Population-level Interventions Research Articles

Impact of New York City's 4-year multi-component natural experiment to improve elementary school physical education on student cardiorespiratory fitness.

School physical education is an important population-level health intervention for improving youth fitness. This study estimated the impact of New York City's PE Works program - which included providing PE teachers, training for classroom teachers, and administrative/ teacher support for PE - on student cardiorespiratory fitness as measured by the FitnessGram's 15-meter PACER test for aerobic capacity. This longitudinal study (2014/15-2018/19) includes 581 elementary schools (n = 315,999 4th /5th -grade students; 84% non-white; 74% who qualify for free or reduced-price meals, a proxy for socioeconomic status). We apply the parametric g-formula to address schools' time-varying exposure to intervention components and time-varying confounding. After four years of staggered PE Works implementation, 49.7% of students/school (95% CI: 42.6%, 54.2%) met age/sex-specific Healthy Fitness Zone (HFZ) aerobic capacity standards set by the FitnessGram. Had PE Works not been implemented, we estimate 45.7% (95% CI: 36.9%, 52.1%) would have met aerobic capacity HFZ standards. Had PE Works been fully implemented in all schools from the program's inception, we estimate 57.4% (95% CI: 49.1%, 63.3%) would have met aerobic capacity HFZ standards. Adding a PE teacher, alone, had the largest impact (6.4% (95% CI: 1.0, 12.0) increase). PE Works positively impacted student cardiorespiratory fitness. Mandating and funding multicomponent PE programs is an important public health intervention to increase children's cardiorespiratory fitness.

Accounting for health equity in policy evaluation: a content analysis of primary research

Abstract Background Public Health researchers increasingly make use of sophisticated study designs and methods to evaluate the effects of policies on health and social outcomes. Natural experiment evaluation (NEE) conceptualises policies as ‘natural’ experiments that occur outside of the control of researchers. Often, NEE employs quasi-experimental methods (QEM) which enable researchers to rigorously evaluate the effect of population-level interventions. As for other health-related research, it is unclear to what extent such public health evaluations can and do consider the (health) equity implications of policies. We sought to investigate how health equity is addressed in NEEs and other policy evaluations that employ QEM. Methods We identified a random sample of primary research as part of a pre-registered scoping review (https://osf.io/3h6cb/). Studies that employed methods labelled as interrupted time series, difference-in-differences, controlled before and after, regression discontinuity, and synthetic control were included. Through content analysis, we examined how health equity was considered in data analysis and discussion sections. Results We analysed 59 studies, of which 25 were stratified for one or more socially-stratifying factors. Results were mainly stratified by sex (n = 15, 25.4%), age (n = 13, 22%), and diverse measures of socioeconomic status (n = 14, 23.7%), i.e. income, employment, education, or other factors. Of these, 21 studies included a discussion of health equity-related results, ranging from a few sentences to a holistic discussion including recommendations for decision-makers. Most commonly, researchers recommended monitoring of policy effects in different sub-populations, and careful policy design that conceptualises complex policy effects, including unintended and unequitable effects. Conclusions Policy evaluations have great potential for informing public health decision-making but health equity aspects were under-examined in these studies. Key messages • Health equity is assessed by evaluating policy effects in relevant sub-populations. Only 25 of 59 studies included results that were stratified for one or more socially stratifying factors. • Studies that were focused on disadvantaged populations commonly included recommendations for policymakers, calling for better policy design and improved monitoring of policy effects.

