High Rates Of Disease Research Articles

Adaptation of the Florida Cognitive Activities Scale for Latinx adults with chronic diseases

ABSTRACT Background Latinx adults experience disparately high rates of chronic diseases and cognitive dysfunction. Participating in cognitive-stimulating activities, such as reading, is thought to improve and preserve cognitive function. However, little is known about cognitively stimulating activities preferred by Latinx adults. In addition, surveys to measure participation in cognitively stimulating activities are not culturally sensitive to Latinx preferences and tend to feature activities that require financial resources and leisure time and may not include cognitively stimulating activities that are more accessible or preferable. Methods We conducted an instrumentation study in three phases to adapt the Florida Cognitive Activities Scale (FCAS): Phase (1) revision and translation of the FCAS for Latinx adults with chronic diseases; Phase (2) feasibility testing; and Phase (3) reliability and validity testing. Results Five experts provided input on existing items, with suggestions for changes or items to remove and for new items. The resulting 17 item FCAS-Latinx (FCAS-L) was translated into Spanish and back-translated and determined to be readable at the 6th grade level. The FACS-L was administered to 70 participants (mean age 62.17 years; 57% female; 51% Mexican American) with other surveys that measured cognitive functioning and chronic disease management. To select the final items, we analyzed the item discrimination index, item-to-total correlations, and participants’ feedback. The final 20-item Spanish – and English versions of the FCAS-L are internally consistent (Cronbach alpha = 0.74 and 0.81, respectively), showed good construct validity (higher scores on cognitive functioning tests correlated with engaging in more frequent cognitively stimulating activities, r = 0.63, P < .01), and temporal reliability (the interclass correlation coefficient between test and retest times was 0.81). Conclusion The FCAS-L is a valid and reliable updated measure of cognitively stimulating activities for Spanish- and English-speaking Latinx adults with chronic conditions.

Impact of acupuncture on mortality in patients with disabilities and newly diagnosed heart failure: a nationwide cohort study

ObjectivePeople with disabilities have high rates of cardiovascular diseases and mortality, and heart failure can worsen their condition. Therefore, preventing and managing cardiovascular diseases is particularly important for this population. Although acupuncture has been used for heart failure, research on its impact on mortality is limited. Given the unique pathophysiological characteristics of people with disabilities, this study aimed to evaluate the effect of acupuncture on mortality in those newly diagnosed with heart failure.MethodsThis retrospective cohort study used data from the Korean National Health Insurance Service, focusing on people with disabilities diagnosed with heart failure between 2014 and 2016. Acupuncture exposure within 1 year of diagnosis was assessed by dividing the participants into acupuncture-exposed and non-exposed groups. Propensity score matching (PSM) was used to adjust for group differences, and all-cause mortality was tracked for 3 years. Cox proportional hazard models were employed to calculate hazard ratios (HRs) and confidence intervals (CIs). Dose-response relationships were also analyzed by dividing acupuncture frequency into quartiles.ResultsAfter PSM, 21,001 individuals were included in both groups. The acupuncture-exposed group had a 20% lower risk of all-cause mortality (adjusted HR 0.80, 95% CI 0.76–0.84) than those in the non-exposed group. Higher acupuncture doses were associated with a greater reduction in mortality, with the highest dose group showing a 36% lower risk (adjusted HR 0.64, 95% CI 0.58–0.69) than those in the non-exposed group. The subgroup analysis showed a consistent reduction in mortality across most groups, particularly in women, older adults, higher-income individuals, and those with severe disabilities.ConclusionThis study suggests that acupuncture exposure is associated with reduced mortality in people with disabilities who are newly diagnosed with heart failure. While several limitations exist, we highlight the potential role of acupuncture in managing cardiovascular diseases in this population and encourage further research to support healthcare policies.

