Preventive Interventions Research Articles

A prediction model for differential resilience to the effects of combat-related stressors in US army soldiers.

To develop a composite score for differential resilience to effects of combat-related stressors (CRS) on persistent DSM-IV post-traumatic stress disorder (PTSD) among US Army combat arms soldiers using survey data collected before deployment. A sample of n=2542 US Army combat arms soldiers completed a survey shortly before deployment to Afghanistan and then again two to three and 8-9months after redeployment. Retrospective self-reports were obtained about CRS. Precision treatment methods were used to determine whether differential resilience to persistent PTSD in the follow-up surveys could be developed from pre-deployment survey data in a 60% training sample and validated in a 40% test sample. 40.8% of respondents experienced high CRS and 5.4% developed persistent PTSD. Significant test sample heterogeneity was found in resilience (t=2.1, p=0.032), with average treatment effect (ATE) of high CRS in the 20% least resilient soldiers of 17.1% (SE=5.5%) compared to ATE=3.8% (SE=1.2%) in the remaining 80%. The most important predictors involved recent and lifetime pre-deployment distress disorders. A reliable pre-deployment resilience score can be constructed to predict variation in the effects of high CRS on persistent PTSD among combat arms soldiers. Such a score could be used to target preventive interventions to reduce PTSD or other resilience-related outcomes.

Beyond anosmia: olfactory dysfunction as a common denominator in neurodegenerative and neurodevelopmental disorders

Olfactory dysfunction has emerged as a hallmark feature shared among several neurological conditions, including both neurodevelopmental and neurodegenerative disorders. While diseases of both categories have been extensively studied for decades, their association with olfaction has only recently gained attention. Olfactory deficits often manifest already during prodromal stages of these diseases, yet it remains unclear whether common pathophysiological changes along olfactory pathways cause such impairments. Here we probe into the intricate relationship between olfactory dysfunction and neurodegenerative and neurodevelopmental disorders, shedding light on their commonalities and underlying mechanisms. We begin by providing a brief overview of the olfactory circuit and its connections to higher-associated brain areas. Additionally, we discuss olfactory deficits in these disorders, focusing on potential common mechanisms that may contribute to olfactory dysfunction across both types of disorders. We further debate whether olfactory deficits contribute to the disease propagation or are simply an epiphenomenon. We conclude by emphasizing the significance of olfactory function as a potential pre-clinical diagnostic tool to identify individuals with neurological disorders that offers the opportunity for preventive intervention before other symptoms manifest.

The Comparison of Oropharyngeal Dysphagia in Alzheimer's Disease versus Older Adults with Presbyphagia.

Dysphagia is defined as difficulty in swallowing, while presbyphagia is described as a change in swallowing process in healthy older adults, which is a compensable physiological impairment and synonymous with dysphagia. Aging is a well-known risk factor for Alzheimer's disease (AD), and oropharyngeal dysphagia (OD) is a common condition in AD. Our study aims to compare OD in AD patients and older adults with presbyphagia (OAwP). 65 older adults (AD = 32, mean age:76.5 ± 6; OAwP = 33, mean age:71.1 ± 4) were included. Swallowing disorders were evaluated by Flexible Endoscopic Evaluation Study, which scored by Penetration Aspiration Scale (PAS) that scores other than 1 indicate dysphagia, Murray Secretion Severity Scale (MSSS), and Eating Assessment Tool-10 (EAT-10). Neurologist determined Clinical Dementia Rating (CDR) scores of AD patients. AD and OAwP groups had OD, respectively, 96.87% vs. 81.81% by PAS, 87.5% vs. 60.60% by MSSS, and 56.25% vs. 18.18% by EAT-10. No statistical differences were observed between AD and OAwP in terms of gender, age, PAS, and MSSS values (p > 0.05). There was a significant difference in EAT-10 total scores (p = 0.000), and had OD by EAT-10 (p = 0.024). No differences were found in age, time elapsed since diagnosis, PAS, and EAT-10 scores based on CDR, but there was a difference in MSSS scores (p = 0.013). CDR in AD were associated with gender, time elapsed since diagnosis, and MSSS scores (p < 0.05). OAwP experience swallowing problems at least as much as those with AD. Evaluation of swallowing disorders after diagnosis is essential for both AD and OAwP. Early-stage management of disease with preventive treatment approaches can delay onset of symptoms.

