Non-communicable Diseases Research Articles

Educating lifestyle modification to diabetic patients

The burden of non-communicable diseases (NCDs) is steadily increasing, making them a major health concern. Diabetes mellitus (DM) is one of the major non-communicable diseases that affects the public health and the community. DM is a chronic, complex disease that requires multi-factor risk reduction strategies apart from its maintaining blood glucose level. One of the community-based strategy is to educate diabetic patients about life style modifications. Keeping that as a guideline, a nurse-led intervention was carried out to ring about a change in life style in these patients. About 60 diabetic patients with equal number of control subjects were taken for the pilot study. Data were collected through interviews with a semi-structured questionnaire before (pre-test) and after nurse-led intervention (post-test) The data were analyzed using descriptive and inferential statistics; the calculated data were tabulated and graphed. The results of the study show that diabetic patients included in the study have improved their knowledge of life style modification. The community nurse intervention improved their perspective and understood the importance of life style medication (from 16.19 to 24.98%). This was tested using the student paired t test. Outcome of the test before the intervention showed significant change. Pre-test value was (53.97%) and the post-test intervention was 83.27%. The effect of such intervention was influenced the age, gender, education, and family structure. The intervention was found to be more effective in male patients of the age group 30-40 years with educational background and stable family structure having a joint family. The awareness created by nurse led intervention is effective and is significant taking age, sex, education level and the family structure. The pilot study indicates that further studies may be carried out in the community with general population and then specifically in patients with diabetes.

Incidence of high blood pressure among Kenyan adults living with HIV: a longitudinal cohort analysis from 2004-2023.

People with HIV (PWH) face a heightened risk of cardiovascular diseases, partly due to increased high blood pressure risk. This study assessed high blood pressure burden (i.e., incidence, prevalence) among PWH in Kenya over time. Longitudinal, open cohort study. We estimated the incidence and prevalence of high blood pressure in a large sample of Kenyans with HIV from the Coptic Hope Center using electronic medical records from 2004-2023. We defined incident high blood pressure as first visit after baseline at which each patient had a systolic blood pressure ≥ 140 mmHg and/or a diastolic blood pressure ≥ 90 mmHg. Our sample included 38,709 PWH seeking care at Coptic Hope Center clinics in Kenya (2004-2023). Nearly 40% of patients had high blood pressure at first visit. Among the 60% of patients initially normotensive, almost 40% developed high blood pressure within 20 years. The yearly prevalence of high blood pressure ranged from 8-58%. Average SBP was higher among patients who had their first visit from 2019-2023 compared to those visiting in the early 2000 s and 2010 s. Our findings reveal a high and rising burden of high blood pressure among PWH in a large, faith-based health system in Kenya. This underscores the need for stronger integration of care for individuals with concurrent HIV, high blood pressure, and other non-communicable diseases. Current systems are insufficient for achieving blood pressure control among PWH. Further research and funding for efforts to address HIV and NCD care in Kenya are warranted.

Incorporating familial risk, lifestyle factors, and pharmacogenomic insights into personalized noncommunicable disease (NCD) reports for healthcare funder beneficiaries participating in the Open Genome Project.

An ethics-guided decision-making framework was developed for applying pathology-supported genetic testing, a multifaceted pharmacodiagnostic approach that translates population risk stratification into clinical utility. We introduce this service, supported by the Open Genome Project, which aligns with the beneficence principle in personalized medicine. Genetic testing of six noncommunicable disease pathways was conducted as part of a pilot program, benchmarked against a readiness checklist for implementation of genomic medicine in Africa. Patient referral criteria were determined using healthcare funder claims data, employing the Adjusted Clinical Groupers and Resource Utilization Band risk rating structure to identify potential nonresponders to treatment. Three of the 135 doctors (2.2%) invited expressed immediate disinterest in the pilot, while 24 (17.8%) actively participated. Inherited, lifestyle-triggered, and therapy-related pathologies were simultaneously assessed in case reports, with special medical scheme reimbursement tariff codes applied to 25 patient referrals. The findings were used by the participating genetic counselor to select three patients for whole exome sequencing, utilizing a novel, level-up data processing algorithm for adaptive reporting. This study demonstrated the implementation of genomics into an evolving workflow for patients with a history of frequent clinic visits. Eliminating the cost barrier provided valuable insights to guide future reimbursement policy decisions.

A study to explore the role of a low threshold, fitness focussed physical rehabilitation intervention with protein supplementation to target physical function and frailty in people with problematic substance use and homelessness: protocol for a single-arm pre-post intervention study.

