Public Health Initiatives Research Articles

Liver Cancer in the Middle East and North Africa: Epidemiology, Trends, and Risk Factors

Objectives: Considering the growing concerns about the rising incidence of this cancer in the Middle East and North Africa (MENA), this literature review presents the local epidemiology and trends of liver cancer, along with a practical estimation of its epidemiology and contributing risk factors. Design: Review Article. Setting(s): Middle East and North Africa. Outcome Measures: MEDLINE (via PubMed), Scopus, and Web of Science databases, as well as Google Scholar, were searched up to September 2024 using representative keywords and MeSH terms. Studies reporting the epidemiology of liver and intrahepatic cholangiocarcinoma in the region or an analysis of the contributing infectious diseases, non-communicable disorders, genetic predispositions, behavioral aspects, and environmental factors were included. A qualitative synthesis was performed, and the results were presented using thematic narrative synthesis. Results: Liver cancer, particularly hepatocellular carcinoma (HCC), is rapidly growing in the MENA region, driven by a combination of viral hepatitis, underlying metabolic disorders, and environmental exposures. Liver cancer epidemiology varies across the region, with countries like Egypt historically burdened by hepatitis C, while Gulf states experience rising cases linked to metabolic disorders. Projections indicate a continued increase in the incidence of liver cancer due to the ongoing obesity and diabetes epidemics. Conclusions: Despite the success of viral hepatitis management campaigns in some countries, the region faces significant challenges in controlling the rising burden of liver cancer related to metabolic disorders. Prevention strategies should focus on lifestyle and dietary interventions, alongside the need for improved cancer registries, better data collection, and policy reforms. A multidisciplinary approach, combining public health initiatives and targeted healthcare improvements, is essential to reduce regional liver cancer incidence and improve outcomes.

A review of exercise interventions for reducing anxiety symptoms: Insights and implications.

Generalized anxiety disorder (GAD) is a prevalent mental health condition affecting a significant proportion of the adult population. Despite the availability of pharmacological treatments, their long-term efficacy and potential side effects necessitate exploring alternative interventions. Aerobic exercise has emerged as a promising non-pharmacological approach for managing anxiety symptoms in individuals with GAD. This narrative review examines the efficacy of aerobic exercise interventions in alleviating symptoms of anxiety disorders, drawing on a comprehensive analysis of relevant literature. The review synthesizes findings from studies investigating various forms of aerobic exercise, including high-intensity interval training, resistance training, Pilates, and walking. The results indicate that aerobic exercise interventions demonstrate efficacy in reducing anxiety symptoms and improving overall well-being across diverse populations, including primary care patients, individuals with coronary heart disease, and older adults with cancer undergoing chemotherapy. The review discusses the neurobiological and psychological mechanisms underlying the anxiolytic effects of aerobic exercise. It highlights the implications of these findings for clinical practice, public health initiatives, and future research directions. Despite the promising evidence, limitations in study methodologies and heterogeneity across interventions warrant a cautious interpretation of the results. Further research is needed to elucidate optimal exercise modalities, dosages, and long-term effects on anxiety outcomes.

Ethnic-Specific Threshold Analysis and BMI and Waist Circumference Cutoffs for Cardiovascular Disease and Subjective Wellbeing: Results using Data from the UK Biobank.

We aimed to identify ethnicity-specific BMI and waist circumference cutoffs for cardiovascular disease (CVD) and to define optimal thresholds for CVD risk and subjective wellbeing (SWB) through predictive modelling, to inform precise public health initiatives. We used data from 296,767 UK Biobank participants and adjusted logistic and linear regression models for CVD and SWB, respectively, complemented by receiver operating characteristic analysis, to explore optimal risk thresholds of CVD in six different ethnic groups and to calculate ethnicity-specific cutoffs of BMI and waist circumference (WC) to further elucidate the relationships between demographic factors and cardiovascular risk among diverse populations. The logistic regression model of CVD revealed moderate discriminative ability (AUROC ~ 64-65%) across ethnicities for CVD status, with sensitivity and specificity values indicating the model's predictive accuracy. For SWB, the model demonstrated moderate performance with an AUROC of 63%, supported by significant variables that included age, BMI, WC, physical activity, and alcohol intake. Adjusted-incidence rates of CVD revealed the evidence ethnic-specific CVD risk profiles with Whites, South Asians and Blacks demonstrating higher predicted CVD events compared to East Asians, mixed and other ethnic groups. Alterations of ethnicity-specific BMI and waist circumference are required to ensure ethnic minorities are provided with proper mitigation of cardiovascular risk, addressing the disparities observed in CVD prevalence and outcomes across diverse populations. This tailored approach to risk assessment can facilitate early detection, intervention and management of CVD, ultimately improving health outcomes and promoting health equity. The moderate accuracy of predictive models underscores the need for further research to identify additional variables that may enhance predictive accuracy and refine risk assessment strategies.