Assessment of parental attitude, knowledge and awareness towards preventive dentistry in south zone of Chhatrapati Sambhajinagar: A questionnaire based cross sectional survey

Introduction: Oral health is a pivotal aspect of overall well-being. In early childhood, primary teeth play a vital role in development of speech, chewing, maintaining proper spacing, and guiding the eruption of permanent teeth. Common oral conditions comprise dental caries, malocclusion, childhood caries, and trauma. Aim: The present study was conducted to assess paternal knowledge towards the forestallment of oral conditions and application of preventive dental procedures in children in South zone of Chhatrapati Sambhajinagar. Materials and Methods: A cross-sectional questionnaire was administered to parents of pediatric patients of age group 3 to12 years in South zone of Chhatrapati Sambhajinagar, Maharashtra, with a sample size of 270 participants. A structured questionnaire, comprising 14 questions in English, was developed, translated and back translated into the local language Marathi by experts to ensure better comprehension by the parents. The questionnaire was divided into two sections: the first focused on demographic information, while the second included 14 multiple-choice, close-ended questions. These questions included topics such as preventive treatments for dental caries, childhood caries, topical fluoride application, fluoridated toothpaste, pit and fissure sealants, habit-breaking dental appliances, malocclusion, mouth guards, and space maintainers. Additionally, the survey addressed harmful habits such as thumb-sucking, tongue-thrusting, and nail-biting. Result: 56.6% of parents sought dental care only after experiencing pain. Additionally, parents of paediatric patients have restricted knowledge about preventive dentistry. Conclusion: Parental knowledge about preventive dental procedures is limited, as is the utilization of these measures.

Short-Term Outcomes of a Healthy Relationship Intervention for the Prevention of Sexual Harassment and Sexual Assault in the US Military: Pilot Pretest-Postest Study.

Sexual harassment (SH) and sexual assault (SA) are serious public health problems among US service members. Few SH and SA prevention interventions have been developed exclusively for the military. Code of Respect (X-CoRe) is an innovative web-based, multilevel, SA and SH intervention designed exclusively for the active-duty Air Force. The program's goal is to increase Airmen's knowledge and skills to build and maintain respectful relationships, ultimately reducing SH and SA and enhancing Airmen's overall well-being and mission readiness. This pilot study aimed to assess the short-term psychosocial impact (eg, knowledge, attitudes, and self-efficacy) of the web-based component of X-CoRe on a sample of junior enlisted and midlevel Airmen. Airmen from a military installation located in the Northeastern United States were recruited to complete the 10 web-based modules in X-CoRe (9/15, 60% male; 7/15, 54% aged 30-35 years). Participants were given pretests and posttests to measure short-term psychosocial outcomes associated with SH and SA. Descriptive statistics and paired 2-tailed t tests were conducted to assess differences from preintervention to postintervention time points. After completing X-CoRe, participants had a significantly greater understanding of active consent (P=.04), confidence in their healthy relationship skills (P=.045), and confidence to intervene as bystanders (P=.01). Although not statistically significant (P>.05), mean scores in attitudes about SH, couple violence, and cyberbullying; perceptions of sexual misconduct as part of military life; and relationship skills self-efficacy with a romantic partner and friend also improved. The findings from this study demonstrate X-CoRe's effectiveness in improving critical determinants of SH and SA, making it a promising intervention for SH and SA prevention. More rigorous research is needed to determine X-CoRe's impact on SH and SA victimization and the long-term impact on associated psychosocial determinants.