Background People who are homeless are more likely to experience poor mental health and addiction as well as suffering from non-communicable diseases. There is evidence of frailty and accelerated physical ageing among people experiencing homelessness. Appropriate physical rehabilitation and nutritional supplementation strategies can stabilise or reverse frailty and general physical decline, but it is not known how this type of intervention would work in practice in this population. Aim To evaluate the feasibility and pre-post intervention impact of a low threshold physical rehabilitation intervention with protein supplementation to target physical functioning and frailty in people with problematic substance use who are experiencing homelessness. Methods The intervention will consist of a 12-week low threshold rehabilitation programme with protein supplementation. Participants will be service users of the Ballyfermot Advance Project, a day services centre for people with addiction issues and experiencing homelessness. Primary outcomes will be feasibility including numbers recruited, retention of participants and adherence to the exercise intervention and protein supplement. Any adverse events will be recorded. Secondary outcomes will be strength and muscular mass, physical performance and lower extremity physical function, pain, frailty and nutritional status. Discussion An immediate impact may be simply a distraction from difficult circumstances and potentially an improvement of physical health of participants, which can be a conduit for the emergence of other positive behaviours and recovery. Longer term, this study will generate preliminary data on which to inform the design of a definitive randomised controlled trial of physical rehabilitation and protein supplementation, if indicated. Ethics and dissemination Ethical approval was granted by the Faculty of Health Sciences Research Ethics Committee in TCD. Study findings will be disseminated through publication into an international peer-reviewed journal and presented at national and international conferences.

The Role of Nutrition in Non-Communicable Diseases: Literature Review

Cardiovascular diseases, diabetes, obesity, and certain types of cancer, collectively referred to as NCDs, are a global concern and contribute to about 71% of the total global mortality. This paper focuses on examining nutrition in an attempt to understand how it influences these diseases since the consumption of certain foods is a modifiable risk factor. The results reveal that an increased concentration of fruits and vegetables, whole meal grains, and health-promoting fats can help reduce the vulnerability to NCDs, but a high diet of processed foods and sugar makes the problem worse. However, there is still a dearth of knowledge on the multifaceted processes regarding how particular diet patterns influence NCDs. This study synthesizes available literature on nutrition and NCDs concerning how dietary patterns and nutrient intakes influence the prevention and treatment of diseases. Conclusions are drawn from numerous investigations, stressing the positive effects of dietary modifications like Mediterranean and DASH diets on NCD risk and actual health status. This review contributes to the future development of nutrition and health as a quick reference for researchers about the specific effects of nutrition on health. However, some barriers have not yet been solved like the incidence of unhealthy dietary patterns. Subsequent research should closely examine factors that can be employed that would ensure the effective administration of both nutritional interventions as well as the formulation of improved public health policies that would ensure a change of habits and eating behaviors in a bid to reduce the effects of NCDs.

A profile approach to physical activity levels: what’s intensity got to do with reasons and motives for exercise?

BackgroundDespite the well-known benefits of physical activity (PA), non-communicable disease and premature mortality rates among adults continue to rise. The relationship between adults’ goals and exercise-specific motivation on the type of PA intensity one engages remains unclear. The purpose of this study was to identify physical activity (PA) profiles based on frequency and intensity (i.e., levels of PA) in an adult sample. A secondary purpose was to examine how the PA profiles differ on the reasons people have for exercising and behavioral regulation.MethodsA Cross-sectional survey was conducted with 1,169 (46.8 ± 16.7 years) participants solicited from a hospital-affiliated wellness center, social media promotions, and a research volunteer registry. The International PA Questionnaire (IPAQ) was used to determine frequency, intensity, and time spent engaging in PA. Additionally, the Reasons to Exercise (REX-2) scale, the Behavioral Regulation in Exercise Questionnaire-3 (BREQ-3), and demographics were assessed. K-cluster analyses were performed to identify profiles based on PA levels using the IPAQ guidelines. Multivariate analysis of variance (MANOVA) was used to assess profile differences.ResultsFive distinct PA clusters were derived, and defined as: a Low, Walking, Moderate Intensity, High Intensity, and Sitting cluster (p < .001). These clusters differed significantly (p < .001) from each other with respect to motivation, the reasons adults have for exercise, and PA levels.ConclusionThe results from this study support the important role of psychological factors such as motivation and reasons for exercise on behavioral outcomes (i.e., physical activity). For future research investigating adults PA- related behaviors, whether it be on adults starting a new exercise program or for PA maintenance, it may be beneficial to develop programs that encourage participants to reflect on the reasons they identify as important for exercising, and how such reasons contribute to their overall PA engagement behaviors.

