Health Strategy Research Articles

Identifying predictors of stroke in young adults: a machine learning analysis of sex-specific risk factors

IntroductionStroke among Americans under age 49 is increasing. While the risk factors for stroke among older adults are well-established, evidence on stroke causes in young adults remains limited. This study used machine learning techniques to explore the predictors of stroke in young men and women.MethodsThe least absolute shrinkage and selection operator algorithm (LASSO) was applied to data from Wave V of the National Longitudinal Survey of Adolescent to Adult Health (N = 12,300)—nationally representative, longitudinal panel containing demographic, lifestyle, and clinical information for individuals aged 33–43—to identify the key factors associated with stroke in men and women. The resulting LASSO model was tested and validated on an independent sample and model performance was assessed using the area under the receiver operating characteristic curve (AUC) and calibration. For robustness, synthetic minority over sampling technique (SMOTE) was applied to address data imbalance and analyses were repeated on the balanced sample.ResultsApproximately 1.1% (N = 59) and 1.3% (N = 90) of the 5,318 and 6,970 men and women in the sample reported having a stroke. LASSO was used to predict stroke using demographic, lifestyle, and clinical predictors on both balanced and imbalanced data sets. LASSO performed slightly better on the balanced data set for women compared to the unbalanced set (Female AUC: 0.835 vs. 0.842), but performance for men was nearly identical (Male AUC: 0.820 vs. 0.822). Predictor identification was similar across both sets. For females, marijuana use, receipt of health services, education, self-rated health status, kidney disease, migraines, diabetes, depression, and PTSD were predictors. Among males, income, kidney disease, heart disease, diabetes, PTSD, and anxiety were risk factors.ConclusionsThis study showed similar clinical risk factors among men and women. However, variations in the behavioral and lifestyle determinants between sexes highlight the need for tailored interventions and public health strategies to address sex-specific stroke risk factors among young adults.

A Statistical Evaluation of the Occurence of Meningitis in Takum, Taraba State, Nigeria

Meningitis remains a critical public health issue in Nigeria, particularly within the dry season when environmental factors such as low humidity and dust elevate transmission risks. Using historical incidence data from 2012 to 2021, this study utilizes the Autoregressive Integrated Moving Average (ARIMA) model estimate and predict the occurrence of meningitis occurrences. Findings frm the study revealed that the ARIMA(1,1,0) model emerged as the optimal fit, capturing the seasonal patterns and temporal trends in meningitis cases. This study recommends the integration of ARIMA-based forecasting into Nigeria’s public health strategies to strengthen early warning systems, optimize resource deployment, and enable more proactive responses during high-risk periods.

Managing Information Overload in a Pandemic: Influence of Social Media on Vaccine Attitudes in the Digital Age

Purpose: This study examined how social media influences public health decisions, focusing on how information overload during a pandemic impacts vaccine hesitancy and acceptance across demographics. It analyzed conflicting vaccine information to understand social media's role in shaping attitudes and identify strategies to mitigate its negative effects. Methodology: This study employed a multi-stage sampling method to gather data from diverse age groups, education levels, and occupations. This approach combines various techniques at different stages, making it suitable for large, geographically dispersed populations. By segmenting the population into manageable units, multi-stage sampling improves the accuracy, reliability, and representativeness of the data collected. Findings: The findings reveal that most respondents consider vaccine information on social media unreliable, underscoring the need for greater trust in online discussions. Many feel overwhelmed by conflicting messages, highlighting the necessity for clearer communication. Social media significantly shapes attitudes toward COVID-19 vaccines, with many shifting views after engaging with online content. Additionally, participants report mental health impacts from the constant stream of vaccine information, illustrating information overload. Unique Contributions to Theory, Policy and Practice: This study advances the information overload model by illustrating how excessive and conflicting vaccine information on social media disrupts comprehension and harms mental health. It emphasizes social media's role in shaping health attitudes and advocates for interdisciplinary approaches that incorporate psychological resilience into public health strategies. Findings highlight the need for regulations against misinformation to improve the credibility of online health information and promote trusted sources, particularly verified health organizations. The study also calls for health literacy initiatives to empower the public in navigating misinformation and suggests strategies for managing information overload through social media disengagement. Targeted initiatives that leverage trusted information sources can effectively combat vaccine hesitancy and boost community engagement in public health campaigns, ultimately improving health outcomes.