Recent trends and disparities in screen-based sedentary behavior and physical activity among U.S. overweight youth, 2018–2022

BackgroundSedentary behavior (SB) and physical activity (PA) are crucial factors influencing health outcomes in overweight children and adolescents. However, recent changes in SB and PA trends among U.S. overweight youth have not been well described, limiting the development of evidence-based clinical and public health interventions. MethodsSerial, cross-sectional analyses were conducted using data from the National Survey of Children's Health (NSCH) on U.S. overweight youth aged 6–17 years, spanning from 2018 to 2022. Linear regression models were employed to analyze time trends, with survey year as the exposure and recreational screen time (ST), adherence to the ≤2 h/day ST guideline, and adherence to the ≥1 h/day PA guideline as the outcomes. Multivariable-adjusted logistic and linear regressions were used to evaluate trends, adjusting for age group, sex, race/ethnicity, household income, and the highest education level of primary caregivers. ResultsData from 11,865 individuals (mean age 12.3 years [SD 2.9]; 6417 [52.3 %] girls) were analyzed. From 2018 to 2022, the average ST duration among overweight youth increased from 3.7 h to 4.1 h per day, a statistically significant increase (p = 0.07). The estimated prevalence of overweight youth meeting the ≤2 h/day ST guideline decreased from 44.6 % to 30.0 % (p = 0.007). Additionally, the prevalence of meeting the ≥1 h/day PA guideline remained low and stable, ranging from 8.4 % to 12.3 % during the analysis period (p = 0.6). DiscussionIn this nationally representative sample of U.S. overweight youth, ST increased by nearly 0.4 h/day over the five-year observation period, while adherence to the ≤2 h/day ST guideline decreased. Adherence to the ≥1 h/day PA guideline remained consistently low. These patterns were consistent across sociodemographic subgroups (age group, sex, ethnicity, and household income). These findings underscore the need for enhanced public health initiatives targeting U.S. youth to reduce recreational screen time and promote a physically active lifestyle.

Comprehending symmetry in epidemiology: A review of analytical methods and insights from models of COVID-19, Ebola, Dengue, and Monkeypox.

The challenge of developing comprehensive mathematical models for guiding public health initiatives in disease control is varied. Creating complex models is essential to understanding the mechanics of the spread of infectious diseases. We reviewed papers that synthesized various mathematical models and analytical methods applied in epidemiological studies with a focus on infectious diseases such as Severe Acute Respiratory Syndrome Coronavirus-2, Ebola, Dengue, and Monkeypox. We address past shortcomings, including difficulties in simulating population growth, treatment efficacy and data collection dependability. We recently came up with highly specific and cost-effective diagnostic techniques for early virus detection. This research includes stability analysis, geographical modeling, fractional calculus, new techniques, and validated solvers such as validating solver for parametric ordinary differential equation. The study examines the consequences of different models, equilibrium points, and stability through a thorough qualitative analysis, highlighting the reliability of fractional order derivatives in representing the dynamics of infectious diseases. Unlike standard integer-order approaches, fractional calculus captures the memory and hereditary aspects of disease processes, resulting in a more complex and realistic representation of disease dynamics. This study underlines the impact of public health measures and the critical importance of spatial modeling in detecting transmission zones and informing targeted interventions. The results highlight the need for ongoing financing for research, especially beyond the coronavirus, and address the difficulties in converting analytically complicated findings into practical public health recommendations. Overall, this review emphasizes that further research and innovation in these areas are crucial for addressing ongoing and future public health challenges.

Prevalence and Predictors of Premature Graying of Hair Before the Age of 30: A Cross-Sectional Study in SaudiArabia.

