Health Strategy Research Articles

NNI nanoinformatics conference 2023: Movement toward a common infrastructure for federal nanoEHS data computational toxicology: Short communication

The National Nanotechnology Initiative organized a Nanoinformatics Conference in the 2023 Biden-Harris Administration’s Year of Open Science, which included interested U.S. and EU stakeholders, and preceded the U.S.-EU COR meeting on November 15th, 2023 in Washington, D.C. Progress in the development of a common nanoinformatics infrastructure in the European Union and United States were discussed. Development of contributing, individual database projects, and their strengths and weaknesses, were highlighted. Recommendations and next steps for a U.S. nanoEHS common infrastructure were discussed in light of the pending update of the National Nanotechnology Initiative (NNI)’s Environmental, Health and Safety Research Strategy, and U.S. efforts to curate and house nano Environmental Health and Safety (nanoEHS) data from U.S. federal stakeholder groups. Improved data standards, for reporting and storage have been identified as areas where concerted efforts could most benefit initially. Areas that were not addressed at the conference, but that are critical to progress of the U.S. federal consortium effort are the evaluation of data formats according to use and sustainability measures; modeler and end user, including risk-assessor and regulator perspectives; a need for a community forum or shared data location that is not hosted by any individual U.S. federal agency, and is accessible to the public; as well as emerging needs for integration with new data types such as micro and nano plastics, and interoperability with other data and meta-data, such as adverse outcome pathway information. Future progress will depend on continued interaction of the U.S. and EU CORs, stakeholders and partners in the continued development goals for shared or interoperable infrastructure for nanoEHS.

Relationship between dietary knowledge, food preference, and long-short term health status among Chinese adults.

In recent years, with the improvement of people's living standards and changes in dietary patterns, dietary knowledge and food preference have been playing an increasingly crucial role in health. The aim of our study was to examine the relationship between dietary knowledge, food preference, and long-short term health status among Chinese adults aged 18-70. This study employed cross-sectional data from the 2015 China Health and Nutrition Survey obtained from 4822 adults. We utilized self-assessed health status as an indicator of long-term health status and utilized sickness in the last four weeks as a measure of short-term health status. Taking advantage of ordered probit regression, long-term health status was regressed on all predictors, while the binary logistic regression was used to analyze the factors influencing short-term health status. The propensity score matching is employed to account for potential selection bias in analysis, thereby increasing the robustness and credibility of results. The analysis revealed that dietary knowledge and food preference can improve an individual's long-term health status significantly. However, there is no evidence to show that short-term health status is affected by food preference. Furthermore, dietary knowledge is negatively associated with short-term health status. These findings highlight the importance of dietary education and healthy eating habits in improving the long-term health status of Chinese adults. The study suggests implications for public health strategies aimed at enhancing the health and well-being of Chinese adults.

Factors associated with medical consumable availability in level 1 facilities in Malawi: a secondary analysis of a facility census.

