Prevention Of Non-communicable Diseases Research Articles

Implementation research on registering cancer cases in primary health centres of Puducherry through community health workers.

Background & objectives Hospital-based cancer registry does not represent the true burden of cancer in the community. Initiating a Primary Health Centre (PHC)-based cancer registry may better estimate population-level data for cancer cases in an area. This study aimed to set up a system for facilitating a PHC-based cancer registry and to assess the registration status of cancer cases in various PHCs of Puducherry. The facilitating and limiting factors while setting up this registry were also assessed. Methods A quasi-experimental study with an embedded mixed-method design was conducted in 31 PHCs/Community Health Centres (CHCs) from March 2021 to November 2022. The interventions were implemented in all PHCs/CHCs of Puducherry with the involvement of the State Non-Communicable Diseases (NCD) cell. The line list of cancer cases from the Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) Hospital-based cancer registry was shared with all PHCs/CHCs. Sensitization sessions for all Community Health Workers (CHWs) were conducted, and feedback on cancer registration status was given to the State NCD cell. Focus group discussion (FGD)/Key informant interview (KII) was undertaken to understand strengths, challenges, and suggestions. The logic model was used to understand the various indicators while setting up this PHC-based cancer registry. Results Over a one-year intervention period, 1270 cancer cases were registered at Puducherry's PHCs/CHCs, 1203 (88%) from the shared list and 67(5%) from other facilities. However, only 53 per cent of the expected living cases were captured in the various PHCs. Major limitations for registration were the COVID-19 pandemic, stigma, inadequate manpower, infrastructure issues, and privacy concerns during screening. Interpretation & conclusions It was feasible to set up a PHC-based cancer registry in all PHCs of Puducherry. However, registration of cancer cases was suboptimal, as population-based screening of cancer cases, as recommended in the National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) programme, was weak due to the COVID-19 pandemic. Once this is strengthened, the PHC-based cancer registry will better represent the population.

Cutting-edge progress in green technologies for resistant starch type 3 and type 5 preparation: An updated review

Resistant starch (RS) is a dietary fiber that resists starch hydrolysis in the small intestine, and is fermented in the colon by microorganisms. RS not only has a broad range of benefits in the food and non-food industries but also has a significance impact on health promotion and prevention of non-communicable diseases. RS types 3 and 5 have been the focus of research from an environment-friendly perspective. RS3 is normally formed by recrystallization after physical modification, whereas RS5 is obtained by the complexation of starch and fatty acids through the thermomechanical methods. This review provides updates and approaches to RS3 and RS5 preparations that promote RS content based on green technologies. This information will be useful for future research on RS development and for identifying preparation methods for functional food.

Evaluating the Potential and Pitfalls of AI-Powered Conversational Agents as Humanlike Virtual Health Carers in the Remote Management of Noncommunicable Diseases: Scoping Review.

The rising prevalence of noncommunicable diseases (NCDs) worldwide and the high recent mortality rates (74.4%) associated with them, especially in low- and middle-income countries, is causing a substantial global burden of disease, necessitating innovative and sustainable long-term care solutions. This scoping review aims to investigate the impact of artificial intelligence (AI)-based conversational agents (CAs)-including chatbots, voicebots, and anthropomorphic digital avatars-as human-like health caregivers in the remote management of NCDs as well as identify critical areas for future research and provide insights into how these technologies might be used effectively in health care to personalize NCD management strategies. A broad literature search was conducted in July 2023 in 6 electronic databases-Ovid MEDLINE, Embase, PsycINFO, PubMed, CINAHL, and Web of Science-using the search terms "conversational agents," "artificial intelligence," and "noncommunicable diseases," including their associated synonyms. We also manually searched gray literature using sources such as ProQuest Central, ResearchGate, ACM Digital Library, and Google Scholar. We included empirical studies published in English from January 2010 to July 2023 focusing solely on health care-oriented applications of CAs used for remote management of NCDs. The narrative synthesis approach was used to collate and summarize the relevant information extracted from the included studies. The literature search yielded a total of 43 studies that matched the inclusion criteria. Our review unveiled four significant findings: (1) higher user acceptance and compliance with anthropomorphic and avatar-based CAs for remote care; (2) an existing gap in the development of personalized, empathetic, and contextually aware CAs for effective emotional and social interaction with users, along with limited consideration of ethical concerns such as data privacy and patient safety; (3) inadequate evidence of the efficacy of CAs in NCD self-management despite a moderate to high level of optimism among health care professionals regarding CAs' potential in remote health care; and (4) CAs primarily being used for supporting nonpharmacological interventions such as behavioral or lifestyle modifications and patient education for the self-management of NCDs. This review makes a unique contribution to the field by not only providing a quantifiable impact analysis but also identifying the areas requiring imminent scholarly attention for the ethical, empathetic, and efficacious implementation of AI in NCD care. This serves as an academic cornerstone for future research in AI-assisted health care for NCD management. Open Science Framework; https://doi.org/10.17605/OSF.IO/GU5PX.