Associations between academic achievement and internalizing disorders in Swedish students aged 16 years between 1990 and 2018

Abstract Background Rising rates of internalizing disorders and rising rates of school failure among adolescents are growing concerns. Despite the strong association between academic achievement and internalizing disorders, possible links between these two trends have not been investigated. Thus, the aim of this study was to investigate the development of the cross-sectional associations between academic achievement and internalizing disorders in Swedish students aged 16 years between 1990 and 2018. Methods Register data on specialist psychiatric care and prescriptions of psycholeptic and psychotropic drugs were linked to data on students’ school grades in the last year of compulsory school. The total sample size was 3,089,674 students. Logistic regression models with internalizing disorders as the dependent variable, and graduation year and academic achievement as independent variables, were estimated. Results Throughout the period, there was a strong negative association between academic achievement and internalizing disorders. Low-achieving students had by far the highest risks of internalizing disorders. In absolute terms, the increase in internalizing disorders was clearly largest for low-achieving students. The relative risks for low-achieving compared to higher achieving students increased between 1990 and 2010 and declined after 2010. Conclusions This study found consistently large, and at least until 2010 growing, achievement-related inequalities in internalizing disorders among Swedish adolescents between 1990 and 2018, with the lowest achieving students having disproportionally high risks. The increasingly pronounced concentration of internalizing disorders in the lowest rungs of the achievement distribution suggests that preventive interventions should focus on supporting this doubly disadvantaged group of students.

COMPLICATIONS AND RISKS ASSOCIATED WITH PROLONGED PARENTERAL NUTRITION IN PEDIATRIC AND NEONATAL ICU PATIENTS: A SYSTEMATIC REVIEW

Objective: The general objective of this study is to analyze the scientific literature on the complications and risks associated with prolonged parenteral nutrition in pediatric and neonatal patients in intensive care units (ICU), aiming to ensure greater knowledge about this therapeutic practice and its clinical implications. Methodology: The searches were performed through searches in the PubMed Central (PMC) databases. Three descriptors were used in combination with the Boolean term “AND”: Parenteral Nutrition, Neonatal Intensive Care Unit and Risk Factors. A total of 101 articles were found, which were subsequently submitted to the selection criteria. After applying the inclusion and exclusion criteria, 20 studies were selected, of which 10 articles were used for detailed analysis. Results: Parenteral nutrition (PN) is essential in the care of premature newborns and critically ill pediatric patients. However, it is associated with several potential complications, including hepatobiliary, infectious, mechanical and metabolic problems such as hyperglycemia and hypertriglyceridemia. Administration of PN requires careful planning and strict safety policies to minimize risks and maximize clinical benefits. Prolonged PN can lead to serious complications, such as catheter-associated bloodstream infections, cholestasis, and liver dysfunction. Conclusion: Prolonged PN in pediatric and neonatal ICU patients is associated with significant risks that require close surveillance and preventive interventions. Continuous monitoring of glucose, triglyceride levels, and liver function, as well as rigorous infection control practices, are crucial to ensure the safety and efficacy of PN. Further studies are needed to identify management strategies that can reduce these complications and improve clinical outcomes.

A Tailored Postpartum eHealth Physical Activity Intervention for Individuals at High Risk of Postpartum Depression-the POstpartum Wellness Study (POW): Protocol and Data Overview for a Randomized Controlled Trial.