Development of a touchscreen-based nutrition learning tool to promote healthy eating practices among early elderly Thai people

Introduction: In Thailand, rapid demographic ageing is closely linked to an increased incidence of non-communicable diseases (NCDs). Effective nutritional management is essential to mitigate NCD risks and delay progression. Given the widespread use of touchscreen devices among older adults, this study focused on developing a nutrition app tailored to enhance knowledge, attitudes, and practices regarding healthy eating among Thai elderly people. Methods: The project consisted of two main phases, namely content preparation and application development. Initial drafts and storyboards were refined through consultations with experts and discussions. The use of healthy menus was approved by a professional chef and nutritionists. The app prototype underwent comprehensive evaluations in terms of content accuracy, design, usability, and acceptability by experts. It was also field tested by elderly volunteers for four weeks. Results: The developed “YoungYou” app features tools such as body mass index assessment, updates on elderly health, and dietary recommendations tailored to Thai elderly individuals based on the nutrition flag system. It includes 60 healthy recipes, 30 cooking tutorials, and an interactive community board. The app allows users to modify and recalibrate the nutritional content of recipes, which can then be saved or shared. Evaluations of the app showed high levels of agreement on its effectiveness across all metrics. The use of rice, vegetables, and meat by 41 elderly volunteers led to increased healthy eating behaviours. Conclusion: The “YoungYou” app has demonstrated potential as a viable tool for promoting healthier eating habits among Thai elderly people, thereby addressing critical public health issues related to ageing and disease prevention.

Talking about practice: agency and its structural context in regional healthcare practice change

ABSTRACT Ageing societies and rising instances of non-communicable diseases require changes in public healthcare service provision. Despite a plethora of propositions, most innovations never become practically applied. In understanding innovation as a place- and path-dependent change process which depends on actors’ agency to reconfigure routinised practices and their structural context, we show how actors create, perceive and act upon opportunities for change while tracing the development trajectories of two networks in the regions of Murcia (Spain) and Örebro (Sweden), respectively. The cases illustrate the role intermediary actors play in creating opportunities and shaping organisational and institutional context.

SAFETY OF DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION 80 YEARS AND OLDER: CLINICAL RISK FACTORS

BACKGROUND: Direct oral anticoagulants (DOACs) use is complicated by bleeding, especially in the geriatric population. Most studies focus on predicting major bleeding, while clinically relevant non-major bleeding (CRNMB) is no less important for practice. АIM: of the study was to evaluate the ability of clinical factors to predict the risk of CRNMB while taking DOACs in patients with atrial fibrillation (AF) aged 80 years and older. MATERIALS AND METHODS: 367 patients were examined with non-valvular AF aged 80 years and older (median age 84 [82; 88] years) taking DOACs. The main population parameters (gender and age composition of groups, body mass index), risk of ischemic stroke according to the CHA2DS2-VASc scale, risk of bleeding according to the HAS-BLED scale, comorbidity, Charlson comorbidity index, risk factors for chronic non-communicable diseases, number of medications taken, objective examination data, vascular wall stiffness, and laboratory test results were assessed. RESULTS: In univariate analysis, significant risk factors for developing CRNMB with all DOACs were: higher frequency of walking (p=0.022), lower heart rate (p=0.08), and history of gastric and duodenal ulcer (GDU) (odds ratio (OR) 5.34 [95% confidence interval (CI): 2.31; 12], p0.001). As a result of multivariate analysis, a model for predicting CRNMB was developed, with age, type of DOAC, liver disease, acute cerebrovascular accident, history of GDU selected as predictors. The resulting model was characterized by 62.6% [95% CI: 57.4; 67.6] predictive accuracy, 66.5% [95% CI: 59.4; 73.1] sensitivity and 58.2% [95% CI: 50.4; 65.7] specificity. CONCLUSION: The study identified specific modifiable, potentially modifiable, and non-modifiable risk factors for the development of CRNMB in patients with AF over 80 years of age taking DOACs. The results of the study can be used to create an electronic system to support medical decision-making, manage risk factors, and improve the quality of life of the population.

Nutrition Education and Practice in University Dental and Oral Health Programmes and Curricula: A Scoping Review.