Burden of non-communicable diseases among women of reproductive age in Kenya: a cross-sectional study

ObjectiveTo examine the burden of non-communicable diseases (NCDs) among women of reproductive age in Kenya, highlighting the prevalence and risk factors.DesignCross-sectional design based on the 2022 Kenya Demographic and Health...

Epidemiological characteristics of fatal drowning and related factors in children in Zhejiang Province, 2022

Objective: To understand the epidemiological characteristics of fatal drowning in children in Zhejiang Province in 2022, analyze factors such as the swimming ability of children, the caregiver behavior at drowning site, types of first aid personnel and methods of first aid of unintentional fatal drowning and provide evidence for targeted intervention. Methods: Using the "Survey Form of Fatal Drowning Case in Children" designed by National Center for Chronic and Non-communicable Disease Control and Prevention of the China CDC, we collected case information of children aged 0-17 years who died due to drowning in Zhejiang in 2022 from medical history/death investigation records, telephone interviews, and home visits. Results: A total of 341 fatal drowning cases in children occurred in Zhejiang in 2022 and 330 cases were investigated (96.77%). The male to female of the cases was 2.33∶1, most cases were aged 15-17 years and 0-4 years, and 54.24% of fatal drowning cases occurred in children from other provinces. In the drowning cases, 83.33% were unintentional ones, and the proportion of intentional fatal drowning cases in children increased with age. Fatal drowning cases mainly occurred in open natural water bodies and public water storage facilities. More fatal drowning cases occurred in open natural water bodies in older children, while more fatal drowning cases occurred in public water storage facilities in younger children. In 275 children who died due to unintentional drowning, 73.09% could not swim, and only 1.09% were fully supervised by adults within an arm's length. First aid personnel, mainly medical staffs, bystanders and adult caregivers, were present for 47.63% fatal drowning cases. The proportion of the cases who had cardiopulmonary resuscitation as the first aid within 5 minutes was 2.18%. Conclusions: Drowning poses a serious threat to children's lives and there are differences in reasons and locations of fatal drowning in children in different age groups in Zhejiang Province in 2022. It is necessary to conduct to interventions to improve children's swimming skills, strengthen effective adult care and conduct health education about field first aid of drowning to reduce the incidence of drowning and related deaths in children.

Implementation of School Nutrition Policies to Address Noncommunicable Diseases in Uzbekistan and Kyrgyzstan.

Noncommunicable diseases (NCDs), including cardiovascular diseases, cancer, and diabetes, account for over 80% of mortality in Uzbekistan and Kyrgyzstan in 2019, and unhealthy dietary behaviors are a major risk factor for NCDs in both countries. In 2021, national stakeholders, in consultation with the World Health Organization, identified school nutrition policies (SNPs) as a major approach to reducing the burden of NCDs in both countries. The SNPs included interventions implemented through a multistakeholder and multisectoral arrangement that aimed to improve the health and nutrition status of children and young people by providing healthy food/beverages and restricting unhealthy foods or beverages in schools. We used a multimethod approach of document review, participatory workshops, and key informant interviews to generate theories of change for the large-scale implementation of SNPs and describe the implementation processes to date, including key implementation and health system challenges, salient implementation strategies, and implementation outcomes in both countries. Multiple pathways for enacting and implementing SNPs successfully were identified. However, significant health system challenges, such as the lack of accountability for contracting and tender processes and coordination among different sectors, continue to hamper the large-scale implementation of these policies in both countries. The pathways, theories, and implementation outcomes identified will facilitate the development of implementation strategies and systematic learning and evaluation around SNPs for NCD prevention and control programs in the Central Asian region and other low- and middle-income countries more broadly.