Postpartum depression (PPD) is associated with significant health consequences for the parent and child. Current recommendations for PPD prevention require intense health care system resources. Evidence-based interventions for PPD prevention that do not further burden the health care system are needed. Evidence suggests that physical activity (PA) can generally reduce depressive symptoms. Technology-based interventions may help decrease common barriers to PA. This study aims to report the protocol and provide a data overview of the POstpartum Wellness study (POW)-an effectiveness trial evaluating whether an eHealth PA intervention tailored for postpartum individuals increased PA and decreased depressive symptoms among individuals at high PPD risk. This remote parallel-group randomized controlled trial included postpartum individuals with a history of depression or at least moderate current depressive symptoms not meeting the PPD diagnostic threshold and with low PA levels from an integrated health care delivery system. Participants were randomized to an eHealth PA intervention or usual care. The intervention group received access to a library of web-based workout videos designed for postpartum individuals, which included interaction with their infants. At baseline and follow-up (3 and 6 months), PA was measured using questionnaires and a wrist-worn accelerometer. Depressive symptoms were measured using the Patient Health Questionnaire-8 (PHQ-8). Data were collected to assess exploratory outcomes of sleep, perceived stress, anxiety, parent-infant bonding, and infant development. The study was funded in January 2020. Participants were enrolled via REDCap (Research Electronic Data Capture) or telephonically between November 2020 and September 2022; data collection ended in April 2023. Randomized participants (N=99) were 4 months post partum at baseline with moderately severe depressive symptoms (mean PHQ-8 score 12.6, SD 2.2). Intervention (n=50) and usual care (n=49) groups had similar sociodemographic characteristics, months post partum, baseline depressive symptoms, number of children at home, and prepregnancy PA levels. Retention in assessments was ≥66% for questionnaires and ≥48% for accelerometry, with modest differences by group. At 3-month follow-up, 73 of 99 (74%) participants (intervention: 35/50, 70%; usual care: 38/49, 78%) completed questionnaires; 53 of 99 (54%) wore the accelerometer for 7 days (27 of 50 (54%) intervention, 26 of 49 (53%) usual care). At 6-month follow-up, 66 of 99 (67%) participants (30 of 50 (60%) intervention, 36 of 49 (73%) usual care) completed questionnaires and 43 of 99 (43%) wore the accelerometer for 7 days (21 of 50 (42%) intervention, 22 of 49 (45%) usual care). Data analysis is completed, and a manuscript with these findings is currently under review for publication. The POW trial evaluates the effectiveness of an eHealth PA intervention for improving depressive symptoms and increasing PA among postpartum individuals at high PPD risk. Results have implications for the design and delivery of behavioral interventions among vulnerable patients. ClinicalTrials.gov NCT04414696; https://clinicaltrials.gov/ct2/show/NCT04414696. DERR1-10.2196/56882.

Financing immunisation in Kenya: examining bottlenecks in health sector planning and budgeting at the decentralised level

BackgroundDecentralisation has increasingly been adopted by countries as an important health sector reform aimed at increasing community participation in decision making while enhancing swift response at decentralised levels, to accelerate the attainment of health system goals. Kenya adopted a devolved system of government where health services delivery became a function of the 47 semi-autonomous county governments with planning and budgeting functions practised at both levels of government. This study sought to explore challenges facing health sector planning and budgeting and how they affect immunisation service delivery at the county level.MethodsData were collected through 77 in-depth interviews of senior county department of health officials across 15 counties in Kenya. We applied an inductive thematic approach in analysing the qualitative data using NVIVO software.FindingsThe study found a lack of alignment between planning and budgeting processes, with planning being more inclusive compared to budgeting. Inadequate capacity in conducting planning and budgeting and political interference were reported to hinder the processes. Limited budget allocations and delayed and untimely disbursement of funds were reported to affect execution of health and immunisation budgets. Low prioritisation of preventive health interventions like immunisation due to their perceived intangibility influenced resource allocation to the programs.ConclusionThe findings highlight the need for effective strategies to align planning and budgeting processes, increased technical support to counties to enhance the requisite capacity, and efforts to improve budget execution to improve budget credibility. Counties should plan to increase their funding commitment toward immunisation to ensure sustainability of the program as Kenya transitions from GAVI support.

Progress in Investigating the Relationship between Omega-3 Polyunsaturated Fatty Acids and Coronary Heart Disease (CHD)

Coronary heart disease (CHD) is a globally common cardiovascular disorder, characterized by atherosclerotic lesions in the coronary arteries, leading to narrowing or blockage of the vessels, which subsequently causes myocardial ischemia, hypoxia, and even necrosis. This condition significantly impacts the daily life of patients and represents a major contributor to both morbidity and mortality on a global scale. Omega-3 polyunsaturated fatty acids (ω-3 PUFA), Principally extracted from marine pisces and certain plants, have been increasingly shown in recent years to be closely associated with various pathophysiological mechanisms related to CHD, which holds significant value in the prevention and treatment of CHD. This review offers a comprehensive summary of the sources of ω-3 PUFA, explores the pathophysiological mechanisms of CHD, and offers an in-depth analysis of the multifaceted contribution of ω-3 PUFA in mitigating the susceptibility to CHD, particularly focusing on their effects on lipid metabolism, endothelial function, and inflammatory pathways, thereby contributing new research perspectives for the tactics for the risk mitigation and administration of CHD, including both preventive measures and therapeutic interventions.