P-1291. Racial disparities in Lyme disease among beneficiaries of US Medicaid and Medicare

Abstract Background Lyme disease (LD) is the most common vector-borne disease in the US. Manifestations range from a localized rash to neurologic, cardiac, and musculoskeletal conditions during disseminated stages. LD incidence is highest among White persons in the US, but evidence suggests that people from racial and ethnic minority groups experience more severe disease. Methods We used a claims-based algorithm (≥ 1 LD ICD-10 code and appropriate antibiotics within 30 days) to identify LD cases among Medicaid (age &amp;lt; 19 and ≥ 19 years) and Medicare fee-for-service (age &amp;lt; 65 [persons with disabilities] and ≥ 65 years old) beneficiaries living in 16 high incidence states ( &amp;gt; 10 cases/100,000 population for ≥ 3 years) during 2016-2021. We calculated prevalence ratios for disseminated disease and hospitalization by racial group using White persons as the reference. Results There were 62,055 LD cases identified among Medicaid beneficiaries and 90,882 among Medicare beneficiaries. In Medicaid, 85% of cases were in White persons, 6% in Hispanic, 4% in Black, 4% in Asian/Pacific Islander, and 1% in Native American persons. In Medicare, 96% of cases were in White persons, with 1% or less reported in other groups. Non-White persons were more likely to be hospitalized at diagnosis, diagnosed outside of primary care, diagnosed outside of the peak months for LD transmission, to be female, and to have disseminated disease (Table 1). Medicaid beneficiaries and Medicare beneficiaries ≥ 65 years old who identified as Black, Asian/Pacific Islander, or Hispanic had a higher likelihood of disseminated disease than White persons. Among Medicaid beneficiaries &amp;lt; 19 years old, those who identified as Black, Asian/Pacific Islander, or Hispanic had a higher likelihood of being hospitalized at diagnosis than those who identified as White. Black Medicaid beneficiaries ≥ 19 and Medicare beneficiaries &amp;lt; 65 also had a higher likelihood of hospitalization (Table 2). Conclusion These data illustrate disparities in LD by race and ethnicity and suggest possible disparities by other characteristics including sex and, given the high rates of disseminated disease in Medicare beneficiaries &amp;lt; 65 years old, disability. Equitable interventions are needed to reduce disparities in LD recognition and severity. Disclosures L. Hannah Gould, PhD, MS, MBA, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Sarah J. Willis, PhD, MPH, Pfizer, Inc.: Employment|Pfizer, Inc.: Stocks/Bonds (Private Company) Christopher G. Prener, PhD, Pfizer, Inc.: Employee|Pfizer, Inc.: Stocks/Bonds (Public Company) Stephanie A. Duench, PhD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Holly Yu, MSPH, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Jennifer Moisi, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) James H. Stark, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company)

Adaptation of the nutrition care process for metabolic diseases in the Mexican population

BackgroundThe Nutrition Care Process (NCP) is a systematic framework designed to enhance the quality of nutrition care. Given the high prevalence of metabolic diseases in Mexican population, there is a critical need for tailored nutrition care strategies.ObjectiveWe aim to describe the adaptation of the NCP to manage metabolic diseases in Mexican individuals.MethodsOur adaptation included a comprehensive literature review of clinical nutrition guidelines, by a structured consultation with experts to ensure clinical setting-specific and culturally appropriate modifications. A team of registered dietitians from two tier 3 hospitals, each with over five years of experience in metabolic disease management, customized the NCP’s four core steps—assessment, diagnosis, intervention, and monitoring—to meet the specific needs of the Mexican population.ResultsWe adapted the NCP to manage five common metabolic disorders: obesity, type 2 diabetes, kidney disease, metabolic dysfunction-associated steatotic liver disease, and dyslipidemia. Each step of the NCP was complemented by the development of educational materials designed to (1) enhance awareness of disease risk, (2) broaden their knowledge of nutritional management, and (3) provide tailored strategies for developing personalized action plans. The adapted NCP was implemented in clinical and research settings and the materials were documented as an online publication to facilitate widespread dissemination.ConclusionOur adaptation represents a significant advancement in the use of structured tools for nutrition care in Mexican populations, who face disproportionately high rates of metabolic diseases. Further research is needed to assess the effectiveness of this approach in clinical settings.

