Non-communicable Disease Research Research Articles

Content Analysis of Food and Beverage Advertisements on TV, Radio, and Billboards in Iran.

Food advertising may influence food preferences and consumption. Due to these advertisements' role in health, the present study has updated the data available on television and radio food advertisements in Iran until 2020. Meanwhile, food advertisements on billboards have been analyzed for the first time. All programs broadcast on two TV and radio channels were downloaded and saved 24 h daily for one week (November 10-16th, 2020). Also, on November 15th billboards located on the busy highways of Tehran were photographed. Validated protocols analyzed the advertisements. A total of 6026 advertisements were analyzed, including 4287 on TV, 1545 on radio, and 194 on billboards. The total duration of TV and radio advertising was 48.6 h. Food products were the most displayed advertisements on TV, radio, and billboards (33.6%). Overall, "condiments" and "desserts" were the most frequently advertised food products among all the studied media (20% and 17%, respectively). The most common advertising appeal included "High quality" on TV and billboards and "Stimulation of profiteering and profit-seeking" on the radio. Advertising violation based on Iran's regulations, Nutrient profile model for the marketing of food and non-alcoholic beverages to children in the WHO Eastern Mediterranean Region, and International Network for Food and Obesity / Non-communicable Diseases (NCDs) Research Monitoring and Action Support (INFORMAS) was reported to be 13%, 74%, and 51%, respectively. Food products ranked the highest among all the advertisements. A clear violation of domestic and international advertising regulations was observed which given the high share of food advertising in the studied media, could endanger public health. This study supports the need for stricter regulations and adherence to international standards to improve nutritional status.

Strengthening policy engagement when scaling up interventions targeting non-communicable diseases: insights from a qualitative study across 20 countries.

Policy engagement is an essential component of implementation research for scaling up interventions targeting non-communicable diseases (NCDs). It refers to the many ways that research team members, implementers and policymakers, who represent government decision-making, connect and interact to explore common interests. Well-conducted engagement activities foster co-production, local contextualization and assist in the successful translation of research evidence into policy and practice. We aimed to identify the challenges and facilitators to policy engagement during the early implementation phase of scale-up research studies. This qualitative study was focused on the research projects that were funded through the Global Alliance for Chronic Diseases in the 2019 round. Nineteen project teams opted to participate, with these studies implemented in 20 countries. Forty-three semi-structured stakeholder interviews, representing research, implementation and government were undertaken between August 2020 and July 2021. Transcripts were open-coded using thematic analysis to extract 63 codes which generated 15 themes reflecting both challenges and facilitators to undertaking policy engagement. Knowledge of the local government structures and trusting relationships provided the foundation for successful engagement and were strengthened by the research. Four cross-cutting concepts for engagement were identified and included: (1) the importance of understanding the policy landscape; (2) facilitating a network of suitable policy champions, (3) providing an environment for policy leaders to genuinely contribute to co-creation and (4) promoting two-way learning during researcher-policymaker engagement. We recommend undertaking formative policy analysis to gain a strategic understanding of the policy landscape and develop targeted engagement plans. Through engagement, researchers must facilitate cohesive vision and build a team of policy champions to advocate NCD research within their networks and spheres of influence. Ensuring equitable partnerships is essential for enabling local ownership and leadership. Further, engagement efforts must create a synergistic policymaker-researcher lens to promote the uptake of evidence into policy.

Funding sources for public health research in Italy.

Funding sources play a critical role in shaping the landscape of scientific research, including the one in public health, as they often determine not only the feasibility of specific projects but also its broader directions. We aimed at assessing current funding sources for public health research in Italy and related implications. We conducted a systematic PubMed search from January 2023 to June 2024, focusing on publications by 208 Italian tenured professors in hygiene and public health. We included only original articles they authored as first or last authors, excluding editorials, comments, and letters. We categorized funding sources into public internal, public external, private external, and unmentioned. We retrieved 760 non-duplicate eligible publications. Research topics focused almost equally on communicable (48.2%) and non-communicable (51.8%) diseases. Public external funding were the most common overall (33.7%), followed by private external (14.3%) and public internal (7.5%). Notably, 58.7% of studies did not report any funding sources. Private external, regional and EU sources predominantly funded communicable disease research, while non-communicable disease research received more support from public external sources, especially governmental. In a European country such as Italy the funding landscape in public health research appears to be complex, due to the wide range of topics and intertwined roles of funding actors. Public funding are more frequent than private funding also independently of research topics, though most research activities did not require specific financial support, implying that public health research frequently has limited financial needs. This likely enables more flexibility and independence to investigators in public health, with major implications in terms of feasibility and absence of conflicts of interest.