Dentists and oral health practitioners have a potential role in supporting the prevention and management of noncommunicable diseases. However, the extent to which university education prepares practitioners to provide nutrition care is unclear. This scoping review identifies and synthesises the evidence related to university-level nutrition education provided to dental and oral health students globally. A scoping review identified relevant literature through search terms "dentistry," "oral health," or "oral hygiene"; "dental students" or "dental education"; "nutrition education" or "nutrition science." Articles were included that examined nutrition education in undergraduate oral health training; or nutrition knowledge, attitudes, confidence, or skills or dietary habits; experts' opinion papers; and position statements. No limitations on the publication years or languages of the articles were applied. A total of 136 articles were included. Half were surveys of students (n = 49) or academic staff (n = 21). The remainder comprised reports of curriculum initiatives (n = 26), opinion papers or narrative reviews (n = 24), position statements (n = 6), curriculum development (n = 6) and curriculum guidelines (n = 9). While dental and oral health students and curriculum experts overwhelmingly recognised the importance of nutrition, most studies that assessed nutrition knowledge of students revealed limited knowledge. Students were not confident in their skills to provide nutrition care. Lack of nutrition experts on teaching teams and unclear expectations about developing nutrition competencies were identified as barriers to greater nutrition education. Nutrition education in university dental and oral health degrees is highly variable. The potential for oral health professionals of the future to promote oral health through nutrition is unrealised.

How likely are Eastern European and Central Asian Countries to Achieve Global NCD Targets?

Abstract Background In Europe, premature deaths from noncommunicable diseases (NCDs) have declined significantly, except in twelve countries of Eastern Europe and Central Asia (EECA), namely Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. Analyses of the long-term trends of NCD premature mortality in EECA are limited making it hard to know what to expect over the next years. Methods We used the 1990-2019 Global Burden of Disease database to analyze NCD trends and identify country-specific change points by using piecewise linear regression. We assessed the likelihood of achieving NCD global targets (GTs) to reduce premature mortality among persons 30-69 years old from four NCDs: cardiovascular diseases (CVD), cancers, diabetes mellitus (DM) and chronic respiratory diseases (CRD) by 25% from 2010 to 2025 (WHO25X25 target) and by 33% from 2015 to 2030 (SDG 3.4.1). Results Only Kazakhstan and Russia are likely to achieve NCD-GTs. For Kazakhstan, WHO25X25 and SDG 3.4.1 GTs mortality rates were 494.3 and 374.8 per 100,000 population respectively; the corresponding predicted values (PVs) were 360.6 [CI 260.1-461.1] and 245.1 [CI 113.4-376.8]. For Russia, WHO25X25 and SDG 3.4.1 GTs were 560.5 and 442.8 per 100,000 population respectively; the corresponding PVs were 427.7 [CI 270.3-585.1] and 311.0 [CI 102.8-519.1]. Achieving NCD-GTs is also possible for Kyrgyzstan. For the rest of EECA countries achieving NCD-GTs is unlikely. All EECA countries have increasing premature mortality from DM, eleven - from CRD and cancers, and six - from CVD. Most EECA countries have higher NCD rates and slower progress among men compared with women. Conclusions In most EECA countries the trend towards achieving NCD-GTs is slow or reversed. Further quantitative and qualitative research is needed to understand the underlying reasons. Separate indicators are needed to monitor countries’ progress for cancers, DM and CRDs. Key messages • Most EECA countries have slow or reversed trend in achieving NCD-GTs. All EECA have increasing premature mortality from DM, eleven – from CRD and cancers, and six – from CVD. • Further research is needed to understand the underlying reasons for slow progress towards NCD-GTs in EECA. Separate indicators are needed to monitor progress for cancers, DM and CRDs.

Expanding access to non-communicable disease screening in war-affected communities in Ukraine