A call to reform the Libyan oral health care system

The Libyan healthcare system was once described as one of the best healthcare systems in Africa.1 A recent study describing the Libyan oral health care system has been published which shows that health care is mainly privatized, and the governmental sector is poorly functioning with limited funding and unclear targets.2 It is well known structural determinants of health such as the health system can have a negative impact on the health outcomes. 3 In the case of the Libyan systems, it seems the impact is heavy on preventive dental care which is deterred by limited resources in the governmental sector and payment issues in the private sector. This has been manifested in the high rates of oral disease in Libyan children and adults.4-10 Furthermore, challenges in the oral health care system include barriers such as time constraints, insufficient incentives, and limited resources that hinder the provision of care.11 However, in Libya, the oral health care system could experience similar or even more severe difficulties due to political instability, inadequate infrastructure, and a lack of trained professionals, which could further aggravate these issues. There is an urgent need to raise the issue and mobilize actions to reform the oral health care system to meet the needs of the society and avoid further deterioration of health services and creating jobless dentists. Government expenditure on oral health in Libya primarily follows an outdated model that emphasizes diagnosis and treatment of oral and dental diseases, rather than funding programs aimed at preventing these conditions.12 In 2012, Libya had approximately six dentists per 10,000 people.13 Although the numbers of dentists is considered sufficient, large numbers of dental graduates are bombarded into the Libyan oral health care system which reflect improper planning of the dental workforces.10 The one might say the dental system of Libya was studied in Benghazi as a case,2 however, similar situation applies to the whole country. For example, the dental faculty in Tripoli enrols up to 1,000 new students each year, and other institutions also admit substantial numbers.14 This situation places considerable strain on the educational system and could, over time, negatively impact the job market for private dental practitioners.

Parkinson Disease Neuropathological Comorbidities: Prevalences from Younger-Old to Older-Old, With Comparison to Non-Demented, Non-Parkinsonian Subjects.

Co-existing neuropathological comorbidities have been repeatedly reported to be extremely common in subjects dying with dementia due to Alzheimer disease. As these are likely to be additive to cognitive impairment, and may not be affected by molecularly-specific AD therapeutics, they may cause significant inter-individual response heterogeneity amongst subjects in AD clinical trials. Furthermore, while originally noted for the oldest old, recent reports have now documented high neuropathological comorbidity prevalences in younger old AD subjects, who are more likely to be included in clinical trials. Comorbid neuropathologies in subjects with Parkinson disease have received much less attention. As with AD, comorbidities may interfere with the evaluation of PD clinical trials. We have here examined the decadal-wise presence of multiple co-pathologies, and their clinical effects, in a series of autopsies of PD and control subjects from the Arizona Study of Aging and Neurodegenerative Disorders. Amyloid plaques were present in more than 40% of PD patients in their 60s, and in 85% of those in their 90s. Neurofibrillary tangles were present in PD, as in all elderly humans, from the 60s onwards, while Braak tangle stages of IV or greater, which are strongly associated with severe cognitive impairment, reached 40%, 50% and 60% in those subjects in their 70s, 80s and 90s, respectively. Both plaques and tangles were significant predictors of a lower MMSE score while greater CAA scores had borderline significance. None of these, however, were independently associated with a higher UPDRS score. The ApoE4 allele, while a known predictor of AD pathology, especially amyloid plaques, was not an independent predictor of function with either of these clinical measures, suggesting that its influence is largely mediated by the neuropathologies that it predisposes to. Non-AD tauopathies, including the major conditions of progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD), as well as the microscopic changes of argyrophilic grains (ARG) and aging-related tau astrogliopathy (ARTAG), also co-existed with PD, especially ARG and ARTAG, which ranged between 20% and 40% across decades for the former and up to 80% for the latter; we did not find significant associations of either with final MMSE or UPDRS scores. We failed to find a significant association of limbic TDP-43 histopathology with either final MMSE score or final UPDRS motor score but our subjects were more heavily weighted with PD than those in prior studies and our cognitive correlate, limited to MMSE score, may have missed associations with cognitive domain subsets. We found several cerebrovascular pathologies to be predictors of both cognitive and motor impairment, including brain infarcts, circle of Willis atherosclerosis, and higher white matter rarefaction score. All of the investigated pathology types were common in the non-demented, non-parkinsonian control subjects, and all increased with age in parallel with those co-existing with PD, while with generally lower prevalences. The high concurrence rate of the neurodegenerative protein aggregate diseases is suggestive of either a synergistic co-pathogenesis, where one aggregate type may instigate or accelerate another type, or of one or more underlying predisposing physiological or molecular mechanisms.