Innovative Biomedical Interventions for Cardiovascular Risk Reduction and Health Promotion: A Review Study

Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide, with increasing prevalence in both developed and developing regions. The complexity of CVD necessitates innovative approaches that combine biomedical research with clinical practice for effective prevention, diagnosis, and treatment. This chapter explores cutting-edge biomedical interventions to reduce cardiovascular risk and promote heart health. It focuses on recent advancements in biomarker identification, gene therapy, nanotechnology, and regenerative medicine, offering new strategies for early detection and targeted treatment of cardiovascular conditions. Additionally, the chapter highlights the role of precision medicine and personalized healthcare approaches in managing individual risk factors, including hypertension, dyslipidemia, and diabetes, while addressing lifestyle influences like nutrition and physical activity. Public health initiatives are also discussed, examining how biomedical research has contributed to the development of population-level interventions, such as community-based screening programs and digital health tools for monitoring cardiovascular health. By integrating biomedical innovation with preventive healthcare strategies, this chapter provides a comprehensive overview of the future directions in cardiovascular risk reduction, underscoring the importance of a multi-disciplinary approach for enhancing patient outcomes and promoting long-term cardiovascular wellness.

Exposure to useable green space and physical activity during active travel: A longitudinal GPS and accelerometer study before and after retirement

Green spaces may serve as population level interventions encouraging active travel. We examined the associations between exposure to useable green space (CORINE Land Cover categories) and physical activity during active travel (GPS and accelerometer) among late middle-aged participants from the Finnish Retirement and Aging study (n = 102). Greater proportion of useable green space was associated with higher physical activity during active travel on days off (+11 min/day per 1 SD increase in exposure) and on retirement days (+12 min/day), but not on workdays. Thus, it appears that in leisure time, people prefer to engage into active travel in green spaces.

Precision Population Cancer Medicine in Brain Tumors: A Potential Roadmap to Improve Outcomes and Strategize the Steps to Bring Interdisciplinary Interventions.

Brain tumors, a significant health burden,rank as the second leading cause of cancer among adolescents and young adults and the eighth most common cancer in older adults. Despitetreatment advances, outcomesfor many brain tumor types,especiallyglioblastoma multiforme (GBM), remain poor. Precision population cancer medicine (PPCM) offerspromising avenues for improving outcomes in brain tumor management.This comprehensive reviewdelves intothe current landscape of brain tumor diagnosis and treatment,with a primary focus onthe potential of PPCM toenhancecare. The reviewexploresseveral key areas where PPCM approaches show promise. In genetics and molecular biology, the genetic heterogeneity of brain tumors poses challengesandopportunities for targeted therapies. Understanding genetic patterns canguidetreatment strategies and improve prognostication. Epigenetic modificationsarecrucialin brain tumor development and progression. Deoxyribonucleic acid(DNA) methylation patterns, particularly of theO6-methylguanine-DNA methyltransferase (MGMT) gene promoter, serve asessentialbiomarkers for treatment response and prognosis in GBM. Targeting epigenetic mechanisms could lead to novel therapeutic approaches. Non-invasive liquid biopsy techniques show potential for diagnosis, monitoring, and prognostication in brain tumors. Analysis of circulating tumor DNA and microRNAs may provide valuable information about tumor characteristics and treatment response. Advanced imaging techniques, including radiomics and radiogenomics, combined with artificial intelligence (AI) algorithms, are enhancing tumor detection, characterization, and treatment planning. These technologies can contribute to more personalized treatment approaches.In addition, emergingnanotherapeutic platforms, which involve the use of nanoparticles to deliver drugs directly to tumors,and theranostic approaches, which combine therapy and diagnostics in a single platform,offer new possibilities for targeted drug delivery and real-time treatment monitoring in brain tumors. The review also addresses socioeconomic and demographic factors influencing brain tumor incidence and outcomes. It highlightsthe starkdisparities in care access and survival rates among different racial and ethnic groups, emphasizing theurgentneed for PPCM strategies to address these inequities. Challenges in implementing PPCM for brain tumors include the blood-brain barrier, which limits drug delivery, and the need for more extensive clinical trials to validate new approaches. The authors stress the importance of interdisciplinary collaboration and data sharing to advance the field, making the audience feel united and part of a larger team. While PPCM holds great promise, the review emphasizes that it should complement, not replace, population-level interventions and standard-of-care treatments. The authors advocate for a balanced approach that leverages cutting-edge personalized strategies while ensuring broad access to effective treatments. In conclusion, PPCM represents a powerful tool in the fight against brain tumors, offering the potential for more targeted, effective, and less toxic treatments. However, realizing its full potential will require ongoing research, clinical validation, and policy interactionsto address disparities in care access.