Graying is an inherent and unavoidable consequence of the aging process, impacting individuals of all genders. There are limited studies in Saudi Arabia that have examined the prevalence and predictors of premature graying of hair (PGH). This study aims to explore the prevalence and predictors of PGH before the age of 30 among the population of Saudi Arabia. This is a cross-sectional online survey that was conducted between July 2023 and February 2024 in Saudi Arabia. Binary logistic regression analysis was used to identify risk factors of having gray hair before the age of 30. A total of 1193 participants were involved in this study. A significant portion of respondents reported having gray hair before the age of 30 (55.9%). The younger population (younger than 44 years), smokers, and those who have comorbidities, have anxiety, have depression, have a family history of gray hair before the age of 30 years, have a dry scalp, suffer from vitamin or mineral deficiencies, have hair loss due to immune diseases (such as alopecia), and use minoxidil or rosemary for hair loss were more likely to have gray hair before the age of 30 years (p < 0.05). This study highlighted the high prevalence rate and associated predictors of PGH in Saudi Arabia. Identified predictors include genetic, health, and lifestyle factors. Healthcare professionals and decision makers are advised to promote the awareness of the general public on its risk factors to enhance the prevention of PGH. Public health initiatives include campaigns on smoking cessation, healthy nutrition, and mental health.

Validation of the Updated "LIfestyle for BRAin health" (LIBRA) Index in the English Longitudinal Study of Ageing and Maastricht Aging Study.

The "LIfestyle for BRAin health" (LIBRA) index was recently updated with three new modifiable factors: hearing impairment, social contact, and sleep (LIBRA2), but has not yet been validated. Comparison of the performance of both LIBRA versions in predicting dementia risk. Longitudinal data from the English Longitudinal Study of Ageing (ELSA) and the Maastricht Aging Study (MAAS) were used. The weighted LIBRA (11/12 factors available) and LIBRA2 (14/15 factors available) scores were calculated, with higher scores representing an unhealthier lifestyle. Dementia diagnoses were based on self- or informant reported physician diagnosis, an informant-based cognitive screening tool, registry data or test data. Cox-proportional hazards regression was used to investigate the association between LIBRA(2) scores and dementia risk. Model fit and predictive accuracy were determined using the Akaike information criterion and Harrell's C index. Over an average follow-up of 8.3 years in ELSA and 17.9 years in MAAS, 346 (4.6%) and 120 (8.5%) individuals developed dementia, respectively. In ELSA, a one-point increase in LIBRA2 was associated with an 8% (1.06-1.11) higher dementia risk (LIBRA: 13%, 1.09-1.16). In MAAS, a one-point increase in LIBRA2 was associated with a 6% (1.01-1.12) higher dementia risk (LIBRA: 8%, 0.99-1.16). In ELSA, LIBRA (Harrell's C = 0.68) and LIBRA2 (Harrell's C = 0.67) performed similarly. In MAAS, LIBRA2 (Harrell's C = 0.62) performed better compared to LIBRA (Harrell's C = 0.52). LIBRA2 is a better model for identifying individuals at increased dementia risk and for public health initiatives aimed at dementia risk reduction.

FDA Approval Summary: Capecitabine Labeling Update under Project Renewal.

On December 14, 2022, the U.S. Food and Drug Administration (FDA) approved revisions to the United States Prescribing Information (USPI) for capecitabine that revised existing indications and dosage regimens, added new indications and their recommended dosage regimens, revised safety information, updated the description of the risk of capecitabine in patients with dihydropyrimidine dehydrogenase (DPD) deficiency, and edited other sections of the USPI to conform with FDA's current labeling guidance. These supplements were reviewed and approved under Project Renewal, a public health initiative established by the FDA's Oncology Center of Excellence that aims to update the prescribing information of certain older oncology drugs to ensure information is clinically meaningful and scientifically up to date. This article summarizes the FDA approach that supported revisions to the capecitabine USPI within the context of Project Renewal.