Balancing realist review outputs with the needs of policymakers and practitioners.

A realist review is a theory-driven approach to synthesizing evidence based on the realist philosophy of science. Realist reviews are conducted to provide the policy and practice community with a rich, detailed, and practical understanding of complex social interventions that will likely be of much more use to them when planning and implementing programs. Robust realist reviews must balance philosophical engagement, methodological rigor, and relevance to practice. Nevertheless, they have been criticized for being more philosophically inclined and less methodologically robust, with findings that have little implication for practice. Using the philosophy/Epistemology→methodology→theory→practice concept flow, we report how we balanced philosophical principles and practical insights in a recently conducted realist review on participatory practices that impact the benefits of non-communicable disease research and interventions in low- and middle-income countries. If realist review reviews are not comprehensible enough for these practitioners, their utility and relevance may suffer from being limited to a specialist cohort of academics. We propose that realist review findings and outputs must be framed and communicated to meaningfully engage practitioners without undertaking translational efforts.

Barriers and facilitators to dissemination of non-communicable diseases research: a mixed studies systematic review.

There is a large number of research studies about the prevention of non-communicable diseases (NCD), with findings taking several years to be translated into practice. One reason for this lack of translation is a limited understanding of how to best disseminate NCD research findings to user-groups in a way that is salient and useful. An understanding of barriers and facilitators to dissemination is key to informing the development of strategies to increase dissemination. Therefore, this review aims to identify and synthesise the barriers and facilitators to dissemination of NCD research findings. A mixed studies systematic review was performed following JBI (formerly known as Joanna Briggs Institute) methodology. The search included articles from January 2000 until May 2021. We conducted a comprehensive search of bibliographic and grey literature of five databases to identify eligible studies. Studies were included if they involved end-users of public health research that were decision-makers in their setting and examined barriers/facilitators to disseminating research findings. Two pairs of reviewers mapped data from included studies against the Framework of Knowledge Translation (FKT) and used a convergent approach to synthesise the data. The database search yielded 27,192 reports. Following screening and full text review, 15 studies (ten qualitative, one quantitative and four mixed methods) were included. Studies were conducted in 12 mostly high-income countries, with a total of 871 participants. We identified 12 barriers and 14 facilitators mapped to five elements of the FKT. Barriers related to: (i) the user-group (n = 3) such as not perceiving health as important and (ii) the dissemination strategies (n = 3) such as lack of understanding of content of guidelines. Several facilitators related to dissemination strategies (n = 5) such as using different channels of communication. Facilitators also related to the user-group (n = 4) such as the user-groups' interest in health and research. Researchers and government organisations should consider these factors when identifying ways to disseminate research findings to decision-maker audiences. Future research should aim to build the evidence base on different strategies to overcome these barriers. The protocol of this review was deposited in Open Science Framework (https://doi.org/10.17605/OSF.IO/5QSGD).

The Africa non-communicable diseases (NCD) Open Lab: Impact of a portfolio of clinical studies to deepen the understanding of NCDs in sub-Saharan Africa.