Primary health care response to noncommunicable diseases: an assessment of Wellness Clinics in Ghana

BackgroundGlobally, there is a significant unmet need for the rapidly growing burden of Non-Communicable Diseases (NCDs). Ghana has adopted and implemented Wellness Clinics (WC) nationwide to respond to the rising burden of NCDs. Regrettably, very little is known about WCs, including their structure and the services they offer. This study explores the concept of WC, their structure, position within the hospital environment, and services from the perspectives of healthcare providers and clients.MethodsAn exploratory qualitative study was conducted with health professionals (n = 12) and clients (n = 26) of Wellness Clinics in two district hospitals and one regional hospital in a deprived region of Ghana where NCDs are rising. Using the WHO-PEN approach, an interview guide was purposely designed for this study. The data were analysed thematically using Atlas.ti.ResultsAll three Wellness Clinics were sub-units under the outpatient department. The WC was created by the facilities to respond to the increase in NCDs and to meet annual performance review requirements. The Wellness Clinics provided NCD diagnosis, counselling, and treatment services to approximately 300 clients per week at the facility level. Only one of the WCs provided NCD prevention services at the community level. Integrated NCD care was also provided at the WC, despite the health system and individual-level challenges reported by the health workers and clients.ConclusionThe implementation of the Wellness Clinic demonstrates the government’s commitment to addressing the increasing burden of NCDs in Ghana through the primary health system. To maximise the impact of the wellness clinics, we recommend developing best practices, providing logistics, and addressing health insurance challenges.

CAN TASTE AND PRESENTATION OF RESTAURANT MENUS CHANGE CUSTOMERS' HEALTH KNOWLEDGE AND PERCEPTIONS? A NATURAL RESTAURANT FIELD EXPERIMENT

This study examines the impact of menu taste and presentation on customers’ health knowledge and perceptions using behavioral economics in a restaurant setting. The increasing prevalence of non-communicable diseases (NCDs) and obesity highlights the importance of dietary choices for health outcomes. Using a natural field experiment involving 349 participants in Chiangmai, Thailand, this study examines how experiments taste and alterations in menu design, specifically through convenience and visibility interventions, can encourage healthier meal selections. The experiment shows that taste significantly influences the perception of meal healthiness, while strategic menu presentation influences customers' meal choices and their ability to accurately estimate caloric content. The findings suggest that making high-calorie options more visible tends to lead participants towards choices with higher caloric content than estimated, indicating the potential of menu design in modifying consumer behavior towards healthier eating habits. Additionally, the study examines demographic factors such as age, gender, and Body Mass Index (BMI), alongside self-reported dietary practices, to understand their influence on meal selection decisions. This study contributes to behavioral economics by providing empirical evidence on how small changes in the food environment can promote healthier diets, addressing the global challenge of tackling non communicable diseases and obesity.

Biodiversity and Diabetes: Is There a link?

Abstract India is rich in agrobiodiversity and is considered to be one of the important countries for production of food, oilseed and horticultural crops, spices, and medicinal plants. However, the prevalence of noncommunicable diseases (NCDs) such as type 2 diabetes (T2D) and obesity has been rapidly increasing in India due to unhealthy food habits, for example, changing from healthy unpolished brown rice to highly polished white rice. Bringing back our traditional foods such as millets and making use of India’s rich biodiversity could help improve the health of its population and help in preventing and control of NCDs such as T2D.