Classification of an Individual's Vaccination Status Using Ensemble Hard Voting Classifier

Vaccination is a proactive medical immunization procedure where an inactivated form of a disease-causing agent (such as a virus) is administered to boost the body's defense systems. Efficient management of vaccination status is crucial in healthcare management, disease eradication, community immunity ("herd immunity"), disease prevention, and global health security. Ensuring precise monitoring and validation of an individual's vaccination status is indispensable, especially in the context of emerging diseases and epidemics. This study evaluates the likelihood of individuals obtaining vaccination for the H1N1 virus and the seasonal flu vaccine. Ensemble methods combine the predictions of multiple base classifiers to enhance overall performance. One such method, the hard voting classifier, aggregates the votes from each base classifier and selects the class with the majority vote as the final prediction. This approach leverages the strengths of different classifiers, reducing the risk of individual model biases and improving generalization using metrics such as precision, recall, accuracy, and F1-score are employed to assess the system's effectiveness. The results demonstrate how data-driven methods can address population wellness and improve vaccination rates using an ensemble method. The proposed ensemble hard voting classifier achieved accuracies of 0.905 and 0.907 on the H1N1 and seasonal vaccine datasets, respectively. Using an ensemble approach like the hard voting classifier enhances prediction accuracy and robustness, ultimately leading to better decision making in public health initiatives.

Unveiling the Value of Meta-Analysis in Disease Prevention and Control: A Comprehensive Review.

Given the plethora of studies today that focus on the same topic, clinicians and other healthcare professionals increasingly rely on meta-analysis to aid in their evidence-based decision-making. This research method, which combines data from multiple studies to produce a single, more precise estimate of effect size, is invaluable for synthesizing evidence, resolving inconsistencies and guiding clinical practice and public health policies. Especially in disease prevention and control, meta-analysis has emerged as a critical tool. Meta-analysis is particularly valuable in assessing the effectiveness of preventive interventions such as vaccines, lifestyle modifications and screening programs. It provides robust evidence that supports the implementation of effective preventive measures and the discontinuation of ineffective or harmful ones. Furthermore, meta-analysis provides evidence to develop clinical practice guidelines, ensuring patients receive evidence-based treatments. In addition, public health policies aimed at disease prevention and control often rely on evidence from meta-analyses, which provide the data needed to justify and design large-scale public health initiatives. This comprehensive review delves into the role of meta-analysis in disease prevention and control, exploring its advantages, applications, challenges and overall impact on guiding clinical practice and public health policies. Through case studies and an examination of future directions, this paper underscores the pivotal role of meta-analysis in disease prevention and control.

Building bridges: enhancing cultural understanding and community engagement in the CHAMPS program—experience sought from Gobe Challa Village, Ethiopia

Public health programs’ successful implementation often requires a thorough consideration ⁠ of local cultural contexts and effective community engagement. The complexities and obstacles that public health initiatives may face in culturally ⁠ diverse communities are highlighted by our case study, offering valuable insights. ‍ This article focuses on analyzing a particular incident that occurred in Gobe Challa Village, connected ⁠ to the implementation of the Child Health and Mortality Prevention Surveillance (CHAMPS) program. In Gobe Challa Village, an incident occurred that centered on discord within the community and religious fears, resulting ⁠ from misunderstandings surrounding and a general lack of comprehension about the CHAMPS program. Our resolution process involved engaging the community, and religious leaders in constructive dialogue. Throughout this involvement, we delivered extensive elucidation on the aims and ⁠ protocols of the CHAMPS program, mitigating conflicts within the community. The community successfully achieved acceptance of the CHAMPS program by directly ⁠ and respectfully addressing misconceptions and fears, fostering a common understanding. This study emphasizes the significance of effective communication, community engagement, and ⁠ consideration of cultural customs when implementing public health programs. The experiences derived from this incident can act as a practical ⁠ manual for future public health initiatives encountering analogous cultural and societal dynamics. The main emphasis is on highlighting how a proactive, sensitive, and inclusive approach can ⁠ alleviate potential conflicts while also promoting program acceptance and encouraging community engagement. These discoveries have relevance to various public health initiatives and emphasize the significance ⁠ of a culturally conscious, community-involved approach in executing global health programs. ‍

Innovative Approaches to Strengthening Preventative Care in Contemporary Healthcare: A Systematic Review

Preventative care plays a critical role in reducing disease burden, improving patient outcomes, and lowering healthcare costs in contemporary medicine. However, the effective implementation of preventative care strategies faces numerous challenges, including technological, financial, and social barriers. This systematic review explores innovative approaches aimed at strengthening preventative care in modern healthcare systems. Key innovations include the use of telemedicine, artificial intelligence (AI), personalized medicine, and community-based public health initiatives. Telemedicine and AI have revolutionized early detection and risk assessment, while personalized medicine and genomic screening allow for tailored preventative interventions. Additionally, behavioral economics and health education programs have proven effective in promoting healthier lifestyles and improving adherence to preventative measures. The review evaluates the impact of these innovations on patient outcomes and highlights both the benefits and challenges of implementing these approaches. While the advancements offer promising results, further research is needed to address issues related to equity, ethical concerns, and global applicability. This review provides valuable insights for healthcare providers, policymakers, and researchers looking to enhance the effectiveness of preventative care strategies in contemporary healthcare systems.