A systematic review and network meta-analysis of population-level interventions to tackle smoking behaviour.

This preregistered systematic review and meta-analysis (PROSPERO: CRD 42022311392) aimed to synthesize the effectiveness of all available population-level tobacco policies on smoking behaviour. Our search across 5 databases and leading organizational websites resulted in 9,925 records, with 476 studies meeting our inclusion criteria. In our narrative summary and both pairwise and network meta-analyses, we identified anti-smoking campaigns, health warnings and tax increases as the most effective tobacco policies for promoting smoking cessation. Flavour bans and free/discounted nicotine replacement therapy also showed statistically significant positive effects on quit rates. The network meta-analysis results further indicated that smoking bans, anti-tobacco campaigns and tax increases effectively reduced smoking prevalence. In addition, flavour bans significantly reduced e-cigarette consumption. Both the narrative summary and the meta-analyses revealed that smoking bans, tax increases and anti-tobacco campaigns were associated with reductions in tobacco consumption and sales. On the basis of the available evidence, anti-tobacco campaigns, smoking bans, health warnings and tax increases are probably the most effective policies for curbing smoking behaviour.

The impact of parkrun on life satisfaction and its cost-effectiveness: A six-month study of parkrunners in the United Kingdom.

An intervention suggested by the World Health Organisation that might increase life satisfaction is parkrun, a free, weekly, timed five kilometre run or walk. The issues with such interventions are (1) whether they impact on the life satisfaction of their participants, and (2) whether they are cost-effective. A study of 548 newly registered parkrunners were asked about their life satisfaction at baseline and six months later. A change of one life satisfaction point per year per participant was defined as one WELLBY (wellbeing adjusted life year), with a value of £13,000. Three approaches were used to estimate the additionality (added value) of parkrun: (1) by comparing a participant's number of parkruns to total activity; (2) by accounting for the participant's perceived impact of parkrun across 16 measures; and (3) combining these two methods equally. After six months, weighted, seasonally adjusted life satisfaction increased from a mean of 7.489 to 7.746, a change of 0.257. Both life satisfaction improvement and additionality were greatest for the least active. Assuming only half a year of benefit, the total value of the life satisfaction change for the 2019 parkrun population of 400,167 participants was estimated as £667.4m, with the least active accounting for almost half. Comparing to the cost of running parkrun in 2019 and using the activity, impact and combined methods for additionality, benefit-cost analysis ratios were found to be 16.7, 98.5 and 59.3 to 1, respectively. These were between 2.8 to 16.7 times that of other population-level physical activity interventions. Physical health was a mediator between activity and life satisfaction; mental health was only found as a mediator when combined with physical activity. Successful features of parkrun that might guide other interventions include its framing (role, time, place and cost) and ability to forge both strong and weak social ties.

Efficacy of a conversational chatbot for cigarette smoking cessation: Protocol of the QuitBot full-scale randomized controlled trial