DUKUNGAN LINTAS SEKTOR DALAM MENINGKATKAN GERAKAN MASYARAKAT HIDUP SEHAT

The prevalence of non-communicable diseases in Indonesia showed a significant increasing trend, from 25% at the end of 2013 to 35% at the end of 2018. Prevention efforts in a community had to be conducted through healthy lifestyle implementation characterized by four indicators, namely physical activity, daily fruit and vegetable intake, not smoking, and routine health checks. Public awareness of healthy life is shallow, even though they have a high educational background. The research aimed to know the role of cross-sector support programs as a solution in improving the Healthy Life Behavior of the citizen. This research was conducted in July-August 2018 in 22 working areas of the Bandung City Health Center. The research used a cross-sectional approach design. The respondents were 205 people, using the purposive random sampling technique. The analysis used chi-square test. The results showed that respondents had poor knowledge about GERMAS, 60.4% of whom were also bad at implementing GERMAS. The respondents whose attitude towards GERMAS was poor, 61.0% of them were also poor in implementing GERMAS. Most people had not felt cross-sector support. There was a significant relationship between cross-sector support and the improvement of people's healthy clean living behavior. The research concluded that almost all people have good knowledge and attitudes about GERMAS, but most people were not good at implementing GERMAS, and there were most people who do not feel any cross-sectoral support in implementing GERMAS. There was a meaningful relationship between cross-sectoral support, both government and private, and the implementation of GERMAS.

Clinical and Metabolic Particularities of a Roma Population with Diabetes-Considering Ethnic Disparities in Approaching Healthcare Management.

The Roma population is Europe's largest ethnic minority, yet data on the prevalence of non-communicable diseases remain scarce in medical literature. This study aimed to compare the clinical and metabolic particularities of a Roma population with diabetes with a group of non-Roma. We conducted an observational, transversal study and evaluated 808 adult patients with diabetes mellitus, from a tertiary diabetes care hospital. The prevalence of metabolic syndrome was high among both groups, 94.3% in the Roma patients and 89.1% in the non-Roma. A slightly higher mean value of the triglyceride-glucose (TyG) index was observed among the Roma group (10.07 ± 0.71 versus 9.71 ± 0.82). Among the non-Roma, variables that were significantly associated with the TyG index were glycated hemoglobin (HbA1c), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-c), and low-density lipoprotein-cholesterol (LDL-c), while among the Roma, HbA1c and HDL-c were correlated with this index. There were no differences concerning myocardial infarction; however, the number of patients with a history of stroke was 2.1 times higher in the Roma group compared to the non-Roma group. The prevalence of cardiovascular risk factors, cardiovascular disease, and microvascular complications among the study's Roma population are quite significant, underscoring the importance of ethnic disparities in approaching healthcare management strategies.

Development of “Intelligent particles” for the treatment of dental caries

Dental caries is one of the most prevalent non-communicable diseases worldwide, mediated by a multispecies biofilm that consists of high levels of acidogenic bacteria which ferment sugar to acid and cause teeth demineralization. Current treatment practice remains insufficient in addressing 1) rapid clearance of therapeutic agents from the oral environment 2) destroying bacteria that contribute to the healthy oral microbiome. In addition, increasing concerns over antibiotic resistance calls for innovative alternatives. In this study, we developed a pH responsive nano-carrier for delivery of polycationic silver nanoparticles. Branched-PEI capped silver nanoparticles (BPEI-AgNPs) were encapsulated in a tannic acid − Fe (III) complex-modified poly(D,L-lactic-co-glycolic acid) (PLGA) particle (Fe(III)-TA/PLGA@BPEI-AgNPs) to enhance binding to the plaque biofilm and demonstrate “intelligence” by releasing BPEI-AgNPs under acidic conditions that promote dental caries The constructed Fe(III)-TA/PLGA@BPEI-AgNPs (intelligent particles − IPs) exhibited significant binding to an axenic S. mutans biofilm grown on hydroxyapatite. Ag+ ions were released faster from the IPs at pH 4.0 (cariogenic pH) compared to pH 7.4. The antibiofilm results indicated that IPs can significantly reduce S. mutans biofilm volume and viability under acidic conditions. Cytotoxicity on differentiated Caco-2 cells and human gingival fibroblasts indicated that IPs were not cytotoxic. These findings demonstrate great potential of IPs in the treatment of dental caries.