Medical consumable stock-outs negatively affect health outcomes not only by impeding or delaying the effective delivery of services but also by discouraging patients from seeking care. Consequently, supply chain strengthening is being adopted as a key component of national health strategies. However, evidence on the factors associated with increased consumable availability is limited. In this study, we used the 2018-19 Harmonised Health Facility Assessment data from Malawi to identify the factors associated with the availability of consumables in level 1 facilities, ie, rural hospitals or health centres with a small number of beds and a sparsely equipped operating room for minor procedures. We estimate a multilevel logistic regression model with a binary outcome variable representing consumable availability (of 130 consumables across 940 facilities) and explanatory variables chosen based on current evidence. Further subgroup analyses are carried out to assess the presence of effect modification by level of care, facility ownership, and a categorisation of consumables by public health or disease programme, Malawi's Essential Medicine List classification, whether the consumable is a drug or not, and level of average national availability. Our results suggest that the following characteristics had a positive association with consumable availability-level 1b facilities or community hospitals had 64% (odds ratio [OR] 1·64, 95% CI 1·37-1·97) higher odds of consumable availability than level 1a facilities or health centres, Christian Health Association of Malawi and private-for-profit ownership had 63% (1·63, 1·40-1·89) and 49% (1·49, 1·24-1·80) higher odds respectively than government-owned facilities, the availability of a computer had 46% (1·46, 1·32-1·62) higher odds than in its absence, pharmacists managing drug orders had 85% (1·85, 1·40-2·44) higher odds than a drug store clerk, proximity to the corresponding regional administrative office (facilities greater than 75 km away had 21% lower odds [0·79, 0·63-0·98] than facilities within 10 km of the district health office), and having three drug order fulfilments in the 3 months before the survey had 14% (1·14, 1·02-1·27) higher odds than one fulfilment in 3 months. Further, consumables categorised as vital in Malawi's Essential Medicine List performed considerably better with 235% (OR 3·35, 95% CI 1·60-7·05) higher odds than other essential or non-essential consumables and drugs performed worse with 79% (0·21, 0·08-0·51) lower odds than other medical consumables in terms of availability across facilities. Our results provide evidence on the areas of intervention with potential to improve consumable availability. Further exploration of the health and resource consequences of the strategies discussed will be useful in guiding investments into supply chain strengthening. UK Research and Innovation as part of the Global Challenges Research Fund (Thanzi La Onse; reference MR/P028004/1), the Wellcome Trust (Thanzi La Mawa; reference 223120/Z/21/Z), the UK Medical Research Council, the UK Department for International Development, and the EU (reference MR/R015600/1).

Navigating the pandemic: an exploration of health behavioral dynamics among Asian Americans during COVID-19

The COVID-19 pandemic brought Asian Americans sharply into focus, revealing both the strengths and vulnerabilities within this community. Despite a myriad of studies on their experiences and health disparities during the outbreak, gaps persist in our understanding of their health literacy, beliefs, and healthcare behaviors. Leveraging the snowball sampling method, our study engaged 20 diverse Asian Americans, delving into facets ranging from English proficiency and health literacy to cultural health beliefs and preventive behaviors. Notably, participants exhibited high English proficiency and health literacy. Their health choices, shaped by their Asian heritage, showcased a proactive approach to combating COVID-19. Most did not defer or sidestep healthcare, underlining their commitment to well-being. These insights underscore the resilience and adaptability of the Asian American community. By decoding their health behaviors and beliefs, our study aims to refine public health strategies, ensuring they resonate not just with Asian Americans but potentially with other ethnic cohorts amidst global health crises.

Building Breastfeeding Research Relations and Beyond: An Interview With Fiona Dykes.

Professor Fiona Dykes is Professor Emerita of Maternal and Infant Health at the University of Central Lancashire in the United Kingdom (UCLAN). Fiona has a particular interest in the global, sociocultural, and political influences upon infant and young child feeding practices; her methodological expertise is in ethnography and other qualitative research methods. She founded the Maternal and Infant Nutrition and Nurture Unit (MAINN) in 2000 which she led until she retired from her full-time professorship in 2020. Fiona established the associated MAINN Conference in 2007. The MAINN conference is a 3 day, international, peer reviewed event held bi-annually in the United Kingdom and, more recently, in alternate years overseas (Sydney, Australia; Falun, Dalarna, Sweden; and Florida, United States). The conference draws together key researchers in the field of infant and young child feeding from around the world. Fiona was a founding member of the journal Maternal and Child Nutrition. She is author of Breastfeeding in Hospital: Mothers, Midwives and the Production Line (Routledge) and co-author, with Dr Tanya Cassidy, of Banking on Milk: An Ethnography of Donor Human Milk Relations (Routledge). She is also joint editor of several books including Infant and Young Child Feeding: Challenges to Implementing a Global Strategy (Wiley-Blackwell) and Ethnographic Research in Maternal and Child Health (Routledge). This interview was conducted on April 20, 2023, by Dr. Tanya Cassidy, and is based on a verbatim transcription and edited for readability.TC = Tanya Cassidy; FD = Fiona Dykes.