Assessment of the inclusiveness of health services and challenges in the context of scheduled tribes in Kerala

This study investigates the health challenges faced by scheduled tribes (S.T.s) in Kerala, a state renowned for its progressive health indicators. Despite significant advancements in healthcare, S.T.s remains marginalised, with a population of 484839 as per the 2011 census. The paper aims to assess the inclusiveness of health services, explore the stagnation of health outcomes in tribal areas, evaluate the effectiveness of health policies, and examine the adequacy of existing health infrastructure. Employing a mixed-methods approach, the study reveals high illiteracy rates and limited access to employment as primary barriers to social and economic progress. Approximately 90 percent of the tribal population engages in seasonal, low-income labour, and around 80 percent live below the poverty line. Health issues prevalent among these communities include malnutrition, anaemia, and high rates of infectious diseases, exacerbated by inadequate sanitation and water facilities. The study highlights a concerning reliance on traditional practices, leading to underutilisation of available health services. Key findings indicate that maternal health and hygiene are critical areas needing intervention, particularly regarding menstrual health issues. The functioning of community health workers, such as ASHAs, requires enhancement to ensure timely access to healthcare information and services. Recommendations emphasise the need for targeted educational initiatives, improved employment opportunities, and better maintenance of health infrastructure to foster inclusivity and address the pressing health challenges faced by scheduled tribes in Kerala.

Precision Medicine Assessment of the Radiographic Defect Angle of the Intrabony Defect in Periodontal Lesions by Deep Learning of Bitewing Radiographs.

In dental diagnosis, evaluating the severity of periodontal disease by analyzing the radiographic defect angle of the intrabony defect is essential for effective treatment planning. However, dentists often rely on clinical examinations and manual analysis, which can be time-consuming and labor-intensive. Due to the high recurrence rate of periodontal disease after treatment, accurately evaluating the radiographic defect angle of the intrabony defect is vital for implementing targeted interventions, which can improve treatment outcomes and reduce recurrence. This study aims to streamline clinical practices and enhance patient care in managing periodontal disease by determining its severity based on the analysis of the radiographic defect angle of the intrabony defect. In this approach, radiographic defect angles of the intrabony defect greater than 37 degrees are classified as severe, while those less than 37 degrees are considered mild. This study employed a series of novel image enhancement techniques to significantly improve diagnostic accuracy. Before enhancement, the maximum accuracy was 78.85%, which increased to 95.12% following enhancement. YOLOv8 detects the affected tooth, and its mAP can reach 95.5%, with a precision reach of 94.32%. This approach assists dentists in swiftly assessing the extent of periodontal erosion, enabling timely and appropriate treatment. These techniques reduce diagnostic time and improve healthcare quality.

Demographic Features, Diagnoses and Real-World Clinical Management of Uveitis in Japan

ABSTRACT Purpose This study aimed to investigate demographic features, diagnoses of uveitis (intraocular inflammation), and real-world clinical practice in the use of local and systemic therapies for patients with uveitis in Tokyo, Japan. Methods Clinical records of 1,174 consecutive new patients (480 males, 694 females) referred to the Kyorin Eye Center, Kyorin University Hospital between January 2011 and December 2018 were retrospectively reviewed. Results Mean age at presentation was 52.6 years (range 4–94 years). By anatomic location, 439 patients (37.4%) had anterior uveitis, 18 (1.5%) had intermediate uveitis, 214 (18.2%) had posterior uveitis and 503 (42.8%) had panuveitis. The 3 most common diagnoses were sarcoidosis (9.1%), Vogt-Koyanagi-Harada (VKH) disease (8.3%), and acute anterior uveitis (5.7%). Compared to our previous study, rates of herpetic anterior uveitis and cytomegalovirus (CMV) retinitis increased while tuberculosis-related uveitis decreased. Unclassified uveitis remained the most common diagnosis (44.9%). Systemic corticosteroids and/or immunomodulatory agents were used in only 18.3% of patients. Immunomodulatory drugs including biologic agents were utilized in 4.9% of patients. Conclusions The most common uveitis anatomic type was panuveitis due mainly to high rates of sarcoidosis and VKH disease. Diagnoses of herpetic anterior uveitis and CMV retinitis increased, while tuberculosis-related uveitis decreased. Less than one-fifth of uveitis patients required systemic treatment.