Globally, cigarette smoking results in over 8 million premature annual deaths. Addressing this issue requires high-impact, cost-effective population-level interventions for smoking cessation. Conversational chatbots offer a potential solution given the recent advancements in machine learning and large language models. Chatbots can deliver supportive, empathetic behaviors, personalized responses, and timely advice tailored to users' needs that is engaging through therapeutic conversations aimed at creating lasting social-emotional connections. Despite their promise, little is known about the efficacy and underlying mechanisms of chatbots for cigarette smoking cessation. We developed QuitBot, a quit smoking program of two to three-minute conversations covering topics ranging from motivations to quit, setting a quit date, choosing cessation medications, coping with triggers, maintaining abstinence, and recovering from relapse. QuitBot employs conversational interactions, powered by an expert-curated large language model, allowing users to ask questions and receive personalized guidance on quitting smoking. Here, we report the design and execution of a randomized clinical trial comparing QuitBot (n = 760) against Smokefree TXT (SFT) text messaging program (n = 760), with a 12-month follow-up period. Both interventions include 42-days of content on motivations to quit, skills to cope with triggers, and relapse prevention. The key distinction between QuitBot and SFT is the communication and engagement feature of QuitBot. This study aims to determine: whether QuitBot yields higher quit rates than SFT; and whether therapeutic alliance processes and engagement are mechanisms underlying cessation outcomes. Additionally, we will explore whether baseline factors including trust, social support, and demographics, moderate the efficacy of QuitBot.Trial Registration numberClinicalTrials.govNCT04308759

Predictors of future overdose among people who inject drugs in Baltimore, Maryland

BackgroundLongitudinal studies of future overdose risk among people who inject drugs (PWID) are needed to inform planning of targeted overdose preventions in the United States. MethodsThe Integrating Services to Improve Treatment and Engagement (INSITE) study followed 720 PWID between June 2018 and August 2019 to evaluate the delivery of mobilized healthcare services in Baltimore, Maryland. The present analyses used logistic regression to identify baseline characteristics predictive of non-fatal or fatal overdose during the 6-month follow-up among 507 participants with overdose information. Non-fatal overdoses were self-reported and fatal overdoses were identified through the National Death Index. ResultsAt baseline, 121 (23 %) reported an overdose in the prior 6 months. Between baseline and follow-up, 66 (13 %) participants reported a non-fatal overdose and 6 (1 %) experienced a fatal overdose. Overdose during follow-up was positively associated with overdose in the 6 months prior to baseline (6.70 aOR; 95 % CI: 3.51, 12.78) and more than 6 months prior to baseline (2.49 aOR; 95 % CI: 1.52, 4.08) versus no prior overdose. Overdose during follow-up was also positively associated with buprenorphine treatment (2.37 aOR; CI: 1.08, 5.21) and negatively associated with non-prescribed methadone at baseline (0.59 aOR; 0.38, 0.93). ConclusionsIdentifying and intervening with PWID who experienced a recent overdose could reduce short-term elevated risk of future overdose. However, as other PWID reported never experiencing an overdose at baseline nonetheless experienced an overdose during follow-up, targeted approaches should be complemented with population-level interventions. Overdose risk implications of buprenorphine treatment and non-prescribed methadone are also discussed.

Population level interventions to prevent severe mental health conditions: Methodological challenges and opportunities for universal and targeted approaches

Population level interventions to prevent severe mental health conditions: Methodological challenges and opportunities for universal and targeted approaches

The Role of Public Health in Promoting Health Programs

Public health plays an important role in promoting health programs by addressing social determinants of health, preventing disease, and enhancing community well-being. Unlike clinical medicine, which focuses on individual treatment, public health targets population-level interventions to create environments that support health-promoting behaviors. Key strategies include education, media campaigns, advocacy, policy change, and community engagement. However, challenges such as financial constraints, public perception, and systemic barriers can hinder program effectiveness. This paper examines the importance of public health, strategies for promoting health programs, and case studies demonstrating success, ultimately reinforcing the significance of cross-sectoral collaboration in addressing global health challenges. Keywords: Public Health, Health Promotion, Disease Prevention, Social Determinants of Health, Health Education.