Sequential Infection with Influenza A Virus Followed by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Leads to More Severe Disease and Encephalitis in a Mouse Model of COVID-19

COVID-19 is a spectrum of clinical symptoms in humans caused by infection with SARS-CoV-2. The coalescence of SARS-CoV-2 with seasonal respiratory viruses, particularly influenza viruses, is a global health concern. To understand this, transgenic mice expressing the human ACE2 receptor (K18-hACE2) were infected with influenza A virus (IAV) followed by SARS-CoV-2 and the host response and effect on virus biology was compared to K18-hACE2 mice infected with IAV or SARS-CoV-2 alone. The sequentially infected mice showed reduced SARS-CoV-2 RNA synthesis, yet exhibited more rapid weight loss, more severe lung damage and a prolongation of the innate response compared to the singly infected or control mice. Sequential infection also exacerbated the extrapulmonary encephalitic manifestations associated with SARS-CoV-2 infection. Conversely, prior infection with a commercially available, multivalent live-attenuated influenza vaccine (Fluenz Tetra) elicited the same reduction in SARS-CoV-2 RNA synthesis, albeit without the associated increase in disease severity. This suggests that the innate immune response stimulated by IAV inhibits SARS-CoV-2. Interestingly, infection with an attenuated, apathogenic influenza vaccine does not result in an aberrant immune response and enhanced disease severity. Taken together, the data suggest coinfection (‘twinfection’) is deleterious and mitigation steps should be instituted as part of the comprehensive public health and management strategy of COVID-19.

Supporting healthy lifestyles for First Nations women and communities through co-design: lessons and early findings from remote Northern Australia

BackgroundThe period before, during, and after pregnancy presents an opportunity to reduce diabetes-related risks, which in Australia disproportionately impact Aboriginal and Torres Strait Islander women. Collaboration with Aboriginal and Torres Strait Islander women/communities is essential to ensure acceptability and sustainability of lifestyle modifications. Using a novel co-design approach, we aimed to identify shared priorities and potential lifestyle strategies. We also reflected on learnings from this approach.MethodsWe conducted 11 workshops and 8 interviews at two sites in Australia’s Northern Territory (Central Australia and Top End), using experience-based co-design (EBCD) and incorporating principles of First Nations participatory research. Workshops/interviews explored participant’ experiences and understanding of diabetes in pregnancy, contextual issues, and potential lifestyle strategies. Participants included three groups: 1) Aboriginal and Torres Strait Islander women of reproductive age (defined as aged 16-45 years); 2) Aboriginal and Torres Strait Islander community members; and 3) health/community services professionals. The study methodology sought to amplify the voices of Aboriginal women.FindingsParticipants included 23 women between ages 16-45 years (9 with known lived experience of diabetes in pregnancy), 5 community members and 23 health professionals. Key findings related to identified priority issues, strategies to address priorities, and reflections on use of EBCD methodology. Priorities were largely consistent across study regions: access to healthy foods and physical activity; connection to traditional practices and culture; communication regarding diabetes and related risks; and the difficulty for women of prioritising their health among competing priorities. Strategies included implementation of a holistic women’s program in Central Australia, while Top End participants expressed the desire to improve nutrition, peer support and community awareness of diabetes. EBCD provided a useful structure to explore participants’ experiences and collectively determine priorities, while allowing for modifications to ensure co-design methods were contextually appropriate. Challenges included the resource-intensive nature of stakeholder engagement, and collaborating effectively with services and communities when researchers were “outsiders”.ConclusionsA hybrid methodology using EBCD and First Nations participatory research principles enabled collaboration between Aboriginal women, communities and health services to identify shared priorities and solutions to reduce diabetes-related health risks. Genuine co-design processes support self-determination and enhance acceptability and sustainability of health strategies.