Effectiveness of home water treatment for the control of diarrhea in children under five years: an intervention study in a rural health zone of Tshopo in the Democratic Republic of Congo

ABSTRACT Villages that were once certified as ‘sanitized’ have lost their status and now have high rates of diarrheal diseases. The goal of this study was to evaluate the effectiveness of water treatment and safe management in reducing diarrheal diseases in children aged 0–59 months. An intervention study with non-randomized allocation of subjects was conducted from 1 September 2023 to 29 February 2024 in two villages in Tshopo province. The control village was the one selected in the similar context in terms of water supply, hygiene and sanitation. The incidence of diarrhea was calculated in each village per 100 person-weeks. Systematic water treatment combined with hygienic storage and reduction of storage time to 24 h reduced the prevalence of diarrhea from 49.6 to 9% in children aged 0–59 months. Village category (IRR = 1.89, 95% CI: 1.8–1.98), education level (IRR = 1.101, 95% CI: 1.05–1.5), marital status of household head (IRR = 1.13, 95% CI: 1.02–1.24) and household size (IRR = 1.08, 95% CI: 1.07–1.08) were associated with diarrhea. Water treatment and safe management are effective measures to reduce diarrheal morbidity and should be recommended in the context of poor household access to improved water sources.

Evaluating hepatitis B screening, prevalence, vaccination coverage, and linkage to care in Abuja, Nigeria: insights from a cross-sectional study

BackgroundHepatitis B virus (HBV) is a major global health threat, especially in Sub-Saharan Africa, where Nigeria has a prevalence exceeding 8%. Despite the availability of effective vaccines, inadequate coverage and lack of awareness have resulted in high rates of chronic infections and HBV-attributable liver disease. The study aimed to raise awareness of HBV, enroll participants for HBV screening, determine HBV prevalence across various communities, vaccinate negative cases and link positive cases to care.MethodsA cross-sectional study was conducted in 16 districts of Abuja from April 2022 to March 2023. Participants aged 18 and over were screened for hepatitis B, and those testing negative were offered on-site vaccination. Blood samples were collected and tested using HBV immunochromatographic tests and real-time polymerase chain reaction (RT-PCR) for HBV DNA quantification. Data were collected through interviews and analyzed using R software, with descriptive statistics calculated for continuous and categorical variables. Associations between socio-demographic factors and hepatitis B/vaccine status were assessed using the Chi-square test of independence.ResultsOut of 3,245 individuals screened, 141 (4.3%) tested positive for HBV. The highest prevalence was observed in the 20–39 age group (5.9%), with males showing a higher infection rate (5.4%) compared to females (3.7%) [p = 0.02]. The mean age of HBV-positive individuals was significantly lower (30.8 years) than those negative for HBV (36.2 years) [p = < 0.001]. Among 2,506 participants who consented to vaccination, 2,488 received the first dose (99.3%), 1,834 the second dose (73.2%), and 1,100 the third dose (43.9%). Vaccination uptake declined with each subsequent dose, but more older participants completed the third dose. A similar pattern of HBV prevalence was observed across gender and age groups.ConclusionThe study reveals a 4.3% prevalence of hepatitis B, with the highest infection rate among individuals aged 20–39 years, and males showing a higher prevalence than females. Although vaccination uptake was high for the first dose, adherence declined for subsequent doses. These findings highlight the need for targeted public health interventions, particularly among younger adults and males, to improve awareness and vaccination completion. Enhanced community engagement and sustained vaccination efforts are crucial for reducing HBV transmission and achieving better coverage.