Effect of a cash transfer intervention on memory decline and dementia probability in older adults in rural South Africa

Evidence on cash transfers as a population-level intervention to support healthy cognitive aging in low-income settings is sparse. We assessed the effect of a cash transfer intervention on cognitive aging outcomes in older South African adults. We leveraged the overlap in the sampling frames of a Phase 3 randomized cash transfer trial [HIV Prevention Trial Network (HPTN) 068, 2011-2015] and an aging cohort [Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community (HAALSI), 2014-2022] in rural Mpumalanga Province, South Africa. In 2011/12, young women and their primary caregivers were randomly assigned 1:1 to receive a monthly cash transfer or control. In 2014/2015, 862 adults aged 40+ y living in trial households were enrolled in the HAALSI cohort, with cognitive data collected in three waves over 7 y. We estimated the impact of the intervention on rate of memory decline and dementia probability scores. Memory decline in the cash transfer arm was 0.03 SD units (95% CI: 0.002, 0.05) slower per year than in the control arm. Dementia probability scores were three percentage points lower in the cash transfer arm than the control arm (β = -0.03; 95% CI: -0.05, -0.001). Effects were consistent across subgroups. A modestly sized household cash transfer delivered over a short period in mid- to later-life led to a meaningful slowing of memory decline and reduction in dementia probability 7 y later. Cash transfer programs could help stem the tide of new dementia cases in economically vulnerable populations in the coming decades.

Addressing Health Care Access Disparities Through a Public Health Approach to Physical Therapist Practice.

As the field evolves as a doctoring profession, the role and scope of physical therapist practice must also grow to meet important and urgent public health needs. Scalable, population-level interventions must be prioritized to the same degree as tailored, individual-level care. Drawing from public health frameworks, this perspective proposes an approach to population-level physical therapist care delivery that aims to mitigate disease and disability and improve health outcomes by expanding access, decreasing cost, and improving quality of care for those facing the greatest health disparities. Application of these frameworks prompts the development of novel approaches to rehabilitation service delivery to advance twin goals of promoting access to care and reducing health disparities. This paper describes how a population health framework and public health approach can be used to support necessary evolution and innovation within the field of physical therapy and to improve rehabilitation service delivery. Rapid developments in the digital and virtual health space have created a unique opportunity for physical therapists to lean into a new vision of their role as clinicians within the broader health ecosystem. This paper will provide clinicians with a broader perspective of physical therapist expertise and describe opportunities for the development and application of a physical therapist skill set toward driving population health outcomes. Real-world examples will guide clinicians to consider opportunities in their own practice for implementing this public health approach and potentially addressing various contributors to persistent health disparities.

Improving Identification of Patients Experiencing Homelessness in the Electronic Health Record: A Curated Registry Approach.

Identification of persons experiencing homelessness (PEH) within healthcare systems is critical to facilitate patient and population-level interventions to address health inequities. We created an enhanced electronic health record (EHR) registry to improve identification of PEH within a safety net healthcare system. We compared patients identified as experiencing homelessness in 2021, stratified by method of identification (i.e., through registration data sources versus through new EHR registry criteria). Sociodemographic and clinical characteristics, healthcare utilization, engagement with homeless service providers, and mortality. In total, 10,896 patients met the registry definition of a PEH; 30% more than identified through standard registration processes; 78% were identified through only one data source. Compared with those identified only through registration data, PEH identified through new registry criteria were more likely to be female (42% vs. 25%, p < 0.001), Hispanic/Latinx or Black/African American (30% versus 25% and 25% vs. 18%, p < 0.0001), and Medicaid or Medicare beneficiaries (74% vs. 67% and 16% vs.10%, respectively, p < 0.0001). New data sources also identified a higher proportion of patients: at extremes of age (16% < 18years and 9% ≥ 65years vs. 2% and 5%, respectively, p < 0.0001), with increased clinical risk (31% with CRG 6-9 vs. 18%, p < 0.0001), and with a mental health diagnosis (56% vs. 42%, p < 0.0001), and a lower proportion of patients with a substance use diagnosis (39% vs. 54%, p < 0.0001) or criminaljustice involvement (8% vs. 15%, p < 0.0001). Newly identified patients were more likely to be engaged in primary care (OR 2.03, 95% CI 1.83-2.26) but less likely to be engaged with homeless service providers (OR 0.70, 95% CI 0.63-0.77). Commonly utilized methods of identifying PEH within healthcare systems may underestimate the population and introduce reporting biases. Recognizing alternate identification methods may more comprehensively and inclusively identify PEH for intervention.