From recognition to cause: analyzing parental knowledge of children’s short stature, preliminary study

Short stature (SS) is a condition where children's growth rates are below the 2.5th percentile for their age and gender. Early intervention is vital due to its association with reduced quality of life and mortality. This study examines the understanding of Qassimi parents regarding their child’s SS. We surveyed 384 Qassimi parents, including those with growing children and those without children willing to participate. Knowledge scores ranged from 0 to 8, with scores over 4 indicating good knowledge. Most of the study participants were Saudis, females, or holding a university degree. The mean score was 4.44 and almost 47% of respondents demonstrated good knowledge. All the study participants were aware of at least one cause of short stature. Of more than 20 causes of short stature, only 24.3% of the study participants could correctly identify 4 or more causes. Multivariable regression revealed that higher knowledge scores were significantly noted among participants younger than 40 years (p-value: < 0.001), students (p-value: < 0.001), unmarried (p-value: 0.001), and/or having no children (p-values: 0.001). Among respondents with children, individuals with children younger than 12 years had significantly better knowledge (p-value: 0.003). In contrast, knowledge was seemingly independent of gender, level of education, nationality, or family history (p-values: > 0.05). Although the knowledge status is overall moderate, it’s recommended to further start public health initiatives and educational programs, while paying special attention to population groups associated with lower knowledge level.

B-215 Evaluating RT-qPCR for Dengue Virus Detection: Outcomes of a Brazilian External Quality Assessment Program

Abstract Background Dengue virus (DENV), responsible for a prevalent arthropod-borne viral illness, poses a substantial public health challenge worldwide. Clinically, DENV's manifestation often resembles that of other arboviruses, resulting in frequent healthcare visits and complicating the early diagnosis, which is critical for patient management. While virus isolation is a viable method, RT-qPCR assays yield significantly quicker results. Rapid immunochromatographic tests are available; yet, RT-qPCR not only matches their sensitivity but also provides distinct advantages in clinical laboratory settings. These include higher throughput and integrated, traceable quality control within each routine, offering less subjective and more dependable results. Maintaining high diagnostic standards for DENV is imperative. External quality assessment programs (EQAP) play a key role in enhancing laboratory diagnostic capabilities by monitoring and assessing diagnostic methods. This study evaluates the diagnostic efficacy of RT-qPCR for DENV using data from an EQAP conducted by a Brazilian provider, accredited by ABNT NBR ISO/IEC 17043:2011. Methods The quality control samples comprised lyophilized suspensions containing viable DENV particles, grown on vero cells (BCRJ 0245/ATCC CCL-81) under BSL-3 conditions. From February 2017 to November 2022, twenty-four EQAP survey rounds were carried out, each encompassing three samples, culminating in 1,153 data points. The evaluation metrics included participant numbers, adequacy percentage, sensitivity, specificity, and the incidence of false positives and negatives. The Mann-Kendall test assessed trends in these metrics over the survey rounds. The RT-qPCR kits employed by participants were classified either as in-vitro diagnostic (IVD) or as laboratory-developed tests (LDT). Kits that demonstrated high performance in terms of adequacy, sensitivity, and specificity were identified and listed. Results The number of laboratories participating has increased. Starting with four in 2017, the program expanded to 28 by 2022. Laboratory accuracy was high during the evaluation period, with a median of 99% (97.8% in 2017 and 99.2% in 2022). The Mann-Kendall test indicated a significant trend of increased accuracy (p&amp;lt;0.001). Specificity remained stable at 98.8%, while sensitivity improved, with a median of 99.4%—rising from 93.3% in 2017 to 100% in 2022 (p&amp;lt;0.001). Only three false negatives were reported over three separate rounds, and six false positives were reported across four rounds. Both LDT and IVD RT-qPCR kits demonstrated high accuracy (99.4% and 98.4%, respectively). Biomanguinhos ZDC, Viasure ZDC, and ZDC Multiplex kits all showed 100% adequacy, sensitivity, and specificity. Conclusions This study highlights the increasing adoption of RT-qPCR for DENV detection, as evidenced by the growing number of laboratories in the EQAP program and the consistently high adequacy rates from 2017 to 2022. Nonetheless, the number of participating laboratories remains relatively small for a vast tropical country like Brazil. The high sensitivity and specificity, along with the infrequency of false results, underscore its effectiveness. The superior performance of certain kits suggests possible advancements in DENV diagnosis, contributing to global public health initiatives against this arboviral disease.