School-based caries prevention using silver diamine fluoride: A pragmatic randomized trial in low-income rural children.

Dental caries is the world's most prevalent noncommunicable disease, disproportionately affecting children from low-income families and rural geographic areas. The CariedAway 3.0 study was a cluster-randomized pragmatic non-inferiority trial comparing silver diamine fluoride (SDF) to sealants and atraumatic restorations (ART) for the prevention and control of dental caries. All participants also received fluoride varnish. Analysis consisted of mixed-effects logistic regression for caries prevalence and weighted least squares and mixed-effects negative binomial regression for caries incidence. A non-inferiority margin of 10% for the difference between groups was used. Dental caries was defined as an ICDAS score of four or greater. A total of 3345 children were enrolled across 35 schools; however there was a large proportion of children who were noncompliant and received external dental care over the course of the trial. In adjusted analyses of compliant participants (n=1083; 543 in the SDF group and 540 in the sealant and ART group), there was no difference in the weighted risk difference between treatment groups (B=0.003, 95% CI = -0.0001, 0.0008). The odds of caries prevalence was elevated in the SDF group in longitudinal analyses (OR = 1.35, 95% CI = 0.86, 2.11) but was not significant and was below the non-inferiority margin. There were no significant differences between groups for caries incidence in adjusted models (IRR = 1.19, 95% CI = 0.81, 1.74). Results for intent to treat analyses were similar to that of per-protocol. In this school-based clinical trial, the prevalence of dental caries in children treated with SDF and fluoride varnish was non-inferior compared to those treated with sealants, ART, and fluoride varnish, although the overall risk was slightly higher. Unfortunately, a high rate of dropout and participant noncompliance was observed, likely due to the impacts of COVID-19 on study procedures. As a result, observed effects may be unreliable beyond the short-term. NCT03448107.

Shifting roles of community health workers in the prevention and management of noncommunicable disease during the COVID-19 pandemic: a scoping review.

Community Health Workers (CHWs) play a crucial role in the prevention and management of noncommunicable diseases (NCDs). The COVID-19 pandemic triggered the implementation of crisis-driven responses that involved shifts in the roles of CHWs in terms of delivering services for people with NCDs. Strategically aligning these shifts with health systems is crucial to improve NCD service delivery. The aim of this review was to identify and describe COVID-19-triggered shifting roles of CHWs that are promising in terms of NCD service delivery. We searched Ovid Medline, Embase, CINAHL, Web of Science and CABI for Global Health for relevant articles published between 1 January 2020 and 22 February 2022. Studies that were conducted within a COVID-19 context and focused on the shifted roles of CHWs in NCD service delivery were included. We used Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to report the findings. A total of 25 articles from 14 countries were included in this review. We identified 12 shifted roles of CHWs in NCD service delivery during COVID-19, which can be categorized in three dimensions: 'enhanced' role of CHWs that includes additional tasks such as medication delivery; 'extended' roles such as the delivery of NCD services at household level and in remote communities; and 'enabled' roles through the use of digital health technologies. Health and digital literacy of people with NCDs, access to internet connectivity for people with NCDs, and the social and organizational context where CHWs work influenced the implementation of the shifted roles of CHWs. In conclusion, the roles of CHWs have shifted during the COVID-19 pandemic to include the delivery of additional NCD services at home and community levels, often supported by digital technologies. Given the importance of the shifting roles in the prevention and management of NCDs, adaptation and integration of these shifted roles into the routine activities of CHWs in the post-COVID period is recommended.

Health and Nutrition Promotion Programs in Papua New Guinea: A Scoping Review.