Abstract P366: Co-Created Intervention Promotes Uptake of Low Sodium Iodized Salt Substitute to Control Hypertension: Results from a Large Community-based Quasi-Experimental Study from India

Introduction: India has a high burden of uncontrolled hypertension (28%) with low control rates (&lt;10%). Mean dietary sodium intake (4000mg/d) is also high, which warrants implementation of population-level sodium reduction interventions, such as using low-sodium iodized salt (LSIS). Given the low awareness about LSIS, we co-created and evaluated an intervention to promote its usage. Objective: To estimate change from baseline to end line in proportion of households reporting LSIS use post implementation of a co-created (involving multiple stakeholders) intervention to provide education (education only arm) on LSIS and education along with subsidy to purchase LSIS (education+subsidy arm). Methods: The study was implemented (8 months intervention) in rural and urban sites of north and south India. In the education only arm, trained health workers provided education on LSIS to community members using pamphlets, a short video and encouraged retailers to sell LSIS to consumers by displaying point of sale posters. In the education+subsidy arm, apart from aforementioned activities, subsidy of $ 0.24/kg (~50% of the price) to purchase LSIS was provided to the distributors, who passed this on to retailers and consumers. Results: A total of 1,602 households and 3,108 participants were interviewed. The mean(SD) age of the participants was 46.9(14.2) years. Fifty two percent were females. At baseline, proportion of households reporting ever use of LSIS was 1.3% (95%CI: 0.9–2.1) and 2.3% (1.8–2.7) respectively, in the education and education+subsidy arms. At end line, this proportion increased to 22.6% (21.1–24.1) and 49.3% (47.5-51.2%) respectively. The odds of LSIS ever use was 2.6 (1.2-5.7) times higher in the education+subsidy arm compared to education only arm. The odds of reporting LSIS use was higher if the household had ≥ one patient with hypertension (1.7[1.3-2.3]), with graduate education (1.6[1.3-2.0]) or belonged to richest quintile (1.6[1.3-2.0]). There was no significant change in mean systolic and diastolic blood pressure, urinary sodium, and potassium between the two arms from baseline to end line. Conclusion: We demonstrated the possibility of increasing LSIS usage through a co-created intervention providing either education only or education+subsidy to buy LSIS with a substantially higher response for the latter. This underscores the need to make LSIS accessible, available, and affordable for regular use to reduce dietary sodium intake and control hypertension.

Trends and socioeconomic inequalities in the dental attendance of adult smokers in Scotland from 2009 to 2019, a repeated cross-sectional study

BackgroundSmoking continues to be the single largest cause of preventable disease and death and a major contributor to health inequalities. Dental professionals are well placed to offer behavioural support in combination with pharmacotherapy to increase smoking cessation rates across the population. We aimed to assess the trends and socioeconomic inequalities in the dental attendance of adult smokers in Scotland from 2009 to 2019 and examine the potential population reach of dental settings for smoking cessation interventions.MethodsA secondary analysis was conducted of combined Scottish Health Surveys (SHeS) from 2009/11, 2013/15 and 2017/19. ‘Recent’ dental attendance (within the past two years) was the focus and descriptive analysis examined attendance of self-reported smokers compared to non-smokers and stratified by the area-based Scottish Index of Multiple Deprivation (SIMD) and individual socioeconomic measures (income, education, and occupation). Generalised linear models were used to model recent attendance in non-smokers relative to smokers adjusted by the socioeconomic measures, for each of the survey cohorts separately. Absolute differences and risk ratios were calculated with 95% Confidence Intervals (CI).ResultsRecent dental attendance was generally high and increased in both smokers (70–76%) and non-smokers (84–87%) from 2009/11 to 2017/19 and increased across all SIMD groups. After adjustment for sociodemographic variables, the adjusted Risk Difference (aRD) for recent attendance between non-smokers and smokers was 8.9% (95% CI 4.6%, 13.2%) by 2017/19. Within smokers, recent attendance was 7–9% lower in those living in the most deprived areas compared to those living in the least deprived areas over the three surveys.ConclusionsSHeS data from 2009 to 2019 demonstrated that a high and increasing proportion of smokers in the population attend the dentist, albeit slightly less frequently than non-smokers. There were large inequalities in the dental attendance of smokers, to a lesser extent in non-smokers, and these persisted over time. Dental settings provide a good potential opportunity to deliver population-level smoking cessation interventions, but smokers in the most deprived groups and older age groups may be harder to reach. Consideration should be given to ensure that these groups are given appropriate proportionate support to take up preventive interventions.