B-192 Covid on the PCR Pro: a consumer-friendly PCR test

Abstract Background The emergence of COVID-19 highlighted the need for rapid and accurate diagnostic solutions that can be deployed on a broad scale. The complexity and long turn-around-time of PCR testing typically performed in molecular laboratories is not compatible with community-wide screening. To overcome these challenges, we present the Co-Dx PCR Pro™, a rapid and simple test platform developed for self-collection and at-home use. The instrument is controlled from the user’s smartphone or tablet and performs sample treatment, RT-PCR, and DNA melting analysis. An automatic calling algorithm provides a simple, “Detected,” or, “Not detected,” result. We demonstrate the utility of this platform using a test for the detection of SARS-COV-2. Methods A self-collected anterior nasal swab sample and 2 mLs of water are added to the collection cup. Closing the lid of the cup initiates rehydrating a dried Proteinase K mixture to digest proteins in the sample. After a brief Proteinase K heat-kill step, the instrument mixes the sample with a dried PCR master mix. Primers target two SARS-COV-2 specific genes (RdRp and E gene) and the human RNase P gene as a control. The sample undergoes an RT step followed by 45 cycles of PCR and DNA melting analysis. Detection is by an automatic calling algorithm that identifies a SARS-COV-2 amplicon melting peak at 82°C and RNase P peak at 87°C. The total runtime is less than 30 minutes. The limit of detection for the assay was assessed by contriving intact virus in negative sample matrix, which was then applied to dry swabs. In addition, frozen and banked clinical samples were tested using the Logix Smart®™ Covid-19 test as a comparator assay. A third party performed a usability assessment by having (1) naïve users follow the instructions and self-administer the test (2) expert trained users perform an independent assessment of the assay. Participants were then asked to complete a usability assessment. Results The 95% limit of detection was 2,100 copies/swab using contrived nasal swabs. Clinical samples were blinded to the operator and run on the platform. All samples resulted in a diagnosis concordant with the comparator assay. The usability assessment was performed by six naïve users and resulted in a systems usability scale score of “Best” (84.2 ± 14.3, out of 100). The two expert users determined an 80% limit of detection of 700 genome equivalents and “ease of use,” and “satisfaction,” scores of 4.5/5.0 and 5.0/5.0, respectively. Conclusions Performance of the PCR Pro platform is on par with laboratory-based PCR testing. The benefits of our assay are its speed and the low complexity platform accessible to the lay. This platform could improve access to molecular diagnostic testing, including use at home. Future expansion to include common respiratory pathogens (Flu, RSV, Strep) will increase utility. Additionally, anonymized results can be aggregated and provide a wealth of epidemiological information at the community level to better inform public health initiatives and health outcomes.

A-354 Evaluating Emergent POC Technology for Sickle Cell Testing in Resource Limited Settings