Antimicrobial Policy in Indonesia within the One Health Context: Literature Analysis and Implementation Challenges

Background: Antimicrobials such as antibiotics, antivirals, antifungals, and antiparasitics are vital for treating infections in humans, animals, and plants. Antimicrobial Resistance (AMR) occurs when microorganisms become resistant to these drugs, posing a serious global threat. In Indonesia, high rates of infectious diseases increase the risks associated with AMR, highlighting the need for effective control measures. This study reviews research on efforts to control antimicrobial resistance in Indonesia within the One Health context, analyze related policies, and identifies key implementation challenges to provide recommendations for improvement. Method: A literature review was conducted, identifying 1,029 articles from databases including EBSCOHost, ProQuest, PubMed, and Google Scholar. After screening and applying inclusion criteria, 14 relevant articles were selected for analysis to evaluate policies related to AMR in Indonesia and their alignment with the One Health approach. Result: The findings showed that the increase in antimicrobial resistance (AMR) in Indonesia is mainly due to the misuse of antimicrobial drugs in different areas. While there are policies in place, putting them into practice has proven difficult, especially in the health sector, which faces more challenges than the livestock and environmental sectors. These results highlight the need for better coordination and alignment of policies across all sectors. Conclusion: Although current AMR policies in Indonesia incorporate the One Health approach, significant challenges remain, including limited resources, insufficient guidelines, and weak coordination among sectors. Strengthening collaboration between health, agriculture, and environmental sectors and improving monitoring systems is essential for effective AMR control in Indonesia.

Acute Promyelocytic Leukemia in the Real World: Understanding Outcome Differences and How We Can Improve Them.

The advent of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) has revolutionized the treatment of acute promyelocytic leukemia (APL), resulting in excellent rates of remission and long-term survival. However, real-world outcomes often fall short of those observed in clinical trials due to various factors related to patient demographics and clinical practices. This review examines APL treatment outcomes in real-world settings and highlights the phenomenon of APL clusters. Clinical trials frequently exclude older patients and individuals with significant comorbidities, yet these groups represent a substantial portion of patients in clinical practice. Early mortality remains high in real-world settings, compounded by delayed diagnosis and treatment initiation, as well as the inexperience of some community providers and limited resources of their centers in managing APL and its associated complications. High rates of disease and induction-related complications further exacerbate early mortality. Continuous education and collaboration between community healthcare centers and expert institutions are essential, and international partnerships between resource-limited settings and expert centers can improve global APL outcomes. Ongoing monitoring for measurable residual disease (MRD) recurrence and long-term treatment toxicity, coupled with comprehensive patient evaluations, and experienced management, can enhance long-term outcomes. The clustered incidence of APL, while frequently reported, remains poorly understood. Regular reporting of these clusters could provide valuable insights into disease pathology and aid in developing predictive models for APL incidence, which would guide future resource allocation.

Examining the Nexus Between Renewable Energy, CO2 Emissions, and Economic Factors: Implications for Countries Marked by High Rates of Coronary Heart Disease

This study investigates the complex interconnections between renewable energy adoption, carbon dioxide (CO2) emissions, and economic factors in 50 countries marked by high rates of coronary heart disease (CHD) between 2000 and 2020. Utilizing a sophisticated two-step system generalized method of moments (GMM) estimator and panel data method, our analysis reveals a significant negative impact of renewable energy on greenhouse gas emissions, emphasizing the role of sustainable energy sources in mitigating environmental and quality of life degradation. Additionally, our findings support the existence of the environmental Kuznets curve (EKC), demonstrating an inverted U-shaped relationship between gross domestic product (GDP) per capita and CO2 emissions. In line with nascent studies, the EKC for CO2 emissions suggests that as a country’s GDP per capita increases, the CO2 emissions initially rise but eventually decline after reaching a certain level of economic development, forming an inverted U-shaped relationship. Specifically, nations facing high cardiovascular heart disease mortality rates display an important link between renewable energy integration and improved environmental quality. These insights underscore the urgency for countries to transition rapidly to green energy, advocating for policies that promote renewable technologies through partnerships between the public, private sector, and government entities. Furthermore, the study emphasizes the necessity of innovative structural reforms in developing countries to stimulate economic growth beyond the EKC turning point, ensuring sustainable development while curbing their carbon footprint resulting from economic activities. Future research should explore the broader global contexts, considering variables like social capital and globalization to inform targeted policies aimed at safeguarding public health and the environment.

Novel therapeutic agents for cardiometabolic risk mitigation in heart transplant recipients.

