicable diseases (NCDs). One-third of adult life is spent at the workplace, with risky exposures often higher than in other environments. Accidents and occupational diseases cause 1,000 deaths daily, with 65% reported in Asia.To assess the knowledge of nursing staff and doctors with respect to gender, age and marital status. Awareness regarding BMW management will help the authorities to develop the strategy for improving the situation in future. Research Methodology: The study followed an observational cross-sectional design and was conducted over a one-month period at Dhiraj Hospital in Vadodara, Gujarat. The sample size consisted of 207 medical staff, including nurses, doctors, housekeeping staff, and lab technicians. The selection criteria included permanent staff of the hospital who signed the informed consent and were willing to participate. Findings and Analysis: The study revealed a gender distribution of 51.7% male and 48.3% female among 207 hospital staff, with the majority aged 25-35, followed by 35-45, and 45-55. Work safety practices were average, with a smaller percentage above 55. Conclusion: The study on the knowledge about disposal of biomedical waste among the hospital staff in a multi-specialty hospital in Vadodara, Gujarat, sheds light on the existing gaps in BMW management practices. It emphasizes the importance of addressing occupational health hazards and promoting a safe work environment

Food for thought: a look at the food industry’s corporate political activity in Portugal

Abstract Background Corporate political activity (CPA) stands for the strategies used by industries to attempt at influencing government policymaking in ways that are beneficial to the company. In the food industry context, these often collide with public health concerns, constituting a major barrier to noncommunicable diseases (NCDs) prevention efforts. This study aimed to characterise the CPA activity of the food industry in the Portuguese context. Methods The methodology conceptualised by Mialon et al. (2015) to identify and monitor the CPA activity of the food industry concerning public health was used in this study. Prominent food industry actors were selected, including processed food and non-alcoholic beverage manufacturers, fast food companies, and food retailers. To depict current practices, publicly available information from 2019 onwards was collected from the 7 selected food industry actors’ websites. A thematic qualitative analysis was performed by classifying the retrieved content according to the 6 CPA framework categories and subcategories. Results Collected data indicate that out of the 151 analysed written records, nearly half were information and messaging CPA strategies that mostly frame the debate on diet and public health-related issues. Constituency building through seeking community involvement was the second most represented category. Policy substitution was barely present, whereas financial incentive, legal, and opposition fragmentation and destabilisation strategies were not identified. Most of the coded content was retrieved from McDonald's and the Dairy Industry National Association websites. Conclusions Recognising the CPA strategies used by the food industry will enable more targeted and informed decisions at the public health intervention and policy levels. Notably, more attention should be paid to the way the food industry frames the diet and public health debate to avoid misinformation among consumers. Key messages • Addressing the global burden of noncommunicable diseases implies recognising corporate political activity strategies used by the food industry that counteract NCDs prevention efforts. • The way the food industry frames the diet and public health debate should be of concern to public health professionals and policymakers to prevent misinformation among consumers.

Sustainable Development Goals: Challenges and the Role of the International Society of Nephrology in Improving Global Kidney Health.

The United Nations 2030 agenda for sustainable development includes 17 sustainable development goals (SDGs) that represent a universal call to end poverty and protect the planet, and are intended to guide government and private sector policies for international cooperation and optimal mobilization of resources. At the core of their achievement is reducing mortality by improving the global burden of noncommunicable diseases (NCDs), the leading causes of death and disability worldwide. CKD is the only NCD with a consistently rising age-adjusted mortality rate and is rising steadily up the list of the causes of lives lost globally. Kidney disease is strongly affected by social determinants of health, with a strong interplay between CKD incidence and progression and other NCDs and SDGs. Tackling the shared CKD and NCD risk factors will help with progress toward the SDGs and vice versa . Challenges to global kidney health include both preexisting socioeconomic factors and natural and human-induced disasters, many of which are intended to be addressed through actions proposed in the sustainable development agenda. Opportunities to address these challenges include public health policies focused on integrated kidney care, kidney disease surveillance, building strategic partnerships, building workforce capacity, harnessing technology and virtual platforms, advocacy/public awareness campaigns, translational and implementation research, and environmentally sustainable kidney care.

Artificial intelligence can dynamically adjust strategies for auxiliary diagnosing respiratory diseases and analyzing potential pathological relationships

Respiratory diseases are one of the leading causes of human death and exacerbate the global burden of non-communicable diseases. Finding a method to assist clinicians pre-diagnose these diseases is an urgent task. Existing artificial intelligence-based methods can improve the clinical diagnosis efficiency, but still face challenges. For example, the lack of interpretability, the problem of information redundancy or missing caused by only using static data, the difficulty of model to learn the interdependence between features, and the performance of model is limited by sparse datasets, etc. To alleviate these problems, we propose a novel RQPA-Net. It consists of Q&A diagnosis module (QAD) and pathological inference module (PI). The QAD is responsible for interacting with patients, adjusting inquiry strategies dynamically and collecting effective information for disease diagnosis. The designed multi-subspace network can alleviate the problem that classical method is difficult to understand the interdependence between features. The deep reinforcement learning designed also can alleviate the problem of classical methods lack of interpretability. The PI is responsible for reasoning potential pathological relationships between diseases or symptoms based on existing knowledge. Through integrating the advantages of deep learning and reinforcement learning techniques, PI can handle sparse datasets. Finally, for auxiliary diagnosis, the model achieves 0.9780 ± 0.0002 Recall, 0.9778 ± 0.0003 Acc, 0.9779 ± 0.0003 Precision and 0.9780 ± 0.0003 F1-score on the test set. In terms of assisting pathological analysis, compared with the end-to-end model, our model achieves higher comprehensive performance on different tasks and datasets with different degrees of sparsity. Even in sparse datasets, it can effectively infer potential associations between diseases or symptoms, and has higher potential clinical application. In this paper, we propose a novel network structure, which can not only assist doctors in diagnosing diseases, but also contribute to explore the potential disease mechanisms. It provides a new perspective for integrating AI technology and clinical practice.

Micronutrients in early life and offspring metabolic health programming: a promising target for preventing non-communicable diseases.

Chronic non-communicable diseases are the leading cause of morbidity and mortality worldwide. Developing and implementing effective preventive strategies is the best way to ensure the overall metabolic health status of the population and to counter the global burden of non-communicable diseases. Predisposition to obesity and other non-communicable diseases is due to a combination of genetic and environmental factors throughout life, but the early environment, particularly the environment during the fetal period and the early years of life, is crucial in determining metabolic health, hence the concept of 'fetal programming'. The origins of this causal link between environmental factors and disease lie in epigenetic mechanisms. Among the environmental factors, diet plays a crucial role in this process. Substantial evidence documented the key role of macronutrients in the programming of metabolic diseases early in life. Recently, the effect of maternal micronutrient intake on offspring metabolic health in later life emerged. The purpose of this narrative review is to bring to light available evidence in the literature on the effect of maternal micronutrient status on offspring metabolic health and underlying epigenetic mechanisms that drive this link to highlight its potential role in the prevention of non-communicable diseases.