Analytical observational study of salmonella PCR and its comparison with routine laboratory parameters in cases of enteric fever in tertiary care hospital in central India

Background Enteric fever, predominantly caused by Salmonella enterica serotype Typhi, remains a significant global health concern, particularly in resource-limited settings. The diagnostic landscape for enteric fever relies on traditional methods such as the Widal test and blood culture, each with inherent limitations regarding sensitivity and turnaround time. Methods The study will employ an Analytical Observational Study design conducted at Acharya Vinoba Bhave Rural Hospital in central India over a two-year period. Participants will include adults above 18 years admitted to the ward or Intensive Care Unit (ICU) with acute febrile illnesses. Inclusion criteria encompass a wide age range, ensuring a diverse study population. Peripheral blood samples will be collected for Salmonella PCR, Widal testing, and blood culture. Dot-PCR for Typhi will be employed, and DNA extraction will follow strict protocols. Data will be systematically recorded, and statistical analyses, including sensitivity, specificity, and comparative assessments, will be conducted to evaluate diagnostic performance. Expected Outcome It is anticipated that Salmonella PCR will exhibit superior sensitivity and specificity compared to traditional diagnostic methods, offering a more rapid and accurate identification of enteric fever cases. The study aims to contribute valuable evidence supporting the incorporation of Salmonella PCR into routine diagnostic algorithms, potentially revolutionizing the approach to enteric fever diagnosis. Moreover, insights gained from the study are expected to inform clinical practices, enhance patient management, and potentially reduce the economic burden associated with misdiagnosis or delayed diagnosis of enteric fever. The outcomes of this research are poised to impact public health strategies, providing a foundation for more effective and efficient diagnostic protocols in the context of enteric fever.

Implicit theories of health predict influenza vaccination intention among elder Chinese: The mediating role of anticipated regret.

Receiving influenza vaccines is the most effective public health strategy to protect people against seasonal flu infection. However, influenza vaccination rates are extremely low in China. This study investigated the association between implicit theories of health and influenza vaccination intention among elder Chinese when the vaccine is free (vs not free), and examined the mediating effect of anticipated regret. The results suggested that implicit theories of health, especially incremental theory of health, significantly predicted Chinese elders' influenza vaccination intention and this relationship was mediated by anticipated regret. Implications of the current research for promoting influenza vaccination among elder Chinese and directions for future research are discussed.

Dispute for hegemony in the Family Health Strategy:

Dispute for hegemony in the Family Health Strategy:

Joinpoint regression analysis of recent trends in desmoplastic malignant melanoma incidence and mortality: 15-year multicentre retrospective study.

Recent data reveal a marked rise in the detection and mortality rates of Desmoplastic Malignant Melanoma (DMM). This trend underscores the imperative for an in-depth analysis of DMM's epidemiology, which is crucial for the formulation of precise medical and public health strategies. This investigation seeks to elucidate the variations in the incidence and mortality of DMM over a 15-year period (2005-2019). Data on DMM patients was sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Both incidence and incidence-based mortality rates (IBM) were directly extracted from the SEER database. Joinpoint regression was used to analyze and calculate the average annual percent change (AAPC) and its 95% confidence interval (CI). Between 2005 and 2019, 3,384 DMM cases were identified, boasting an age-adjusted incidence rate of 36.3 cases per 1000,000 person-years (95% CI 3.51-3.76) and an IBM of 1.65cases per 1000,000 person-years (95% CI 1.57-1.74). Of these, 2,353 were males (69.53%) and 1,031 were females (30.47%). There were 1894 patients (55.97%) who were over 70years old. Predominantly, DMM lesions manifested in exposed areas: Limbs (955, 28.22%), Face (906, 26.77%), and Scalp and Neck (865, 25.56%). The incidence of DMM increased significantly at a rate of APC = 0.9% during 2005-2019, while the incidence-based mortality showed a significant upward trend (APC = 7%) during 2005-2012, and slowly increasing trend (APC = 0.6%) during 2012-2019. In contrast to the modest upward trajectory in female incidence and mortality, male incidence initially surged, later declining, while male mortality peaked and stabilized post-2012. The primary sites for incidence and mortality were chronically sun-exposed areas: Face, Scalp and Neck, and Limbs. In recent years, the incidence and incidence-based mortality of DMM have significantly increased. Each subgroup analysis has different trends, and these trends can provide better support for our exploration of DMM.