Clinical research in sub-Saharan Africa (SSA) has often focussed on communicable diseases. However, with the increasing burden of non-communicable diseases (NCDs), there is a need for Africa-specific NCD research. GSK established the Africa NCD Open Lab in 2014. Three calls for proposals were advertised through various media channels. An external independent scientific advisory board, predominantly representing African scientists and NCD experts, reviewed and selected projects to receive funding. An additional programme in the Africa NCD Open Lab was designed to build statistical capability by supporting training initiatives. We assessed the impact of the Africa NCD Open Lab in three ways: scientific quality with impact; research training and professional development; and research environments. We captured metrics through regular reports/interactions with researchers; via a final report; and through exit interviews with principal investigators. Twenty projects in 11 African countries were funded; reports from 18 completed projects are available (data capture is ongoing). Overall, 139 articles have been published in peer-reviewed journals and other data have been presented at conferences and other forums. Most completed projects led to positive outcomes, such as further research, informing policy, or positively impacting clinical care, including three projects that saw changes to regional or national practice guidelines: the CREOLE study in Nigeria; the African Severe Asthma Program in Uganda; and the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension in South Africa. Participation in the Africa NCD Open Lab led to the award of 34 grants related to or influenced by increased research capacity or experience. Significant professional development related to the projects also occurred with higher-level degrees being awarded, including 30 MScs, 30 PhDs, and nine postdoctoral fellowships. Through these projects, research capacity was strengthened across the region by equipping core research facilities, training research staff, strengthening research support services, and supporting the expansion of investigator networks. The completed Africa NCD Open Lab projects demonstrate high-quality research outcomes addressing important health challenges with potential benefits to African populations. Based on the success of the Africa NCD Open Lab, additional funding has been secured to extend the Open Lab initiative.

Strengthening research capacity of early-mid career researchers: Implementation and evaluation of the Excellence in Non-COmmunicable disease REsearch (ENCORE) program.

High-quality training and networking are pivotal for enhancing the research capacity of early- to mid-career researchers in the prevention and control of non-communicable diseases. Beyond building research skills, these professionals gain valuable insights from interdisciplinary mentorship, networking opportunities, and exposure to diverse cultures and health systems. Despite the significance of such initiatives, their implementation remains underexplored. Here, we describe the implementation and evaluation of the Excellence in Non-COommunicable disease REsearch (ENCORE) program, a collaborative initiative between Australia and India that was launched in 2016 and spanned a duration of 3 years. Led by a consortium that included the University of Melbourne and leading Indian research and medical institutions, ENCORE involved 15 faculty members and 20 early-mid career researchers. The program comprised various elements, including face-to-face forums, masterclasses, webinars, a health-technology conference, and roundtable events. ENCORE successfully trained the early-career researchers, resulting in over 30 peer-reviewed articles, 36 conference presentations, and the submission of seven grant applications, three of which received funding. Beyond individual achievements, ENCORE fostered robust research collaboration between Australian and Indian institutions, showcasing its broader impact on strengthening research capacities across borders.

The V-BRCH Project: Strengthening HIV Research Capacity in Nigeria through Intensive Workshops in Implementation Science and Grant Writing.

As persons with HIV live longer as the result of antiretroviral therapy, morbidity from HIV-associated noncommunicable diseases (NCDs) is increasing. The Vanderbilt-Nigeria Building Research Capacity in HIV and Noncommunicable Diseases program is a training platform created with the goal of training a cohort of successful Nigerian investigators to become leaders in HIV-associated NCD research. We describe survey findings from two week-long workshops in Kano, Nigeria, where trainees received instruction in implementation science and grant writing. Surveys assessed participants' self-perceived knowledge and confidence in topics taught during these workshops. Thirty-seven participants (all assistant professors) attended the implementation science workshop; 30 attended the grant-writing workshop. Response rates for the implementation science workshop were 89.2% for the preworkshop survey and 91.9% for the postworkshop survey. For the grant-writing workshop, these values were 88.2% and 85.3%, respectively. Improvement in participant knowledge and confidence was observed in every domain measured for both workshops. On average, a 101.4% increase in knowledge and a 118.0% increase in confidence was observed across measured domains among participants in the implementation science workshop. For the grant-writing workshop, there was a 68.8% increase in knowledge and a 70.3% increase in confidence observed. Participants rated the workshops and instructors as effective for both workshops. These workshops improved participants' knowledge and competence in implementation science and grant writing, and provide a model for training programs that aim to provide physician scientists with the skills needed to compete for independent funding, conduct locally relevant research, and disseminate research findings.

National Non-Communicable Diseases Conferences- A Platform to Inform Policies and Practices in Tanzania.