Heart transplant (HT) recipients experience high rates of cardiometabolic disease. Novel therapies targeting hyperlipidemia, diabetes, and obesity, including proprotein convertase subtilisin/kexin inhibitors, sodium-glucose cotransporter-2inhibitors, and glucagon-like peptide-1agonists, are increasingly used for cardiometabolic risk mitigation in the general population. However, limited data exist to support the use of these agents in patients who have undergone heart transplantation. Herein, we describe the mechanisms of action and emerging evidence supporting the use of novel pharmacologic agents in the post-HT setting for cardiometabolic risk mitigation and review evidence supporting their ability to modulate immune pathways associated with atherogenesis, epicardial adipose tissue, and coronary allograft vasculopathy.

BLASTOCYSTIS HOMINIS INFECTION IN CHILDREN WITH HIV/AIDS DURING COVID-19 RELATED DISRUPTION ERA: A CROSS-SECTIONAL STUDY

Introduction: The coronavirus disease 2019 (COVID-19) epidemic has resulted in significant disruption to health services in multiple nations. In Indonesia, the impact occurred on changes in services for HIV/AIDS patients. As a result, there is a high rate of parasitic co-infection disease, including Blastocystis hominis. Prior research indicates that the occurrence of this illness varies greatly among individuals with HIV/AIDS, with rates ranging from 3.86% to 72.40%. Aims: The objective of this study is to ascertain the prevalence and molecular epidemiology of infection, develop a predictive model, and examine the correlation between clinical symptoms and the severity of Blastocystis results. Methods: Thirty-eight children with HIV/AIDS in Yogyakarta-Indonesia, from May until August 2021 were examined by direct examination, culture, PCR, and sequencing. In addition, a structured questionnaire was used to obtain additional data regarding baseline information and other factors influencing Blastocystis infection. The results obtained were subjected to phylogenetic, univariate and multivariate data analysis. Results: Out of the 38 samples studied, 26 (68.4%) were positive for Blastocystis. The results of sequencing demonstrated the finding of subtype 3 (ST3) and subtype 4 (ST4). From univariate and multivariate analysis, a longer duration of therapy is a predictor of Blastocystis infection (AOR 6.54, P=0.04). The relationship between clinical manifestations and intensity of Blastocystis findings showed a non-significant association (P&gt;0.99). Conclusion: Children with HIV/AIDS had a significantly high incidence of Blastocystis infection, potentially attributed to the interruption of services resulting from the COVID-19 pandemic.

Efficacy and safety of bendamustine, rituximab and bortezomib treatment in relapsed/refractory Waldenstrom Macroglobulinaemia: results of phase 2 single-arm FIL-BRB trial.

This multicentre phase II study Fondazione Italiana Linfomi (FIL)-bortezomib plus rituximab plus bendamustine (BRB) tested a combination of bendamustine (90 mg/m2 on days 1-2), rituximab (375 mg/m2 intravenously on day 1) and bortezomib (1.3 mg/m2 sc on days 1, 8, 15, 22) every 28 days for six cycles in 38 symptomatic patients with relapsed/refractory Waldenstrom macroglobulinaemia (RR-WM). Moreover, MYD88L265P and CXCR4S338X mutations were tested by droplet digital polymerase chain reaction (ddPCR) both at baseline and at the end of treatment in 21 patients. Overall response rate at the end of therapy was 84.6%, including 4 (11%) complete remission, 15 (39%) very good partial response, 12 (32%) partial responses according to IWWM response criteria. At 18, 24 and 30 months, progression-free survival was 84.2% (95% CI 68.2%-92.6%), 81.5% (95%CI 65.1-90.7) and 78.8% (95%CI 62.0-88.8) respectively. At 18 months, the Overall survival was 92.1% (95%CI 77.5%-97.4%). Overall, 19 patients (50%) experienced grade 3-4 haematological toxicity, mainly thrombocytopenia, and grade 1-3 neuropathy rate was about 10% and required bortezomib dose reduction but did not result in treatment interruption. Moreover, BRB treatment induced the high rates of undetectable molecular minimal residual disease (MRD) at the end of the therapy. BRB regimen used as second line is an effective and well-tolerated salvage treatment for relapsed refractory Waldenstrom macroglobulinaemia patients. MRD monitoring showed promising efficacy in clearing the residual disease.