Modulating the organization of medical care and early diagnosis of prostate cancer

Aim. To analyze the existing system of medical care organization and timely diagnostics for prostate cancer (PC).Materials and Methods. The study utilized data from official statistics to analyze the system of medical care organization and the diagnostic methods applied for prostate cancer at different stages.Results. In the country, medical care for patients with prostate cancer is organized into three levels. The first level involves family physicians, urologists, and oncologists in oncology clinics, where access to modern diagnostic facilities is limited. The second level provides advanced diagnostic services through regional oncology centers and major urology departments. The third level offers specialized care at the National Cancer Research Center (NCRC) and select urology clinics. Based on the experience of other countries, it is recommended to improve the system of medical care for prostate cancer by establishing four stages of care. The proposed model takes into account the real situation, emphasizing the need for prevention, timely diagnosis, and effective treatment in accordance with clinical protocols, as well as the coordinated use of human and technological resources from oncology, urology, and morphological services at all stages.Conclusions. The proposed model for organizing medical care, based on evidence-based practices, aims to improve early detection of prostate cancer, enhance the clinical effectiveness of treatment, and optimize the use of resources.

Deciphering the Symptom Spectrum: A Comprehensive Analysis of Migraine Patterns and Types

Complex neurological diseases like migraine migraine affect a large section of the global population, causing health, social, and economic issues. Migraine causes intense, painful headaches that are usually one-sided and pulsing. Auras, nausea, vomiting, and excessive light and sound sensitivity may precede these episodes. Migraine affect millions worldwide and can be intermittent or persistent, impairing function. Diet and stress may induce it, but the cause is unknown. Prevention and symptom treatment drugs and lifestyle changes are used. Debilitating migraines are hard to diagnose due to their varied presentation and subjective symptom reporting. Traditional migraine diagnosis, based on clinical evaluation, typically fails to classify migraine types, requiring more objective and rigorous instruments. This study proposes a machine learning-based migraine categorization method to address this issue. The dataset includes different patient demographics and clinical variables; thus, we use complex algorithms like Random for Forest, XGBoost, and Extra Trees. These algorithms are great for deciphering migraine patterns because they excel at evaluating complex datasets. The research seeks to close this gap to improve migraine classification accuracy, objectivity, and reliability, enabling tailored migraine management and treatment. This neurology study could im- prove migraine diagnosis and treatment with more effective and personalized plans.

Short-term high-fat and high-carb diet effects on glucose metabolism and hedonic regulation in young healthy men

BackgroundDaily dietary intake of macronutrients and energy is closely associated with long-term metabolic health outcomes, but whether 24-h nutritional intervention under isocaloric conditions leads to changes in metabolism remains unclear. Moreover, the short-term effect of diets with different macronutrient composition on hedonic appetite regulation is less clear.MethodsThis study examined the impact of an acute high-fat (F+) and high-carbohydrate (C+) diet on glucose metabolism and hedonic regulation of food intake in young healthy men under controlled conditions. Using a cross-over design, 19 male participants received a one-day isocaloric diet with different macronutrient composition (F+ = 11% carbohydrates, 74% fat; C+ = 79% carbohydrates, 6% fat) compared to a control diet (CON = 55% carbohydrates, 30% fat). Protein content was set at 15% of energy in all diets. The feeling of hunger, as well as “liking” and “wanting” for foods, was assessed through visual analog scales, and blood samples for glucose, insulin, and cortisol levels were assessed repeatedly during the experimental day. An intravenous glucose tolerance test was conducted the next morning.ResultsPostprandial glucose and insulin levels were lowest in F+ over the 24 h. Except for dinner, the CON diet showed the highest mean values in glucose. F+ diet improved insulin resistance, lowering Homeostatis Model Assessment Insulin Resistance (HOMA-IR) values. Changes in hedonic regulation of food intake were not observed during the intervention between the diets, except for higher feelings of satiety under the CON diet.ConclusionAn acute, isocaloric, high-fat diet improved insulin resistance even in healthy individuals but did not affect hedonic food intake regulation. Macronutrient composition modulate glucose metabolism even under short-term (24-h) and isocaloric diets, which should be considered for personalized preventive dietary treatments.