Non-communicable diseases (NCDs) arise from diverse risk factors with differences in the contexts and variabilities in regions and countries. Addressing such a complex challenge requires local evidence. Tanzania has been convening stakeholders every year to disseminate and discuss scientific evidence, policies, and implementation gaps, to inform policy makers in NCDs responses. This paper documents these dissemination efforts and how they have influenced NCDs response and landscape in Tanzania and the region. Desk review was conducted through available MOH and conference organizers' documents. It had both quantitative and qualitative data. The review included reports of the four NCDs conferences, conference organization, and conduct processes. In addition, themes of the conferences, submitted abstracts, and presentations were reviewed. Narrative synthesis was conducted to address the objectives. Recommendations emanated from the conference and policy uptake were reviewed and discussed to determine the impact of the dissemination. Since 2019, four theme-specific conferences were organized. This report includes evidence from four conferences. The conferences convened researchers and scientists from research and training institutions, implementers, government agencies, and legislators in Tanzania and other countries within and outside Africa. Four hundred and thirty-five abstracts were presented covering 14 sub-themes on health system improvements, financing, governance, prevention intervention, and the role of innovation and technology. The conferences have had a positive effect on governments' response to NCDs, including health care financing, NCDs research agenda, and universal health coverage. The National NCDs conferences have provided suitable platforms where stakeholders can share, discuss, and recommend vital strategies for addressing the burden of NCDs through informing policies and practices. Ensuring the engagement of the right stakeholders, as well as the uptake and utilization of the recommendations from these platforms, remains crucial for addressing the observed epidemiological transition in Tanzania and other countries with similar contexts.

Enhanced or hindered research benefits? A realist review of community engagement and participatory research practices for non-communicable disease prevention in low- and middle-income countries

IntroductionCommunity engagement and participatory research are widely used and considered important for ethical health research and interventions. Based on calls to unpack their complexity and observed biases in their favour,...

Revisiting HPV infection pattern among urban Indonesian women in general population and its implication on health burden: A cross-sectional analysis from Indonesian Noncommunicable Disease Research 2016

Objective: To identify circulating HPV types among urban Indonesian women and their specific co-infection patterns in bid to curb HPV infection in the general population and minimize its complications. Methods: Urban Indonesian women from general population were selected as sample framework. Sample size and distribution across regions were determined by the Indonesian Bureau of Statistics (Badan Pusat Statistik, BPS), which represented the national level. Up to 35 408 cervical swab specimens were collected from August to September 2016 in 34 Indonesian provinces, categorized into six regions based on the development criteria set by the Ministry of National Development Planning (Badan Perencanaan Pembangunan Nasional, BAPPENAS). From all 1874 samples identified as HPV-positive, hybrid capture was implemented to evaluate type-specific HPV. This study analyzed descriptive data to determine the core-cluster of HPV combination. Co-occurrence HPV network was assessed using ‘qgraph’ package version 1.6.3 and computed in R version 3.6.3. Two-HPV association was analyzed in logistic regression using bias-reduction generalized linear model (brglm2) package version 0.5.1 adjusted by age and six main Indonesian regions. Results: The logistic regression analysis demonstrated that HPV type 52 had rare relationship despite its common co-occurrence, cementing its role in single HPV infection. HPV type 16 and 18 tended to form infection cluster and were strongly associated with other types. Conclusions: HPV type 52 was the most frequent HPV type among urban Indonesian women and accounted for most single infection cases. Concurrently, HPV 16 and HPV 18 accounted for most multiple infection cases and had strong tendency to attract other types, which may add further complications. However, due to lack of cytology and histological examination and information for other potential determinants, further in-depth studies are necessary to confirm whether these infection patterns truly connect to certain clinical outcomes.

Performance evaluation of national healthcare systems in the prevention and treatment of non-communicable diseases in sub-Saharan Africa.