Abstract Background Non-communicable diseases (NCDs) account for 91% of premature deaths in Ukraine. However, NCD screening lags among young people and across the entire population. The ongoing war has exacerbated barriers to NCD screening due to damaged infrastructure, understaffed medical facilities, and health system deterioration. Intervention/response To improve screening, diagnosis, and care, in March 2023 the PATH-led, USAID-funded Support TB Control Efforts in Ukraine (STBCEU) project established community level health access points (HAPs) in five conflict-affected communities. STBCEU procured screening tools (tannometers, glucometers, portable ECGs) for common NCDs, printed informational materials, trained 143 specialists, designed a reporting system, and facilitated monitoring visits to 77 HAPs. Results By the end of 2023, the project equipped 113 HAPs in the five communities, and 102 of them initiated NCD screening. From January-March 2024, 1,694 people under 40 years old were screened for NCDs. Among 1,488 blood pressure measurements, 143 cases had high readings (9.6 ±1.5%), 90 (62.9%) of which were first-time diagnoses, and 53 (37.1%) treatment monitoring. Glucose levels were measured 809 times, with elevated levels in 44 cases (5.4 ±1.5%), 30 (68.2%) of which were first-time diagnoses, and 14 (31.8%) treatment monitoring. Additionally, 1,144 mental health consultations were provided. Conclusions This initiative represented a first in Ukraine: per national requirements, young people have not historically been screened for NCDs. Expanding NCD screening in war-affected communities has demonstrated substantial early success, with significant detection of high blood pressure and elevated glucose levels among people under 40. This proactive, cost-effective intervention underscores the need for accessible, community-level health interventions in crisis settings and showcases a scalable model for integrating NCD screening into emergency health response frameworks. Key messages • The implementation of community-level NCD screening has shown early success in detecting high blood pressure and elevated glucose levels among people under 40. • Cost-effective NCD screening underscores the need for accessible, community health interventions, providing a scalable model for integrating NCD screening into emergency health response.

Joining forces to accelerate cancer and NCD prevention in Europe

Abstract JA PreventNCD, a Joint Action to prevent cancer and other non-communicable diseases (NCDs) aims to assist authorities in prioritizing the most effective prevention strategies and policies to reduce the burden of cancer and NCDs, focusing on both personal and societal risk factors. A key objective is to tackle social inequalities by addressing the root causes of NCD risk factors and adopting a life-course approach. Recognizing that health is created by policies in several sectors is key when addressing health determinants, including social and commercial determinants of health. Consolidated efforts across countries will be required to tackle some of these determinants. To achieve the project’s objectives, the JA PreventNCD will build a comprehensive European infrastructure for monitoring risk factors, disease burden, and the impact of policies and interventions. Rigorous evaluation will ensure that the project’s deliverables will have an impact at local, national and EU levels. Three technical work packages address common risk factors for NCDs through actions ranging from policies and structural measures at societal level to interventions targeting individuals. Another set of cross-cutting work packages address monitoring, social inequalities, and health in all policies. More than 100 partners across 25 countries are involved, with almost 100 pilots to be conducted over the course of the project’s four years. One way of ensuring sustainability of the project’s outcomes is the building of a sustainable governance structure through the establishment of an EU Consortium on Cancer Prevention. Furthermore, as a mechanism to ensure high policy relevance of this JA, a Policy Decision Maker’s Forum will be established to engage policymakers and ensure feasibility of the project’s recommended actions. Speakers/Panelists Claudia Habl Austrian National Public Health Institute, Vienna, Austria Ane Fullaondo Biosistemak, Bilbao, Spain Arnfinn Helleve Norwegian Institute of Public Health, Oslo, Norway

NCD prevention and control in Kenya: feasibility study of health kiosks in markets “HEKIMA Study”

Abstract Introduction Non-communicable diseases (NCDs) account for 50% of hospital admissions and 55% of hospital mortality in Kenya. Cardiovascular diseases (CVDs) lead NCD mortality at 14% due to high prevalence of multiple risk factors. Community markets are social institutions with untapped potential for public health. HEKIMA is a multi-phased theoretically driven intervention exploring whether health kiosks in community markets, manned by community health workers (CHWs) and supervised by health centre (HC) nurses, can improve the reach of preventive care to vulnerable communities. Methods A mixed methods study in Vihiga County targeting 320 participants aged 15 years and above. Nurses and CHWs were trained to deliver evidence-based CVD health promotion, risk screening, and early intervention. Multi-sector stakeholder consultations, readiness assessments of markets and HCs, and semi-structured interviews informed intervention development. Evaluation use the Re-AIM framework. Results At 6 months of intervention there 2224 kiosk users which exceeded target of 300; 61% primary school education; 77% females; median age - males 48y, females 52y. Proportion with high blood pressure, overweight, obesity, and diabetes 48%, 32%, 25% and 12% respectively. 30% were referred to HC, and 34% followed up at least once at the kiosk. High acceptability of HEKIMA among CHWs, nurses and market users led to HEKIMA kiosks being integrated in the primary healthcare pathway. Key enablers were multi-sectoral alliance of government, civic organisations, community market champions, local businesses and health sector; culture centred coproduction and capacity building Challenges included understaffing, commodity supplies and seasonality. Conclusions HEKIMA successfully promoted NCD prevention and control, particularly among vulnerable populations. Scaling up across Kenya is planned to explore translational impacts in different contexts. Key messages • Multisectoral alliance critical for prevention of NCDs. • Theoretically underpinned complex systems interventions addresse inequities.