Effect of Bookkeeping on Financial Performance of Agribusiness Enterprises in Mbale City

This study delves into the relationship between bookkeeping practices and the financial performance of agribusiness enterprises in Mbale City. A mixed-method approach was employed, combining quantitative data collected via questionnaires and qualitative insights gathered from interviews with management personnel. The findings reveal a significant correlation between robust bookkeeping practices and enhanced financial performance. Statistical analyses, including regression models and ANOVA, affirm that effective bookkeeping accounts for a substantial portion of the variance in financial performance among these enterprises. Notably, the study showcases that bookkeeping practices positively impact financial performance by nearly 30%. These results underscore the critical role of meticulous record-keeping in shaping the fiscal health and future strategies of agribusiness enterprises. The study aligns with previous research highlighting the pivotal link between accounting records, business performance, and informed decision-making. Interviews with participants further confirm the emphasis placed on comprehensive record-keeping in driving operational efficiency and strategic planning within these enterprises.

Twenty-Year Climatology of Solar UV and PAR in Cyprus: Integrating Satellite Earth Observations with Radiative Transfer Modeling

In this study, we present comprehensive climatologies of effective ultraviolet (UV) quantities and photosynthetically active radiation (PAR) over Cyprus for the period 2004 to 2023, leveraging the synergy of earth observation (EO) data and radiative transfer model simulations. The EO dataset, encompassing satellite and reanalysis data for aerosols, total ozone column, and water vapor, alongside cloud modification factors, captures the nuanced dynamics of Cyprus’s atmospheric conditions. With a temporal resolution of 15 min and a spatial of 0.05° × 0.05°, these climatologies undergo rigorous validation against established satellite datasets and are further evaluated through comparisons with ground-based global horizontal irradiance measurements provided by the Meteorological Office of Cyprus. This dual-method validation approach not only underscores the models’ accuracy but also highlights its proficiency in capturing intra-daily cloud coverage variations. Our analysis extends to investigating the long-term trends of these solar radiation quantities, examining their interplay with changes in cloud attenuation, aerosol optical depth (AOD), and total ozone column (TOC). Significant decreasing trends in the noon ultraviolet index (UVI), ranging from −2 to −4% per decade, have been found in autumn, especially marked in the island’s northeastern part, mainly originating from the (significant) positive trends in TOC. The significant decreasing trends in TOC, of −2 to −3% per decade, which were found in spring, do not result in correspondingly significant positive trends in the noon UVI since variations in cloudiness and aerosols also have a strong impact on the UVI in this season. The seasonal trends in the day light integral (DLI) were generally not significant. These insights provide a valuable foundation for further studies aimed at developing public health strategies and enhancing agricultural productivity, highlighting the critical importance of accurate and high-resolution climatological data.

How group structure impacts the numbers at risk for coronary artery disease: polygenic risk scores and non-genetic risk factors in the UK Biobank cohort.