There is a rising prevalence of non-communicable diseases (NCDs) in Papua New Guinea (PNG), adding to the disease burden from communicable infectious diseases and thus increasing the burden on the healthcare system in a low-resource setting. The aim of this review was to identify health and nutrition promotion programs conducted in PNG and the enablers and barriers to these programs. Four electronic databases and grey literature were searched. Two reviewers completed screening and data extraction. This review included 23 papers evaluating 22 health and nutrition promotion programs, which focused on the Ottawa Charter action areas of developing personal skills (12 programs), reorienting health services (12 programs) and strengthening community action (6 programs). Nineteen programs targeted communicable diseases; two addressed NCDs, and one addressed health services. Enablers of health promotion programs in PNG included community involvement, cultural appropriateness, strong leadership, and the use of mobile health technologies for the decentralisation of health services. Barriers included limited resources and funding and a lack of central leadership to drive ongoing implementation. There is an urgent need for health and nutrition promotion programs targeting NCDs and their modifiable risk factors, as well as longitudinal study designs for the evaluation of long-term impact and program sustainability.

Protection of public health at the level of supranational organizations

Emergence of international integration processes raises new issues of the development of the legislative and regulatory framework at the supranational level for public health benefit. The paper explains the need to actively protect the interests of public health at the supranational level based on the analysis of relevant aspects of the policy, structure, functioning and experience of the largest regional integration structures – the Eurasian Economic Union and the European Union. The review of the basic principles, approaches and measures is carried out, using the example of ensuring food safety, which is directly related to solving the problem of prevention and control of infectious and non-communicable diseases. The relevant regulatory framework of the World Trade Organization (WTO), as well as the development of technical regulation, are discussed. The relevance of cooperation between supranational structures and the World Health Organization and other relevant UN organizations in the field of public health is emphasized. Specialists in this field are called upon to participate in the regulation of international integration processes, including the activities of the WTO, trade and investment agreements, and tariff policy.

Intersectoral Collaboration in Healthcare: an Overview of International Practices

Background. Health promotion and universal health coverage are among the functions of any healthcare system which include public, private and voluntary organizations providing health services to the population. However, healthcare actors cannot single-handedly ensure the accessibility of medical care to all individuals. It is intersectoral interactions that could improve the capabilities, performance and efficiency of healthcare system. Objective. To consider the possibilities of intersectoral collaboration in healthcare through the relevant examples of the implementation of intersectorality in healthcare practices. Materials and methods. Common research methods with the content analysis of international scientific articles as the main one were applied. The practices of intersectoral interaction for ensuring public health promotion and access to medical care were identified and collected from all analyzed articles. Results. Intersectoral collaboration might be carried out between various departments and authorities, educational and civil society organizations, commercial companies and other entities. The performance and efficiency of intersectoral collaboration are achieved using the specially developed tools. The international practice of intersectoral collaboration on public health protection issues has many great examples of interactions facilitating the accomplishment of different goals, such as accessibility of medical care, prevention of noncommunicable diseases, and health emergency response.

Accessibility to palliative care services in Colombia: an analysis of geographic disparities

ObjectivesDue to the increase in the prevalence of non-communicable diseases and the Colombian demographic transition, the necessity of palliative care has arisen. This study used accessibility and coverage indicators to measure the geographic barriers to palliative care.MethodsPopulation-based observational study focused on urban areas and adult population from Colombia, which uses three measurements of geographic accessibility to services: a) density of palliative care services per 100,000 inhabitants, b) analysis of geographic distribution by territorial nodes of the country, and c) spatial analysis of palliative care services using Voronoi diagrams. ArcGIS Pro software was used to map services’ locations and identify geographic disparities.ResultsA total of 504 palliative care services were identified, of which 77% were primary health care services. The density of palliative care services in Colombia is 1.8 primary care services per 100,000 inhabitants and 0.4 specialized services per 100,000 inhabitants. The average palliative care coverage is 41%, two regions of the country have a coverage below 30%. Twenty-eight percent of the services provide care for a population greater than 50,000 inhabitants within their coverage area, exceeding the acceptable limit by international standards.ConclusionsPalliative care services are concentrated in three main regions (Bogotá D.C., the Center, and the Caribbean) and are limited in the Orinoquia and Amazonia nodes. Density of specialized palliative care services is extremely low and there are regions without palliative services for adults with palliative needs.