Evaluation of the common skin diseases in patients with malignancies and the cutaneous side effects of cancer treatments

Purpose The diversity of skin diseases in patients with malignancies leads to diagnostic difficulties and complicate cancer treatment. Furthermore, the increasing use of chemotherapy drugs and novel treatment regimens raises the risk of the development of various cutaneous side effects and the need for dermatologists during cancer management. We investigated the skin diseases in patients with malignancies and the cutaneous side effects of cancer treatments. Methods Medical records of cancer patients evaluated in the Dermatology clinic between July 2018 and April 2023 were retrospectively reviewed. Results This study included 872 cancer patients, 374 females and 498 males. Acute myeloid leukaemia was the most common malignancy, followed by multiple myeloma and invasive ductal breast carcinoma. Graft versus host disease was observed in 89 (10.2%) patients after stem cell transplantation and radiodermatitis developed in 16 (1.8%) patients. Maculopapular drug eruption and hand foot syndrome were the most common cutaneous side effects of chemotherapy drugs. Capecitabine was the most common etiologic agent in hand foot syndrome. Cellulitis was the most frequent bacterial infection in cancer patients, whereas herpes zoster was the most frequent viral infection. Among the chemotherapy drugs that caused acneiform drug eruption, cetuximab and cytarabine were notable. Facial erythema was associated with cytarabine use in 27.3% of patients. Conclusion Identifying the common skin diseases in cancer patients and cutaneous side effects due to chemotherapy drugs may help to take preventive measures, develop specific and effective treatments, determine the most appropriate cancer treatment options, and increase patients’ compliance with cancer treatment.

Profiles of Sexual Economic Exchanges among Women in Kisumu, Kenya: A Latent Class Analysis.

Sexual economic exchanges, including sex work and transactional sex, have been consistently associated with HIV acquisition among young women in sub-Saharan Africa. Heterogeneity in HIV vulnerability across overlapping types of sexual economic exchange has not been sufficiently explored, limiting appropriate and effective linkage to prevention interventions. From January 2017 to May 2018, cross-sectional data were captured at screening for entry into an HIV incidence cohort in Kisumu, Kenya. Men and women aged 18-35years completed a socio-behavioral questionnaire. Latent class analysis was used to classify sexually active women into discrete groups based on self-identification of occupational sex and other sexual exchanges, including exchange for money, gifts, food, school fees, substances, shelter/rent, and/or clothing. Profiles examined characteristics within and across typologies. Mixed logistic regression models assessed demographic and socio-behavioral characteristics associated with probabilistic class membership. A total of 1063 participants were screened, of whom 536 (50.4%) were sexually active women (median age: 27years [interquartile range 23-30]). Sexual economic exchange was reported by 403 (77.2%) sexually active women, who most commonly reported recent exchange of sex for money (73.9%), gifts (19.6%), food (25.9%), and substances (17.7%); 44.6% reported selling sex as a primary or secondary occupation. Three profiles of sexual economic exchange were identified, each with distinct demographic, behavioral, and occupational characteristics: exchange for money and other necessities (23.3% prevalence), exchange for primarily money (38.2% prevalence), and sex comprising limited or no exchange (38.4% prevalence). In mixture modeling, as compared to limited or no exchange, exchange for money and other necessities, and exchange for primarily money were both associated with increased age, higher number of partners, and partners at least 10years older. Heterogeneous patterns of sexual economic exchange were observed among women in Kenya reflect the different motivations and pathways by which women exchange sex. Female sex workers are often considered a homogeneous group, but these data highlight the need for differentiated services based on the diverse needs of women who engage in sexual economic exchange.