The UK Biobank is a large cohort study that recruited over 500,000 British participants aged 40-69 in 2006-2010 at 22 assessment centres from across the UK. Self-reported health outcomes and hospital admission data are two types of records that include participants' disease status. Coronary artery disease (CAD) is the most common cause of death in the UK Biobank cohort. After distinguishing between prevalence and incidence CAD events for all UK Biobank participants, we identified geographical variations in age-standardised rates of CAD between assessment centres. Significant distributional differences were found between the pooled cohort equation scores of UK Biobank participants from England and Scotland using the Mann-Whitney test. Polygenic risk scores of UK Biobank participants from England and Scotland and from different assessment centres differed significantly using permutation tests. Our aim was to discriminate between assessment centres with different disease rates by collecting data on disease-related risk factors. However, relying solely on individual-level predictions and averaging them to obtain group-level predictions proved ineffective, particularly due to the presence of correlated covariates resulting from participation bias. By using the Mundlak model, which estimates a random effects regression by including the group means of the independent variables in the model, we effectively addressed these issues. In addition, we designed a simulation experiment to demonstrate the functionality of the Mundlak model. Our findings have applications in public health funding and strategy, as our approach can be used to predict case rates in the future, as both population structure and lifestyle changes are uncertain.

Markov modeling on dynamic state space for genetic disorders and infectious diseases with mutations: Probabilistic framework, parameter estimation, and applications

Abstract The emergence and dynamic prevalence of genetic disorders and infectious diseases with mutations pose significant challenges for public health interventions. This study investigated the parameter estimation approach and the application of the dynamic state-space Markov modeling of these conditions. Using extensive simulations, the model demonstrated robust parameter estimation performance, with biases and mean-squared errors decreasing as sample size increased. Applying the model to COVID-19 data revealed distinct temporal patterns for each variant, highlighting their unique emergence, peak dominance, and decline or persistence trajectories. Despite the absence of clear trends in the data, the model exhibited a remarkable accuracy in predicting future prevalence trends for most variants, showcasing its potential for real-time monitoring and analysis. While some discrepancies were observed for specific variants, these findings suggest the model’s promise as a valuable tool for informing public health strategies. Further validation with larger datasets and exploration of incorporating additional factors hold the potential for enhancing the model’s generalizability and applicability to other evolving diseases.

Dengue Treatment-Seeking Behavior: A Qualitative Study With Costa Rican Residents.

Treatment-seeking behavior (TSB) in relation to dengue infection is a critical aspect of public health, and understanding the factors that influence it is crucial for effective disease management. This research delves into key determinants of dengue TSB by examining the perceptions and behaviors of individuals in Costa Rica, in relation to the Health Belief Model (HBM). This study utilized naturalistic inquiry and incorporated a qualitative research design involving nine students organized into four teams, with at least one student on each team with high Spanish fluency. In total, we initiated 102 semi-structured field interviews with Costa Rican residents in four communities. The interviews were recorded, transcribed verbatim, and coded in several cycles using MAXQDA 2022©. Thematic analysis was used to identify patterns and themes using an inductive approach. We found that several HBM themes influenced dengue TSB among participants. Self-treatment was the most common initial step in managing dengue. Perceived inaccessibility of health care services and perceived ineffective treatment options discouraged medical care-seeking. Ultimately, the prevalence of self-treatment practices suggests a need for interventions that emphasize the importance of timely professional medical attention, while addressing real barriers and perceptions of existing health care services as inaccessible and ineffective. These findings provide a key perspective on dengue TSB, guiding future public health strategies aimed at optimizing health-seeking behaviors and mitigating the negative impacts of dengue on population health.

#2449 Prevalence and determinants of chronic kidney disease among older community-dwelling adults in Ireland