9.C. Round table: The Global Oral Health Action Plan – Integrating Oral Health into the global health agenda

Abstract Oral diseases (OD) are a global public health problem affecting 3.5 billion people, with a global prevalence of 45%, higher than the prevalence of any other non-communicable disease (NCD). Recognizing the global public health importance, the 76th World Health Assembly (WHA) (May 2023) adopted the WHO’s Global Oral Health Action Plan (GOHAP) 2023-2030; a crucial step to bring momentum and mobilise all actors to address the burden of OD and common risk factors for all NCDs, while integrating oral health (OH) as part of general health and promoting cross-sectoral cooperation on good OH worldwide to reach UHC. Drawing insights from other successful global health action plans, this roundtable (RT) will explore key lessons learned in implementing effective strategies to improve OH outcomes at European and global levels, ensuring access to quality care for all. The objectives of the RT are: 1.To present the GOHAP 2023-2030, incl. challenges and opportunities; 2. To draw insights from other global health action plans; 3. To present good examples of civil society organization (CSO) actions supporting the GOHAP’s implementation - The Manifesto of the Platform for Better Oral Health, calling for policy actions by EU policymakers; 4. To present findings from the EU DELIVER (DELiberative ImproVEment of oRal care quality) and PRUDENT projects, funded by the European Commission, aiming to provide and implement a blueprint model for ensuring access to quality OH care for all; 5. To inform follow-up actions and collaboration across EUPHA sections, its strategy, as well as that of European Member States (MS), CSOs and other institutional partners, and to raise awareness across the European public and global health communities. The structure of the RT will include brief interactive presentations with real-time polling to maximize participant engagement and to consolidate key messages to present at the end of the session, incl. to inform follow-up actions across EUPHA. The first brief presentation on GOHAP will highlight the aims and evidence-informed actions, followed by: 1. Insights from other global health action plans, exploring lessons learned in implementing effective strategies, examining the approaches, opportunities, challenges and outcomes; 2. Good examples of actions taken by CSOs; 3. Preliminary findings from the EU DELIVER and EU PRUDENT will be presented, incl. key co-creation tools of deliberative dialogues and the development of a set of quality indicators for applicability on the practice, community and policy levels. Guided discussion will focus on opportunities and challenges in GOHAP implementation, with the targeted questions to panellists on: What can countries learn from other global health action plans? What should be the priorities of EU MS? What is the role the public health community can play? What are key steps needed to eliminate common NCD risk factors to drastically reduce the prevalence and burden of ODs? Key messages • There is an urgent need in the global and public health communities to better understand the processes involved in implementing the GOHAP, incl. challenges and opportunities. • Interdisciplinary and cross-sectoral collaboration is key to address the common risk factors of NCDs, to inform concerted action and evidence-informed policymaking to improve oral health care. Speakers/Panelists Pauline Vassallo European Association of Dental Public Health, Valletta, Malta Benoit Varenne Dental Officer, Prevention of Non Communicable Disease Department, WHO, Geneva, Switzerland Dympna Kavanagh Chief Dental Officer, Platform for Better Oral Health in Europe, Dublin, Ireland Neville Calleja Department of Health Information and Research, G’Mangia, Malta

Benefits of hypothetical air pollution reduction interventions on NCDs in Belgium

Abstract Background The adverse health impact of air pollution on non-communicable diseases (NCDs) is well documented, yet methodological tools for assessing the potential health benefits of interventions are lacking. This study uses a parametric g-computation approach to evaluate the impact of hypothetical interventions targeting long-term air pollution exposure on reducing NCDs prevalence in Belgium, using data from three national Health Interview Surveys (BHIS 2008-2013-2018). Methods BHIS data (n = 27,536) were linked to environmental data at participants’ residential addresses. A g-computation approach was used to calculate the potential impact fractions of air quality interventions on several NCDs. Regression models were adjusted for socio-economic, environmental and lifestyle factors. The scenarios involved reducing individual long-term air pollution exposure to WHO air quality guideline levels, followed by investigating dose-response functions through various percentage reductions in air pollution exposure. Results Significant associations were found between air pollution and asthma, stroke, and multimorbidity. Adhering to WHO air quality guidelines would substantially reduce stroke risk in Belgium by 0.87% (95% CI:0.38; 1.35) for PM2.5 and 0.32% (95% CI:-0.05; 0.70) for NO2, preventing 63% and 22% of cases, respectively. For asthma, risk reduction was 1.43% (95% CI:-0.53; 3.4) for PM2.5 and 0.83% (95% CI: 0.01; 1.63) for NO2, preventing 27% and 16% of cases, respectively. For multimorbidity, risk reduction was 3.20 % (95% CI: -1.75; 8.16) for PM2.5 and 0.43% (95% CI:-2.03; 2.90) for NO2, preventing 7% and 0.4% of cases, respectively. Results revealed a clear dose-response association between air pollution reduction and the prevalence of stroke, asthma, and multimorbidity in Belgium. Conclusions This study demonstrates that air pollution reduction interventions could effectively decrease the prevalence of asthma, stroke, and multimorbidity in Belgium. Key messages • Air pollution reduction interventions could effectively decrease the prevalence of asthma, stroke, and multimorbidity in Belgium. • The g-computation approach to assess PIF of interventions represents a straightforward approach for drawing causal inferences from observational data.