Pharmacovigilance in Pregnancy Studies, Exposures and Outcomes Ascertainment, and Findings from Low- and Middle-Income Countries: A Scoping Review.

Pharmacovigilance (PV), or the ongoing safety monitoring after a medication has been licensed, plays a crucial role in pregnancy, as clinical trials often exclude pregnant people. It is important to understand how pregnancy PV projects operate in low- and middle-income countries (LMICs), where there is a disproportionate lack of PV data yet ahigh burden of adverse pregnancy outcomes. We conducted a scoping review to assess how exposures and outcomes were measured in recently published pregnancy PV projects in LMICs. We utilized a search string, secondary review, and team knowledge to review publications focusing on therapeutic or vaccine exposures among pregnant people in LMICs. We screened abstracts for relevance before conducting a full text review, and documented measurements of exposures and outcomes (categorized as maternal, birth, or neonatal/infant) among other factors, including study topic, setting, and design, comparator groups, and funding sources. We identified 31 PV publications spanning at least 24 LMICs, all focusing on therapeutics or vaccines for infectious diseases, including HIV (n = 17), tuberculosis (TB; n = 9), malaria (n = 7), pertussis, tetanus, and diphtheria (n = 1), and influenza (n = 3). As for outcomes, n = 15, n = 31, and n = 20 of the publications covered maternal, birth, and neonatal/infant outcomes, respectively. Among HIV-specific publications, the primary exposure-outcome relationship of focus was exposure to maternal antiretroviral therapy and adverse outcomes. For TB-specific publications, the main exposures of interest were second-line drug-resistant TB and isoniazid-based prevention therapeutics for pregnant people living with HIV. For malaria-specific publications, the primary exposure-outcome relationship of interest was antimalarial medication exposure during pregnancy and adverse outcomes. Among vaccine-focused publications, the exposure was assessed during a specific time during pregnancy, with an overall interest in vaccine safety and/or efficacy. The study settings were frequently from Africa, designs varied from cohort or cross-sectional studies to clinical trials, and funding sources were largely from high-income countries. The published pregnancy PV projects were largely centered in Africa and concerned with infectious diseases. This may reflect the disease burden in LMICs but also funding priorities from high-income countries. As the prevalence of non-communicable diseases increases in LMICs, PV projects will have to broaden their scope. Birth and neonatal/infant outcomes were most reported, with fewer reporting on maternal outcomes and none on longer-term child outcomes; additionally, heterogeneity existed in definitions and ascertainment of specific measures. Notably, almost all projects covered a single therapeutic exposure, missing an opportunity to leverage their projects to cover additional exposures, add scientific rigor, create uniformity across health services, and bolster existing health systems. For many publications, the timing of exposure, specifically by trimester, was crucial to maternal and neonatal safety. While currently published pregnancy PV literature offer insights into the PV landscape in LMICs, further work is needed to standardize definitions and measurements, integrate PV projects across health services, and establish longer-term monitoring.

Relationship between Helicobacter pylori infection, osteoporosis, and fracture.

Osteoporotic fracture is a prevalent noncommunicable disease globally, causing significant mortality, morbidity, and disability. As the population ages, the healthcare and economic burden of osteoporotic fracture is expected to increase further. Due to its multifactorial features, the development of osteoporotic fracture involves a complex interplay of multiple risk factors, including genetic, environmental, and lifestyle factors. Helicobacter pylori, which infects approximately 43% of the world's population, has been associated with increased fracture risk due to hypochlorhydria from atrophic gastritis and systemic inflammation from elevated pro-inflammatory cytokines. However, the potential impact of H. pylori infection and eradication on fracture risk remains contentious among various studies due to the study design and inadequate adjustment of confounding factors including baseline gastritis phenotype. In this review, we provided a comprehensive evaluation of the current evidence focusing on the underlying mechanisms and clinical evidence of the association between H. pylori infection and osteoporotic fracture. We also discussed the potential benefits of H. pylori eradication on fracture risk.