Abstract Background and Aims Chronic Kidney Disease (CKD) is a major global health challenge with substantial morbidity and mortality. In Ireland, a comprehensive understanding of the determinants of CKD is lacking, with limited data on the combined impact of socioeconomic and traditional risk factors. While the Irish Longitudinal Study on Ageing (TILDA) has offered insights into CKD burden, a detailed examination of its determinants remains unexplored. The goal of this study was to explore the prevalence and determinants of CKD at the community level within the Irish population. Method This is a retrospective cohort study that utilised cross sectional data from the first wave of TILDA conducted between 2009 and 2011. Participants aged 50 years and older who had health assessment and kidney function tests performed were included. The 2012 and 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations were employed to calculate estimated glomerular filtration rates (eGFR) based on cystatin C and creatinine levels. CKD was classified as eGFR < 60 ml/min/1.73 m². We determined the weighted prevalence of CKD using sample weights. Stepwise multivariable logistic regression models were used to identify correlates of CKD and models’ performance were assessed using AUC-ROC curves and the Akaike Information Criterion (AIC). Associations were expressed using adjusted odds ratios (AOR) with 95% confidence intervals (CIs). Results Among the 5 386 participants tested for cystatin C and serum creatinine, the weighted CKD prevalence was 11.3% based on the 2021 CKD-EPI definition (excluding race) and 13.9% using the 2012 definition. Prevalence was significantly higher in women than men, and increased with age, reaching about 45% in women over 71 years versus 29% in men. Burden of comorbid conditions in CKD individuals varied from 11% (for cancer) to 89% (for hypertension) and were significantly higher than non-CKD individuals (P< 0.001). Adjusting for age, sex, education, and employment, the adjusted odds of CKD were significantly higher for individuals with hypertension AOR 2.15 (95% CI: 1.58–2.96), diabetes AOR 2.00 (95% CI: 1.50–2.66), cardiovascular disease AOR 1.72 (95% CI: 1.43–2.21), cancer AOR 1.64 (95% CI: 1.16–2.30), and obesity AOR 2.18 (95% CI: 1.61–2.96). The likelihood of CKD was also higher for patients with a hospital admission in the previous year AOR = 1.50 (95% CI: 1.14–1.96), possession of a medical card AOR 1.41 (95% CI: 1.06–1.89), and unemployed individuals AOR 1.61, (95% CI: 1.06–2.50), while the likelihood was significantly lower for individuals with a tertiary education (versus primary) AOR 0.73 (95% CI: 0.54–0.98). With further adjustment for medications, the magnitude of these associations was greatly attenuated with increasing odds of CKD for those receiving higher medication burden: 2-3 drugs AOR 2.02, (95% CI: 1.29–3.29), 3-4 drugs AOR 2.52 (95% CI: 1. 59–4.11), and > 5 drugs AOR 4.49 (95% CI: 2.81–7.39) (see Fig. 1). The AUC score ranged from 0.84 to 0.88, indicating strong model performance. Conclusion This study brings renewed attention to observed variation in national estimates of CKD prevalence (11.3% vs 13.9%) that are derived from current prediction equations with important implications for the strategic planning and resourcing of CKD care. This study emphasises the impact of socioeconomic factors, such as health coverage and financial barriers to heath care, education attainment, and employment, on CKD beyond traditional risk factors. Furthermore, the attenuation of known risk factors with increasing medication use highlights the influence of these treatments on CKD dynamics. These findings provide valuable insights for targeted public health strategies and awareness programs in Irish communities to address the increasing burden of CKD.

MicroRNAs Associated with Metformin Treatment in the Diabetes Prevention Program

The Diabetes Prevention Program (DPP) randomized controlled trial demonstrated that metformin treatment reduced progression to type 2 diabetes (T2D) by 31% compared to placebo in adults with prediabetes. Circulating micro-ribonucleic acids (miRs) are promising biomarkers of T2D risk, but little is known about their associations with metformin regimens for T2D risk reduction. We compared the change in 24 circulating miRs from baseline to 2 years in a subset from DPP metformin intervention (n = 50) and placebo (n = 50) groups using Wilcoxon signed rank tests. Spearman correlations were used to evaluate associations between miR change and baseline clinical characteristics. Multiple linear regression was used to adjust for covariates. The sample was 73% female, 17% Black, 13% Hispanic, and 50 ± 11 years. Participants were obese, normotensive, prediabetic, and dyslipidemic. Change in 12 miR levels from baseline to 2 years was significantly different in the metformin group compared with placebo after adjusting for multiple comparisons: six (let-7c-5p, miR-151a-3p, miR-17-5p, miR-20b-5p, miR-29b-3p, and miR-93-5p) were significantly upregulated and six (miR-130b-3p, miR-22-3p, miR-222-3p, miR-320a-3p, miR-320c, miR-92a-3p) were significantly downregulated in the metformin group. These miRs help to explain how metformin is linked to T2D risk reduction, which may lead to novel biomarkers, therapeutics, and precision health strategies.