Exploring the Link between the Obesity and ADHD

Obesity is a chronic, multifactorial and recurrent disease. ADHD is a chronic neurodevelopmental disorder in early childhood. The core symptoms include attention deficit, hyperactivity/impulsivity and oppositional defiance. Research shows that there is a significant correlation between obesity and ADHD, and the probability of overweight and obese children suffering from ADHD is significantly higher than that of normal weight children. This paper discusses the association mechanism between ADHD and obesity from the perspectives of genetics, eating disorders, intestinal flora and poor physical exercise. At the same time, in view of the prevention and intervention of the comorbidity of ADHD and obesity, this paper also puts forward various means such as diet intervention, exercise prevention intervention and drug treatment. However, the relationship between obesity and ADHD is complex, and the comorbidity problem needs to be solved urgently. Establishing an effective early screening system, implementing targeted prevention and intervention measures, and strengthening public awareness and understanding of comorbidities are important ways to improve the quality of life of this group. Further research is needed in the future.

Prevalence and predictors of malaria in pregnant women in Sub-Saharan Africa: a systematic review and meta-analysis

Malaria remains a significant threat to pregnant women in sub-Saharan Africa. This systematic review and meta-analysis aims to estimate the prevalence and identify predictors of malaria infection among pregnant women in the region. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a comprehensive search of PubMed Central, Google Scholar, EMBASE, ScienceDirect, and Cochrane Library was conducted, including 15 studies published between 2013 and 2023. The pooled prevalence of malaria, calculated using a random-effects model, was 19.0% (95% CI: 0.13-0.26), with heterogeneity (I²=81.9%) reflecting geographical and climatic diversity. Prevalence rates ranged from 6.4% in Burkina Faso to 36.4% in Tanzania. Asymptomatic cases had a prevalence of 19.0% (95% CI: 0.10-0.38), while symptomatic cases were slightly lower at 17.0% (95% CI: 0.12-0.23). Predictors of malaria included maternal age, parity, insecticide-treated net usage, intermittent preventive treatment, trimester-specific risk, and education level. These findings underscore the need for targeted, context-specific interventions to mitigate malaria risk among pregnant women in sub-Saharan Africa and inform effective malaria control strategies.

Preventive interventions on vector-borne diseases related to climate change: an Umbrella review

Abstract Background Vector-borne diseases (VBDs) are a global challenge to public health, being influenced by ecological factors and climate change. Despite the several preventive public health interventions that can be implemented, the evidence of their impact is still fragmented. An organic overview of the current evidence can provide relevant information on the effectiveness of these actions. Methods We conducted an umbrella review following the PRIOR checklist. Relevant reviews were searched using PubMed and Cochrane databases. We considered eligible all systematic reviews published in English between 2013 and 2023, containing meta-analysis on public health interventions aimed at reducing incidence, prevalence, or the burden of disease of VBDs, without demographic restrictions. Results We screened 1971 records. 51 reviews were included. 38 reported outcomes targeting Malaria, 9 Dengue, 2 Yellow Fever, 1 Leishmaniasis,1 Zika, 1 Chikungunya, 1 Crimean-Congo haemorrhagic fever, 1 Lyme disease and 1 Schistosomiasis. Several interventions were assessed worldwide. 18 reviews considered chemoprophylaxis, 9 net/curtains, 8 vaccines, 6 repellents, 3 housing interventions, 2 community participation, 2 MTaT and 2 oral supplementations. Authors stated conclusions are favourable to the interventions assessed for the 73%, but the certainty level is mostly considered low. Conclusions Public health preventive interventions are fundamental in responding to the threat of VBDs, but their impact may vary depending on several factors. Further research must provide more effective interventions and strategies, with a cohesive presentation of their evidence. Key messages • Effective reduction of VBDs burden requires a combination of interventions that must be tailored to local ecological, social, and epidemiological factors. • Evidence presented in this umbrella review can inform evidence-based policies and programs aimed at combating VBDs at local, national, and global levels.