Social Determinants of Health and Health-Related Social Needs Among Adults With Chronic Diseases in the United States, Behavioral Risk Factor Surveillance System, 2022.

The relationship between social determinants of health (SDOH) and health-related social needs (HRSN) and some chronic diseases at the population level is not well known. We sought to determine relationships between SDOH/HRSN and major chronic diseases among US adults by using data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS). We used data from the new Social Determinants and Health Equity (SD/HE) module, conducted in 39 states, the District of Columbia, and 2 territories as part of the 2022 BRFSS. These data yielded a sample of 324,631 adult participants (aged ≥18 y). We examined 12 indicators of SDOH/HRSN and 9 chronic diseases. We calculated weighted prevalence estimates for each SDOH/HRSN measure for each chronic disease and associations between each SDOH/HRSN and each chronic disease. Two-thirds of participants (66.3%) had 1 or more chronic diseases, and 59.4% reported 1 or more adverse SDOH/HRSN. Prevalence estimates for individual SDOH/HRSN measures were generally higher among participants with chronic diseases (except cancer). The more chronic diseases reported, the more likely participants were to have SDOH/HRSN (P < .05 for linear trend). The leading SDOH/HRSN measures associated with each chronic disease varied; however, the most common were mental stress, receiving food stamps or participating in the Supplemental Nutrition Assistance Program, cost as a barrier for needed medical care, and life dissatisfaction. From a treatment and prevention perspective, health care providers should consider the influence of SDOH/HRSN on people with or at risk for chronic diseases. Additionally, human service and public health systems in communities with high rates of chronic disease should consider these findings as they plan to mitigate adverse SDOH.

Vaccination Communication Strategies and Uptake in Africa: A Systematic Review.

Background: African countries experience high rates of infectious diseases that are mostly preventable by vaccination. Despite the risks of infections and other adverse outcomes, vaccination coverage in the African region remains significantly low. Poor vaccination knowledge is a contributory factor, and effective communication is crucial to bridging the vaccination uptake gap. This review summarises vaccination communication strategies adopted across African countries and associated changes in vaccine uptake. Methods: A systematic search was conducted in five bibliographic databases between 2000 and 2023 and supplemented with an additional Google Scholar search. Studies with data on vaccination communication and uptake in the English language were considered. A narrative synthesis was performed, and findings were presented in text and tables. Findings: Forty-one studies from fourteen African countries met the inclusion criteria. Several communication strategies were implemented for 13 different vaccines, mainly childhood vaccines. Mass campaigns and capacity building were the most common strategies for the public and health workers, respectively. Community-based strategies using social mobilisation effectively complemented other communication strategies.Overall, vaccination uptake increased in all countries following vaccination communication interventions. Barriers and facilitators to optimising vaccination communication at systemic and individual levels were also identified. Key barriers included lack of vaccine information, access issues, and high cost, while facilitators included improved vaccine education, reminders, trust-building initiatives, and community involvement. Conclusions: This review highlights effective vaccination communication strategies implemented across Africa as well as systemic and individual barriers and facilitators influencing vaccination uptake. The findings can inform strategies for vaccination communication and campaign planning to improve vaccination coverage in Africa.

Genetic risk factors for Mesoamerican nephropathy

Mesoamerican nephropathy (MeN) is a progressive kidney disease found on the Pacific coast of Central America primarily in young male agricultural workers without typical kidney disease risk factors. While it is generally accepted that environmental exposures contribute to MeN, we hypothesized that there was also an important genetic component. We performed a genome-wide association study comparing individuals with MeN versus individuals with normal kidney function. We found that Native American ancestry was strongly associated with increased risk of MeN. We also identified candidate variants in the OPCML gene, which encodes a protein that binds opioid receptors, that were associated with ~sixfold reduced odds of MeN (allele frequency 0.029 in controls and 0.005 in cases, OR = 0.16; P = 4 × 10-8). Sugarcane workers with the protective OPCML variants had markedly increased urine osmolality suggesting greater ability to defend against hypovolemia. Experiments with Opcml knock-out mice revealed roles for OPCML in fluid balance and temperature regulation consistent with our findings in humans. Our data suggest that heritable differential sensitivity to heat stress and dehydration contributes to high rates of kidney disease in Central America.