Non-communicable diseases (NCDs) remain a major public health concern globally, threatening the achievement of sustainable development goal 3.4 (SDG 3.4), which seeks to reduce premature NCD-related deaths by one-third by 2030. According to the World Health Organization (WHO), improving the efficiency of NCD spending (i.e., maximizing the impact of every dollar spent on NCDs) is one of the strategic approaches for achieving SDG target 3.4. This study aims to assess the efficiency and productivity of NCDs spending in 34 sub-Saharan African (SSA) countries from 2015 to 2019. The study employed the data envelopment analysis (DEA) double-bootstrap truncated and Tobit regressions, one-stage stochastic frontier analysis (SFA) model, the Malmquist productivity index (MPI), and spatial autocorrelation analysis to estimate NCDs spending efficiency, identify the context-specific environmental factors that influence NCDs spending efficiency, evaluate total productivity change and identify its components, and assess the spatial interdependence of the efficiency scores. The estimated average DEA bias-corrected NCD spending efficiency score was 87.3% (95% CI: 86.2-88.5). Additionally, smoking per capita, solid fuel pollution, alcohol use, governance quality, urbanization, GDP per capita, external funding for NCDs, and private domestic funding for NCDs healthcare services were found to be significantly associated with NCDs spending efficiency. The study also revealed a decline of 3.2% in the MPI, driven by a 10.6% technical regress. Although all countries registered growth in efficiency, except for the Central Africa Republic and DR Congo, the growth in efficiency was overshadowed by the decline in technical change. Global Moran's I test indicated the existence of significant positive spatial autocorrelation in the efficiency of NCDs spending across SSA countries. The study underscores the importance of efficient use of resources in NCDs treatment and prevention and increased investment in NCDs research and development in achieving the SDG target 3.4.

S4-3 Protocol for assessing implementation of physical activity policies by national governments using the Physical Activity Environment Policy Index (PA-EPI)

Abstract Purpose The implementation of physical activity policies has been slow and uneven. As a remedy, the World Health Organization has recommended that national policy implementation should be supported with practical tools and guidance. The Physical Activity Environment Policy Index (PA-EPI) is a tool that allows the extent of policy implementation to be assessed. It comprises a list of good practice policy indicators. These are categorized into eight policy domains targeting aspects of the physical activity environment and seven infrastructure support domains for strengthening physical activity policy systems. This protocol provides researchers with guidance on how to use this tool. Project Guided by a protocol developed by the International Network for Food and Obesity / Non-communicable Diseases (NCDs) Research, Monitoring and Action Support (INFORMAS), the PA-EPI protocol. The INFORMAS protocol was modified based on the research teams experience carrying out the first study utilising the PA-EPI tool. A multi-step process is recommended. This process relies upon the identification of two groups of partners: national policymakers and independent stakeholders tasked with the promotion of physical activity directly and/or indirectly. During the early steps of the process the desk-based research is undertaken to identify information about and evidence of physical activity policy implementation- the PA-EPI Evidence Document. This mapped information is presented to the national policymakers to verify that it is valid and comprehensive. Subsequently, the evidence of implementation is presented to the stakeholders who, using a 5-point Likert scale (1-little or none to 5 high), individually rate the extent of policy implementation in practice. These individual ratings are aggregated and a implementation scorecard is generated displaying the extent of implementation of each of the good practice indicators Stakeholder then engage in an expert workshop to review implementation scores, and identify key policy implementation recommendations which are presented to government. Conclusions The process of conducting a policy implementation assessment using the PA-EPI requires the cooperation of several stakeholders as part of a national coalition. It is envisioned that PA-EPI assessments will enable international cross comparison. This will promote learning from international best practice.

A nude mutant rat derived from Sprague Dawley-National Institute of Nutrition rat colony with normal thymus: A potential model for noncommunicable diseases.

A spontaneous mutant rat with a hairless phenotype and an intact thymus was discovered in a long-standing Sprague Dawley-National Institute of Nutrition (SD/NIN) rat colony at a national animal resource facility. We conducted extensive phenotypic and biochemical analyses on this mutant strain to determine its suitability as a preclinical model for immunocompetent testing in noncommunicable disease research. We subjected the mutant rats to strict and frequent phenotypic and genetic surveillance to accomplish this objective. The animals were assessed for food intake, body weight, blood cell profile, clinical chemistry, adipose tissue deposition, and bone mineral density (BMD) using total electrical body conductance (TOBEC) and dual-energy X-ray absorptiometry (DXA) analysis. Initially, only two hairless mutant rats, a male and a female, were born from a single dam in the SD/NIN rat strain. However, the results indicate that the mutant colony propagated from these unique pups displayed distinct phenotypic features and exhibited differences in feeding behavior, weight gain, and clinical biochemistry. The food conversion rate was significantly higher in nude females (2.8-fold) while 26% lower in nude males. Both sexes of nude rats had significantly higher triglycerides and lower glucose levels in females. However, glucose levels did not change in male nude rats. Furthermore, nude female and male rats had significantly lower fat (TOBEC) and bone mineral content (DXA). Nonetheless, BMD was only slightly lower (7%-8%) compared to the heterozygous groups. These findings indicate that the spontaneous mutant rat has the potential to serve as an immunopotent and modulatory testing system in pharmacokinetics/pharmacodynamics and toxicology, which can be further explored for therapeutic drug discovery.