Abstract Background Sickle cell disease (SCD) represents a collection of inherited hematological disorders characterized by abnormal sickle-shaped erythrocytes resulting in an increased risk of morbidity and mortality. SCD represents a significant global health burden, affecting more than 300,000 newborns per year. Most of these births occur in resource limited areas, including sub-Saharan Africa, where the mortality rate before the age of five is estimated to be as high as 50-80% and the existing infrastructure and resources cannot support most current and robust methods that offer hemoglobin variant detection and quantification for the diagnosis and monitoring of SCD. While newborn screening programs (NBS) to identify individuals affected with SCD have demonstrated efficacy in reducing morbidity and early mortality, NBS programs are limited outside of the US and Europe and face many practical challenges for universal implementation in a resource limited setting. The need for inexpensive and reliable hemoglobin variant detection and quantification at the Point of Care is essential to the diagnosis and management of SCD in resource limited settings with a high prevalence of SCD, and the expansion of NBS programs. This study aims to evaluate an inexpensive testing strategy using two methodologies for POC screening and confirmation of SCD that could be supported in a low resource setting. Methods The two-step testing strategy for evaluation of POC testing for hemoglobin variant detection and quantification included testing residual specimens from normal and known sickle cell patients by first screening with the HemoTypeSC, a qualitative lateral flow immunoassay (LFIA) that has improved sensitivity and specificity from other available LFIA methodologies given the use of monoclonal antibodies for the detection of hemoglobin variants. Confirmatory testing and quantification of hemoglobin variants was accomplished with the use of the Gazelle POC test a miniaturized chip-based cellulose acetate electrophoresis device capable of identification and quantification of normal and variant hemoglobin. Statistical evaluation of device performance and clinical agreement between the device and known disease status was achieved in EP evaluator. Results The two-tier testing strategy demonstrated effective and inexpensive mechanism for SCD screening and confirmation. Overall, the HemoTypeSC and Gazelle demonstrated 100% qualitative agreement between methods, with the total cost of the two-tiered testing strategy estimated at under $6 per sample. Conclusions In conclusion, the two-tiered approach using the HemoTypeSC and Gazelle yielded a practical and cost-effective strategy for screening and confirmation of hemoglobin variants for the detection and monitoring of SCD. Both the strip and chip-based methodologies provide rapid results, are accessible at the point-of-care, and require minimal sample volume, a feature ideal for use in a pediatric population in low resource settings. Overall, these methods show promise for the use and expansion of NBS programs to improve public health initiatives for the diagnosis of SCD.

Obesity prevention across the lifespan: assessing the efficacy of intervention studies and discussing future challenges.

Obesity is intricately linked with metabolic conditions that disrupt hormones and metabolism, often resulting in weight-related challenges. Given the heightened mortality rates associated with cardiovascular and metabolic disorders linked to obesity, there is a pressing call to mobilize medical professionals, researchers, and policymakers towards advocating for healthy lifestyles and preventing obesity. Traditionally, obesity prevention and treatment have been viewed as separate endeavors, with prevention primarily falling under public health initiatives and treatment within the purview of clinicians. However, this division has led to significant healthcare costs without a substantial reduction in obesity rates. Our search encompassed published articles focused on prevention, excluding any mention of "treatment". Data was gathered from diverse sources including academic databases, government health agency websites like the CDC, research organizations, clinical trials registries, and public health campaigns. Due to the diverse range of interventions (encompassing dietary modifications, physical activity promotion, policy initiatives, education, and community-based programs, either independently or in combination), and the variability in study design and population demographics, we conducted a narrative review to systematically present and critically analyze evidence on preventing overweight and obesity across different age groups. Effectively addressing obesity prevention necessitates a comprehensive, multidisciplinary approach that establishes an environment where healthier choices are accessible and viable for all. This requires collaborative efforts between individuals, communities, healthcare providers, policymakers, and industries to institute enduring change. Furthermore, there remains a critical need for national and international guidelines tailored to age-related risk factors, paving the way for innovative precision medicine approaches centered on salutogenesis rather than pathogenesis.

Concentrations and predictors of select nutrients in Canadian human milk samples from the Maternal-Infant Research on Environmental Chemicals pregnancy cohort