7.G. Round table: Primary prevention and management of NCDs – the added value of joint actions across Europe

Abstract Two ambitious European joint action projects, funded through the EU4Health programme, are ongoing to reduce the burden of non-communicable diseases (NCDs) and related risk factors in Europe, targeting both individual and societal levels. Together, these projects aim to scale up effective prevention and management strategies, strengthen public health policies and promote equitable and sustainable healthcare systems across Europe. The Joint Action on CARdiovascular Diseases and DIabetes (JACARDI), with 21 participating countries and a total budget of over €66 million, is focusing on enhancing the implementation of evidence-based innovative pilot projects across the entire patient journey. This includes efforts to improve prevention, early diagnosis, and proactive management of NCDs. The Joint Action Prevent Non-Communicable Diseases (JA PreventNCD), with 25 participating countries and a total budget of over €95 million, particularly aims to enhance joint capacities of countries for implementing, scaling up and evaluating prevention policies and actions at various levels. These projects represent complementary responses to calls for action in Europe’s Beating Cancer Plan and the Healthier Together - EU NCD Initiative, with JA PreventNCD emphasizing primary prevention and policy while JACARDI focuses on secondary prevention and health systems strengthening. Both projects will generate new policy-relevant evidence based on implementation, monitoring and scaling-up of best and innovative practices and policies across Europe. The projects share a focus on equity, diversity, scalability and sustainability, while avoiding fragmentation and duplication of actions. Under the EU4Health programme, launched to strengthen European health collaboration in the wake of the COVID-19 pandemic, the EU has recently invested over €200 million in public health initiatives, with additional investments from national authorities participating in the joint actions. With this new wave of funding, real population impact should be anticipated, but what can we realistically expect to be the outcomes and what are the criteria for success? In this round table discussion 1) these two joint action projects will be presented, highlighting their innovative aspects; 2) views on the added value and potential in cross-national collaborations for prevention and management of NCDs will be debated, and 3) how synergies will be leveraged for maximum impact will be explored. Panelists will share their perspectives on the projects’ potential to change the public health landscape in Europe. Workshop participants will subsequently be encouraged to engage in the discussion with the objective that views and experiences are exchanged, opportunities for collaboration and engagement are shared and energy is mobilized to harness the benefits of such large-scale policy-relevant collaborations. Key messages • Synergies and collaboration to drive policy development and foster increased capacity are the pillars to build a healthier Europe. • Two large-scale Joint Actions drive impact by highlighting innovative NCD prevention strategies and fostering collaborative engagement.

Evaluation of university food environment and healthy space policy implementation at university

Abstract Issue/problem Unhealthy diets, along with factors like tobacco, alcohol, and inactivity, contribute significantly to non-communicable diseases (NCDs). Prevention strategies should prioritize reducing exposure to these risk factors. It’s also crucial to consider environmental well-being alongside promoting health. Description of the problem During 2023/2024, university cafeterias (UC) were evaluated for healthy eating standards compliance, resulting in a noticeable presence of unhealthy foods together with plastic use, alcohol and tobacco consumption. This led to the development of an accreditation program to boost UC as healthy spaces. Results The developed program includes 5 mandatory standards and 42 recommendations. Priority objectives are offering healthy food options like fruit, avoiding alcohol and sugary drink ads, banning tobacco, promoting physical activity, and reducing waste for example by encouraging unpackaged water consumption. Our policy emphasizes evaluation and monitoring, so accreditation is valid only for two years. Our goal is to establish UC as sustainable, healthy spaces. To encourage compliance, we offer institutional financial support and accreditation seals to UC, showcasing their commitment to community health. Implementation begins in the 2024/2025 academic year, with an initial evaluation scheduled at that time. Lessons Monitoring UC food offerings is crucial for ensuring healthier options. Cafeterias play a key role in promoting healthy habits. Creating environments with healthier options can mitigate non-communicable disease risk factors presence. Key messages • University cafeterias are pivotal in fostering a healthy lifestyle. • Prioritizing policies to address non-communicable diseases is crucial. Clear programs are essential for sustained effectiveness.