Unhealthy food advertising on Costa Rican and Guatemalan television: a comparative study.

This study aimed to exhaustively explore the characteristics of food advertising on TV in Guatemala and Costa Rica. The International Network for Food and Obesity Non-Communicable Diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) methodology was applied. In 2016, we recorded 1440 h of video among 10 TV channels. We used the Pan American Health Organization (PAHO) Nutrient Profile (NP) Model to identify 'critical nutrients', whose excessive consumption is associated with NCDs. We created a nutritional quality score (0 if the product did not exceed any critical nutrient, 1 if the product exceeded one and 2 if it exceeded ≥2). We classified food ads as permitted (score = 0) and not-permitted (score 1 or 2) for marketing. Persuasive marketing techniques were classified as promotional characters (e.g. Batman), premium offers (e.g. toys), brand benefit claims (e.g. tasty) and health-related claims (e.g. nutritious). In Guatemala, foods that exceeded one critical nutrient were more likely to use persuasive marketing techniques, and in Costa Rica were those with an excess of ≥2 critical nutrients, compared with foods without any excess in critical nutrients [Guatemala: promotional characters (odds ratio, OR = 16.6, 95% confidence interval, CI: 5.8, 47.3), premium offers (OR = 3.4, 95% CI: 1.4, 8.2) and health-related claims (OR = 3.5, 95% CI: 2.2, 5.7); Costa Rica: health-related claims (OR = 4.2, 95% CI: 2.0, 8.5)]. In conclusion, Guatemalan and Costa Rican children are exposed to an overabundance of not-permitted food ads on TV. This justifies implementing national policies to reduce exposure to not-permitted food for marketing, including on TV and other media.

Patient priority setting in HIV ageing research: exploring the feasibility of community engagement and involvement in Tanzania

ObjectiveThe chronic complications of ageing with HIV are not well studied in sub-Saharan Africa (SSA) where general healthcare resources are limited. We aimed to collaborate with individuals living with HIV aged ≥ 50 years, and community elders (aged ≥ 60 years) living with non-communicable diseases in the Kilimanjaro region of Tanzania in a health research priority-setting exercise.MethodsWe conducted structured workshops based on broad questions to aid discussion and group-based patient priority setting, alongside discussion of the feasibility of future community research engagement. Participant priorities were tallied and ranked to arrive at core priorities from consensus discussion.ResultsThirty older people living with HIV and 30 community elders attended separate priority setting workshops. Both groups reported motivation to participate in, conduct, and oversee future studies. In this resource-limited setting, basic needs such as healthcare access were prioritised much higher than specific HIV-complications or chronic disease. Stigma and social isolation were highly prioritised in those living with HIV.ConclusionsCommunity engagement and involvement in HIV and ageing research appears feasible in Tanzania. Ageing and non-communicable disease research should consider the wider context, and lack of basic needs in low-income settings. A greater impact may be achieved with community involvement.

The Global Alliance for Chronic Diseases researchers’ statement on non-communicable disease research with Indigenous peoples

The Global Alliance for Chronic Diseases researchers’ statement on non-communicable disease research with Indigenous peoples

Trends and all-cause mortality associated with multimorbidity of non-communicable diseases among adults in the United States, 1999-2018: a retrospective cohort study.