Benefits of population-level interventions for dementia risk factors: an economic modelling study for England

Individual-level interventions for dementia risk factors could reduce costs associated with dementia and some are cost-effective. We aimed to estimate the cost-effectiveness of population-level interventions for tackling dementia risk factors. In this economic modelling study, we included recommended population-based interventions from a previously published review article for which there was consistent and robust evidence of effectiveness in tackling a dementia risk factor (tobacco smoking, excess alcohol use, hypertension, obesity, air pollution, and head injury). We only included interventions if they had not been introduced in England or were in place but could be extended. The interventions studied were increases in tobacco pricing, minimum pricing for alcohol, raising alcohol price, salt reduction policies, sugar reduction policies, low emission zones, and compulsory helmet use for cycling by children (aged 5-18years). We used published intervention effect sizes and relative risks for each risk factor and a Markov model to estimate progression to dementia in populations with and without the intervention, looking at lifetime risk, in the population of England. We estimated that reductions in excess alcohol use through minimum unit pricing would lead to cost-savings of £280million and 4767 quality-adjusted life-years (QALYs) gained over an indefinite succession of age cohorts. Reformulation of food products to reduce salt would lead to cost-savings of £2·4billion and 39 433QALYs gained and reformulation to reduce sugar would lead to cost-savings of £1·046billion and 17 985QALYs gained. Reducing dementia risk from air pollution by introducing low emission zones in English cities with a population of 100 000or more (that do not already impose restrictions) would lead to £260million cost-savings and 5119QALYs gained. Raising cigarette prices by 10% to reduce dementia risk from smoking would lead to 2277QALYs gained and cost-savings of £157million. Making bicycle helmets compulsory for children (aged 5-18years) to reduce dementia risk from head injury would lead to cost-savings of £91million and 1554QALYs gained. Population-level interventions could help tackle life course dementia risk and save costs. UK National Institute for Health and Care Research Three Schools dementia research programme.

Visual Impairment, Eye Conditions, and Diagnoses of Neurodegeneration and Dementia