Company commitments on nutrition and sustainability: A three-country comparison

Abstract Background The Business Impact Assessment (BIA) tools were developed by INFORMAS to document companies’ commitments on population nutrition (BIA-Obesity) and environmental sustainability (BIA-Sustainability). As part of the EU-funded Food Systems that Support Transitions to Healthy and Sustainable Diets (FEAST) project, we used the BIA-Obesity and BIA-Sustainability to map the public commitments of a range of national and international food companies active in Belgium, Ireland, and Portugal. Methods We selected companies (Belgium n = 37; Ireland n = 39; Portugal n = 36) across the packaged food, soft drinks, quick service restaurant, grocery retailers, infant formula, and catering industries. Selection was based primarily on the companies’ market shares in each country, but minor adaptations were made to enable comparison of findings between the countries. We searched each company’s website, annual reports, and other public sources, logging all commitments relevant to the domains of the BIAs. Domains and criteria were adapted to reflect the regulatory and legislative environment in each country. Results In all three countries, commitments on sustainability were significantly stronger than those on nutrition, though still falling short of best practice. Within sustainability, commitments found in Belgium and Portugal were significantly stronger than those found in Ireland. Nutrition-related commitments were more consistent across the three countries, with companies in Ireland and Portugal showing the highest-scoring commitments in relation to product formulation. Conclusions Companies across all industry sectors and countries fall short of best practices, with a stronger commitments to environmental sustainability than to tackling obesity and non-communicable diseases. These results underscore the critical necessity for more ambitious government regulations at both European and national levels. Key messages • Critical necessity for government regulations at both European and national levels to adress environmental and nutritional challenges. • Industry need stronger commitments to tackling obesity and non-communicable diseases.

Impact of Noncommunicable Diseases on Years of Life Lost in FB&amp;H During the COVID-19 Pandemic

Abstract This study aims to comprehensively investigate the impact of noncommunicable diseases (NCDs) on years of life lost (YLL) within the Federation of Bosnia and Herzegovina (FB&amp;H) across distinct phases: pre-pandemic, pandemic, and post-pandemic periods. Given that NCDs currently represent more than half of the global disease burden, our focus lies in assessing YLL specifically for cerebral infarction (I63-I64) and diabetes mellitus (E10-E14). Conducting a retrospective data analysis, we utilized mortality data sourced from the Institute for Statistics of FB&amp;H to quantify YLL. This assessment involved multiplying age-specific mortality figures by the remaining life expectancy at the corresponding age, utilizing the GBD 2019 life expectancy table. Examining the period between 2019 and 2022, our analysis aimed to elucidate the pandemic’s potential influence on NCD burden, through the examination of age-standardized YLL rates based on the world standard population. In 2019, YLL attributable to I63-I64 for both sexes totaled 41,244 in 2019, escalating to 44,790 in 2020, and subsequently decreasing to 39,439 and 32,055 in the pandemic years of 2021 and 2022, respectively. For diabetes mellitus (E10-E14), YLL in 2019 amounted to 23,675, with figures for 2020, 2021, and 2022 standing retrospectively at 24,329, 24,114, 19,125. The increase in 2020 may be attributed, in part, to initial healthcare hesitancy during the pandemic’s onset, leading to delayed treatment and heightened mortality rates. Furthermore, patients who died in 2020 from C-19 without being tested may have skewed mortality registration by inflating rates attributed to pre-existing conditions. The declining rates thereafter could be due to a harvesting pandemic effect, in that people who were previously ill died prematurely from C-19. These insights show the pandemic’s profound impact on NCD-related mortality, underscoring the urgent need for targeted interventions and healthcare strategies. Key messages • A substantial reduction in years of life lost (YLL) related to certain noncommunicable diseases was observed during the pandemic. • The pandemic significantly influenced mortality among individuals with noncommunicable diseases, driven partly by healthcare hesitancy and potential misregistration of causes of death.