Multimorbidity of non-communicable diseases (NCDs) has brought enormous challenges to public health, becoming a major medical burden. However, the patterns, temporal trends, and all-cause mortality associated with NCD multimorbidity over time have not been well described in the United States. All adult participants were sourced from nationally representative data from the National Health and Nutrition Examination Survey. In total, 55,081 participants were included in trend analysis, and 38,977 participants were included in Cox regression. The 5 NCDs with the largest increases over the study period were diabetes, osteoporosis, obesity, liver conditions, and cancer. The estimated prevalence of multimorbidity increased with age, especially for middle-aged participants with 5 or more NCDs; in general, the prevalence of NCD multimorbidity was higher among females than males. Participants with 5 or more NCDs were at 4.49 times the risk of all-cause mortality of participants without any diseases. Significant interactions were found between multimorbidity and age group (p for interaction <0.001), race/ethnicity (p for interaction<0.001), and educational attainment (p for interaction=0.010). The prevalence of multiple NCDs significantly increased from 1999 to 2018. Those with 5 or more NCDs had the highest risk of all-cause mortality, especially among the young population. The data reported by this study could serve as a reference for additional NCD research.

The spectrum of inborn errors of immunity: a single tertiary center retrospective study in Alborz, Iran.

Background. Inborn errors of immunity (IEIs) are a group of heterogeneous disorders with inherited faults in the immune system that increase susceptibility to infections, malignancies, lymphoproliferation, and autoimmune/autoinflammatory disorders. Methods. We retrospectively studied the demographic characteristics, clinical features, and immunological profiles of the 90 IEIs patients, who were diagnosed and classified according to the European Society for Immunodeficiencies (ESID) and International Union of Immunological Societies (IUIS) criteria from July 2010 to June 2021. The study was carried out in the Non-communicable Diseases Research Center, Imam Ali Hospital, Alborz, Iran. Results. Within a period of 11 years, 53 (58.9%) males and 37 (41.1%) females were diagnosed and followed up for 20 IEI disorders. The median (IQR) age of onset, age of clinical diagnosis and diagnostic delay was 0.7 (0.08-2.0), 3.18 (1.0-8.0) and 1.5 (0.17-5.0) years, respectively. Twelve patients (36.4%) had a positive family history of IEI, and the majority of patients (84.5%) had recurrent infections. Pneumonia (51.7%) was the most common clinical manifestation among IEI patients, followed by skin complications (46.2%). The most frequently diagnosed IEI was immunoglobulin A deficiency (IgAD) (14.4%) and severe combined immunodeficiency (SCID) (11.1%). Predominantly antibody deficiencies group (36.7%) was the most common category, followed by combined immunodeficiencies with associated or syndromic features group (27.8%). Conclusions. IEIs have different patterns within populations with high consanguinity. There is a need to search for underlying genetic and epigenetic factors in most common IEIs in Alborz.

Research Capacity for Prevention and Control of Non-communicable Diseases and their Risk Factors in Nepal: Findings of a Needs Assessment Study

Background Despite a high burden, there are limited trainings in non-communicable disease research in Nepal.&#x0D; Objective We conducted a needs assessment to assess existing research training capacity in academic health institutions of Nepal for the prevention and control of noncommunicable diseases, identify gaps in research, and explore the feasibility of developing research training program in Nepal targeting non-communicable diseases.&#x0D; Method We did mixed-method research and reviewed academic institution curricula and scientific articles authored by Nepali researchers. We conducted 14 Focus Group Discussions with bachelor and masters level students of public health and community medicine; 25 In-depth Interviews with department heads and faculties, and government stakeholders. We surveyed medical and public health students on their research knowledge and skills development.&#x0D; Result Research methodology component was addressed differently across academic programs. One-third (33.7%) of students expressed lack of skills for analysis and interpretation of data. They felt that there is a wide scope and career-interest in non-communicable diseases research in Nepal. However, specific objectives in the curriculum and practical aspects regarding non-communicable diseases were lacking. Most of the non-communicable diseases research in Nepal are prevalence studies. Lack of funding, conflicting priorities with curative services, and inadequate training for advanced research tools were reported as major barriers.&#x0D; Conclusion Nepal must strengthen the whole spectrum of research capacity: epidemiological skills, research management, and fund development. Generation of a critical mass of non-communicable disease researchers must go together with improved funding from the government, non-governmental, and external funding organizations.