BackgroundHuman milk (HM) composition data are widely used in clinical, regulatory, and public health initiatives. The existing HM profiles in United States and Canadian nutrient databanks are outdated and now considered inappropriate to estimate current nutrient intakes. Recent reviews have underscored the limited North American data available to generate a new profile. ObjectivesTo describe concentrations and sources of variability of nutrients in HM from a large cohort collected in Canada. MethodsThe Maternal-Infant Research on Environmental Chemicals (MIREC) study recruited participants in the first trimester of pregnancy from 10 Canadian cities between 2008 and 2011. HM samples (n = 559–835, depending on nutrient) were collected 3–10 wk postpartum and analyzed for minerals (calcium, magnesium, phosphorus, potassium, sodium, manganese, molybdenum, zinc, copper, iodine, selenium), vitamin D [vitamin D3, 25-hydroxyvitamin D3], folate vitamers (folic acid, 5-methyltetrahydrofolate, total folates), and fatty acids (panel). We examined associations between participant characteristics and log-transformed nutrient concentrations using linear regression. ResultsConcentrations of HM components in MIREC samples were within the range observed in literature except for manganese, which was >100-fold lower than the value in the existing Canadian nutrient databank profile [2.43 (standard deviation 2.84) compared with 260 ng/g]. In multivariable models, concentrations of folate vitamers, vitamin D, and fatty acids demonstrated greater variability with maternal and sample characteristics than minerals. Factors such as relevant supplement use, body mass index, and for vitamin D, skin color and season, had a larger impact on nutrient concentrations than characteristics typically standardized in HM research, such as maternal or infant health, and method of collection. ConclusionsHM mineral concentrations from this study meet the methodological inclusion criteria for updating nutrient databank values and dietary reference intakes. Consideration of factors such as diet, skin color, and BMI will be important for selecting studies for developing representative reference values based on HM.

Loneliness, Internalizing and Externalizing Problems, and Suicidal Ideation Among Chinese Adolescents: A Longitudinal Mediation Analysis

PurposeResearch indicates that loneliness and emotional and behavioral problems increase the risk of suicidal ideation in adolescents, but less is known about the distinct contributions of these problems. This study aimed to distinguish the pathways through which loneliness, internalizing problems, and externalizing problems contribute to suicidal ideation in Chinese adolescents. MethodsWe did a longitudinal mediation analysis with data collected at 3 time points (2021.05, 2021.10, and 2022.05) from 28 Taizhou high schools. Loneliness and suicidal ideation were assessed using the UCLA 3-Item Loneliness Scale and one suicide item from the Children’s Depression Inventory, respectively. The Strength and Difficulties Questionnaire assessed internalizing (emotional and peer problems) and externalizing problems (conduct and hyperactivity problems). Structural equation modeling was used to construct complete longitudinal path models. ResultsUsing data from 2,190 adolescents in junior and senior high schools, we found that loneliness, internalizing problems, and externalizing problems separately contributed to subsequent higher levels of suicidal ideation. Most notably, loneliness predicted worse subsequent internalizing problems (β = 0.279, p < .001) and externalizing problems (β = 0.159, p < .001), which in turn predicted more severe suicidal ideation (β = 0.019, p < .001; β = 0.018, p < .001). Loneliness also partially mediated the association between internalizing or externalizing problems and suicidal ideation. DiscussionLoneliness, internalizing problems, and externalizing problems were strongly intertwined with suicidal ideation in adolescents. Public health initiatives could reduce loneliness and emotional and behavioral problems by implementing multifaceted interventions, thereby breaking the vicious circle and protecting against the development of suicidal ideation.

Trends in the incidence and prevalence of cirrhosis in Manitoba, Canada: A population-based study (2010-2019)

Introduction and objectivesThe burden of chronic liver disease and cirrhosis continues to increase in North America. We sought to estimate the incidence and prevalence of cirrhosis in Manitoba, Canada over time and assess changes in trends between 2010-2019. Material and methodsWe performed a population-based study using Manitoba administrative health care data, and two validated case-finding algorithms. Annual incidence and prevalence rates were estimated using a generalized linear model with generalized estimating equations, adjusting for age and sex. Changes in estimates were tested using linear trend regression models. ResultsTwo algorithms estimated the number of prevalent cirrhosis to be 16,140 and 29,943 respectively. The age- and sex-adjusted incidence rates increased over the study (from 149 to 264 cases per 100,000 population in 2010, to 177 to 388 cases per 100,000 population in 2019). Cirrhosis incidence increased annually by 2-6 %, with the largest increase (6-8 % 95 % CI 7-9 %, p <0.0001) in those aged 18-44 years. Irrespective of the algorithm used, females consistently exhibited higher cirrhosis incidence and prevalence compared to males over time (P <0.0001). Prevalence demonstrated an upward trend among all age groups over time for both algorithms (P < 0.0001). ConclusionsThis population-based study highlights concerning temporal trends in cirrhosis, characterized by rising annual incidence and prevalence estimates, particularly among young adults and females. These findings underscore the urgent need for comprehensive strategies that encompass prevention, early detection, and the delivery of high-quality healthcare and public health initiatives to effectively tackle this escalating health burden.