Healthy Neighbourhoods Hub (HNH) Framework: A Practical Guide for Fostering Healthy and Inclusive Living in Florence’s Urban Environment

By 2050, an estimated 69% of the global population will reside in urban areas, underscoring the pivotal role of city neighbourhoods in enhancing quality of life by respecting and accommodating diverse identities and needs. The physical environment of neighbourhoods significantly influences community health and well-being, alongside social factors and access to health services. In Italy, prioritising health-promoting and accessible designs in neighbourhoods can form a solid foundation for urban health strategies. This study introduces a theoretical framework developed for the Healthy Neighbourhoods Hub (HNH) project in Florence, Italy, aiming to enhance health and accessibility across different scales. The HNH framework categorises healthy and inclusive neighbourhoods into 7 themes, 25 general characteristics, and 67 specific attributes, supported by verifiable variables derived from comprehensive research and design tools. This innovative framework addresses the need for multilevel, multidisciplinary approaches, and spatialization efforts to ensure equitable benefits for all community members.

#850 The association between proteinuria and stroke: results from the non-communicable diseases screening programme of Chiang Mai Region, Northern Thailand

Abstract Background and Aims Stroke is a significant global health issue, representing the second leading cause of death and a major contributor to disability. It can be classified into two main types: ischemic stroke, caused by blockage of a brain blood vessel, and haemorrhagic stroke, resulting from blood vessel rupture. Chronic kidney disease (CKD) is another prevalent health concern, affecting approximately 10% of all populations worldwide. CKD impairs kidney function and has been associated with an increased risk of cerebrovascular events, including stroke. Within the Northern Thai population, the prevalence of CKD is higher than the global average, underscoring the importance of investigating the relationship between CKD and stroke in this region. Method All patients for which accurate proteinuria measurement was obtained as part of the NCD screening program in Chiang Mai, Northern Thailand were included in the study. Multilinear cox regression analysis was used to estimate the hazards ratio for the association between proteinuria on stroke. The model was adjusted for other significant confounders of the association including age, sex, CKD, diabetes, hypertension and hypercholesterolaemia Results In a cohort of 3967 patients for which accurate proteinuria measurements were obtained and for whom had complete data for covariates, there was no evidence for an association between proteinuria and stroke. Hazards ratio for stroke in patients with trace proteinuria (adjusted for covariates) was 1.08 (95% CI 0.80-1.45) and positive proteinuria 0.06 (0.78-1.44) compared to a baseline of no proteinuria. Conclusion This study provides important insights into stroke risk factors in the Northern Thai population. The lack of substantial association between proteinuria and stroke suggests that proteinuria may not independently contribute to stroke risk in this cohort. Generalizability, however, is limited due to overrepresentation of diabetes and hypercholesterolaemia in the cohort, which is a strong independent risk factor for stroke. Increasing age is identified as the most critical risk factor for stroke. Understanding these associations can guide targeted interventions and public health strategies for stroke prevention in this population. The study limitations highlight the importance of analysis of a cohort that is more representative of a wider population in terms of chronic disease, such as diabetes and hypercholesterolaemia, and highlights the importance of longer follow up to fully elucidate whether proteinuria has an association with stroke. Furthermore the study raises questions as to whether measurement of proteinuria via urine dipstick analysis may limit conclusions that can be drawn compared to more robust methods such as urine albumin:creatinine or urine protein:creatinine ratios. Finally this study may be underpowered to detect subtle changes of a hazards ratio of less than 1.2, so is at risk of a type 2 statistical error.