Vision and eye conditions are associated with increased risk for Alzheimer disease and related dementias (ADRDs), but the nature of the association and the underlying biological pathways remain unclear. If causal, vision would be an important modifiable risk factor with viable population-level interventions. To evaluate potentially causal associations between visual acuity, eye conditions (specifically cataracts and myopia), neuroimaging outcomes, and ADRDs. A cohort and 2-sample bidirectional mendelian randomization (MR) study was conducted using UK Biobank participants and summary statistics from previously published genome-wide association studies on cataract, myopia, and AD. The participants included in the analysis were aged 55 to 70 years without dementia at baseline (calendar years 2006 to 2010), underwent genotyping, and reported on eye conditions; a subset completed visual acuity examinations (n = 69 852-71 429) or brain imaging (n = 36 591-36 855). Data were analyzed from August 15, 2022, through November 28, 2023. Self-reported cataracts, visual acuity, and myopia measured by refraction error. ADRD, AD, and vascular dementia were identified from electronic medical records. Total and regional brain volumes were determined using magnetic resonance imaging. The sample included 304 953 participants (mean [SD] age, 62.1 (4.1) years; 163 825 women [53.72%]); 14 295 (4.69%) had cataracts and 2754 (3.86%) had worse than 20/40 vision. Cataracts (hazard ratio [HR], 1.18; 95% CI, 1.07-1.29) and myopia (HR, 1.35; 95% CI, 1.06-1.70) were associated with a higher hazard of ADRD. In MR analyses to estimate potential causal effects, cataracts were associated with increased risk of vascular dementia (inverse variance-weighted odds ratio [OR], 1.92; 95% CI, 1.26-2.92) but were not associated with increased dementia (OR, 1.21; 95% CI, 0.98-1.50). There were no associations between myopia and dementia. In MR for potential reverse causality, AD was not associated with cataracts (inverse variance-weighted OR, 0.99; 95% CI, 0.96-1.01). Genetic risk for cataracts was associated with smaller total brain (β = -597.43 mm3; 95% CI, -1077.87 to -117.00 mm3) and gray matter (β = -375.17 mm3; 95% CI, -680.10 to -70.24 mm3) volumes, but not other brain regions. In this cohort and MR study of UK Biobank participants, cataracts were associated with increased risk of dementia, especially vascular dementia, and reduced total brain volumes. These findings lend further support to the hypothesis that cataract extraction may reduce the risk for dementia.

Persistence of Antibodies against Measles, Mumps, and Rubella after the Two-Dose MMR Vaccination: A 7-Year Follow-Up Study.

In 2014, the Expanded Program on Immunization of Thailand changed the timing of the second dose of the measles-mumps-rubella (MMR) vaccine from 4-6 years to 2.5 years, while maintaining the first dose at 9 months of age. This study aimed to examine the dynamics and durability of immune responses induced by the two-dose MMR vaccine in a group of 169 Thai children from 4 to 7 years of age (4.5 years after the second MMR dose). We followed a cohort of healthy children from a clinical trial (ClinicalTrials.gov NCT02408926) where they were administered either the Priorix vaccine (GlaxoSmithKline Biologicals, Rixensart, Belgium) or M-M-RII (Merck & Co., Kenilworth, NJ, USA) at 9 months and 2.5 years of age. Blood samples were collected annually from ages 4 to 7 years. Anti-measles, -mumps, and -rubella IgG levels were evaluated using the enzyme-linked immunosorbent assay (EUROIMMUN, Lubeck, Germany). A total of 169 children completed this study. Over the 4.5 years following the two-dose MMR vaccination, we observed a decline in the seroprotection rates against measles and mumps, but not rubella. Longitudinal monitoring of antibody persistence, among other strategies, will help predict population-level immunity and inform public health interventions to address potential future outbreaks.

Evaluation of weather and environmental factors and their association with cutaneous melanoma incidence: A national ecological study

BackgroundCutaneous melanoma (CM) is a significant contributor to skin cancer-related mortality globally and in Canada. Despite the well-established link between ultraviolet (UV) radiation exposure and skin cancer risk, there remains a gap in population-level interventions and persistent misconceptions about sun exposure and impact of environment on individual behavior. ObjectiveThe current study provides an ecological analysis using latest available data (2011-2017) to define geographic/environmental contributors to the CM landscape in Canada. MethodsUtilizing Canadian Cancer Registry (CCR) and Canadian Urban Environmental Health Research Consortium (CANUE) data, we analyzed 39,605 CM cases occurring in Canada from 2011-2017. Environmental data, including UV radiation, greenspace (NDVI), temperature, heat events, and precipitation was used to evaluate the effect of environment on CM incidence rates across Forward Sortation Area (FSA) postal codes. ResultsFSAs with increased CM incidence were associated with higher annual average temperature, snowfall, heat events, NDVI, and vitamin D-weighted UV exposure. Conversely, factors associated with decreased incidence included an increased annual highest temperature, rain precipitation, and a longer duration of heat events. LimitationsThis study is subject to ecological bias and findings should be interpreted with caution ConclusionThis study further substantiates associations between specific environmental factors and CM incidence.