Atrial fibrillation, prevention and rehabilitation in a primary healthcare setting. A feasibility study

Abstract Background Atrial fibrillation (AF) often influences daily life with symptoms like palpitations, dyspnoea, fatigue, fear and anxiety. Research show that patients with AF benefit from prevention and rehabilitation interventions. However, evidence is scarce and mainly hospital-based, and it is unknown whether the transition to the primary healthcare sector gives the same positive results. In 2019, a Danish primary care Health Center and the cardiology department at the local hospital completed a multidimensional prevention and rehabilitation intervention for patients with AF. Purpose To investigate the feasibility of delivering a multidimensional prevention and rehabilitation intervention for patients with AF in a primary care Health Center. Methods This study was a mixed-methods, non-randomized, intervention, feasibility study. A convergent mixed-methods design was used, and results were illustrated in side-by-side joint displays. Patients were included at a Hospital AF clinic referring to the Health Center. The prevention and rehabilitation intervention consisted of risk factor management, patient education, physical activity and yoga. Two patient-reported outcomes measures (PROMs) were used, the HeartQoL measuring health-related quality of life (HRQoL) and the Hospital Anxiety and Depression Scale (HADS) measuring symptoms of anxiety and depression. Data were collected at baseline (T0), at end of intervention (T1), and at two-months follow-up (T2) and analysed descriptively. Focus group interviews were analysed thematically and covered experiences of participating, needs and preferences, outcomes and feasibility of collecting PROMs. The reporting was guided by the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot and feasibility trials. Results 43 patients (53% women; median age 66 (range 52-81) years) completed the intervention. Table 1 shows that HRQoL increased, and symptoms of anxiety and depression decreased. These results maintained at follow-up. Figure 1 shows the qualitative themes. Patients experienced being understood and supported by health professionals and peers. They thought it difficult to know what their needs were. However, some patients had specific preferences for interventions. For changes in outcomes, the patients identified that gaining tools and knowledge about the disease from the interventions helped. It was feasible to collect PROMs during the intervention and finally, the patients had an attention to what comes next, when finishing the intervention in the primary care setting. Conclusion It was feasible to deliver a multidimensional prevention and rehabilitation intervention for patients with AF at a primary care Health Center. HRQoL increased and symptoms of anxiety and depression decreased. The patients experienced being supported and gaining tools and knowledge to handle AF. Future large randomized controlled trials must confirm these results.

Long-term continuation to pharmacological treatment for secondary prevention after a myocardial infarction: a register study

Abstract Background Pharmacological treatment for secondary prevention after acute myocardial infarction (MI) is crucial to prevent new events. Several studies report inconsistence and need for improvement of pharmacological treatment. Study follow-up is often less than 10 years and showing that continuation to drug treatment decreases with time. Objective To study long-term follow-up of nationally guideline recommended medical therapy (GDMT) for secondary prevention after a myocardial infarction. Method The study population consisted of individuals aged 18-84 years, who were hospitalized for a MI between January 2006 and December 2022 and were followed up to 16 years. The study subjects were identified through the National Inpatient Register and linked to the Prescribed Drug Register. Four classes of drugs were analyzed: antiplatelet/anticoagulant therapy, lowering therapy, betablockers and angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB). Time-updated survival analyses were used to investigate the relationship between continuation of preventive pharmacological treatment and mortality and recurrent MI after an acute MI. Results A total number of 139 413 individuals (mean age 69.1±10.6) were included and 33.3% were female. At baseline 51.2% had hypertension, 21.5% diabetes mellitus and 15.2% heart failure. All prescriptions of GDMT were decreased significantly after hospitalization after MI and during first years and remained plateau (figure 1). During follow-up 55487 persons died (39.8%, event rate 5.81 per 100 person years [95% CI 5.76-5.86]). Medication with antiplatelets/anticoagulantia, ACEi/ARB and statins decreased risk of all cause-mortality and myocardial infarction [HR 0.83 [95% CI 0.79-0.86], p-value &amp;lt;0.001, HR 0,79 [95% CI 0.77-0.83], p-value &amp;lt;0.001, HR 0.70 [95% CI 0.67-0.73], p-value &amp;lt;0.001) respectively. Conclusion Pharmacological treatment as a part of secondary prevention remained greatly underutilized both shortly and during long-term after MI. Usage of antiplatelets or antigulantia, ACEi or ARB and statins decreased the risk of all-cause mortality and recurrent myocardial infarction.