Cerebral white matter myelination is associated with longitudinal changes in processing speed across the adult lifespan

Abstract Myelin's role in processing speed is pivotal, as it facilitates efficient neural conduction. Its decline could significantly affect cognitive efficiency during aging. In this work, myelin content was quantified using our advanced MRI method of myelin water fraction (MWF) mapping. We examined the relationship between MWF at the time of MRI and retrospective longitudinal change in processing speed among 121 cognitively unimpaired participants, aged 22 to 94 years, from the Baltimore Longitudinal Study of Aging and the Genetic and Epigenetic Signatures of Translational Aging Laboratory Testing (mean follow-up duration of 4.3 ± 6.3 years) using linear mixed-effects models, adjusting for demographics. We found that higher MWF values correlated with longitudinally better-maintained processing speed, with particularly significant associations in several white matter regions. Detailed voxel-wise analysis provided further insight into the specific white matter tracts involved. This research underscores the essential role of myelin in preserving processing speed and highlights its potential as a sensitive biomarker for interventions targeting age-related cognitive decline, thereby offering a foundation for preventative strategies in neurological health.

Chrononutrition and Mental Health: Exploring Links Between Eating Patterns Circadian Rhythms and Psychological Well-being

This study investigates the relationship between chrononutrition—timing and patterns of food intake—and mental health, focusing on how circadian rhythms influence psychological well-being. Using a qualitative approach, this literature review synthesizes recent research exploring the connections between eating patterns, biological rhythms, and mental health outcomes, such as anxiety, depression, and overall mood stability. Findings indicate that irregular eating times, late-night meals, and skipping meals disrupt circadian alignment, potentially leading to mood dysregulation and decreased psychological resilience. Conversely, eating in sync with the body’s natural circadian rhythms appears to support mental health, with regular meal timing shown to enhance mood and reduce anxiety symptoms. The review also highlights the importance of specific nutrients in promoting stable circadian cycles, suggesting that diets rich in complex carbohydrates, proteins, and certain vitamins may aid in stabilizing mood. These findings underscore the need for an integrative approach to nutrition and mental health that considers both the timing and composition of meals. This review provides valuable insights into the emerging field of chrononutrition, emphasizing the potential of circadian-aligned eating as a preventive and therapeutic strategy for mental health. Further qualitative studies are recommended to explore individualized chrononutrition interventions and their effects on mental well-being across diverse populations.

A ATUAÇÃO DO FISIOTERAPEUTA NA ATENÇÃO PRIMÁRIA À SAÚDE NO CONTEXTO DA ESTRATÉGIA DE SAÚDE DA FAMÍLIA DO BRASIL

The physical therapist has been gradually integrated into the family health strategy (FHS), acting in a relevant role in the national healthcarenetwork. The objective of this studywas to investigate, through an integrative literature review, scientific evidence on the role of physical therapists in primary care within the context of the FHS. The literature search was conducted in the Google Scholar database, Pubmed, Scientific Electronic Library Online (SciElO), Literatura Latino-Americana e do Caribe em Ciências em Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Periódicos CAPES databases. A total of 45 articles published between 2014 and 2024 were included in the study.. The analysis of the studies demonstrated that the integration of physical therapists into the FHS, alongside the multidisciplinary team, is essential to providing comprehensive care and individualized attention, ensuring efficient assistance.. The study concludes that the role of physical therapists in Primary Health Care is of great importance to public healthgreat importance to public health, as these professionals contribute to the promotion, prevention, and recovery of both individual and collective health, restoring functionality, enhancing quality of life, and helping to reduce waiting times for care in the Unified Health System.. The expansion of the presence of physical therapists in Primary Care, specifically in the Family Health Strategy, is not onlybeneficial for the population but also enhances humanized care and functionality. Therefore, in addition to acknowledging the evidence, there is a need to recognize and support investments from health managers.

Alexithymia, Inner Thinking Patterns, and Perceptions of Mental Health Therapy Strategies Among Autistic Adults.

Autistic adults are at high risk for mental health challenges, yet there has been limited research on mental health interventions for this population. Individual differences in how thoughts and emotions are perceived may directly relate to the success of specific therapy strategies. This study examined whether alexithymia and inner thinking patterns relate to helpfulness and ease of use of mental health therapy strategies among autistic adults. Participants (n = 269 autistic adults, ages 21-77) completed questionnaires assessing alexithymia, inner thinking patterns (i.e., self-talk, verbal thinking, visual thinking), and experiences with mental health therapy strategies. Ordinal logistic regressions were used to examine associations between alexithymia, inner thinking, and perceived helpfulness and ease of use of therapy strategies. Autistic adults with greater alexithymia found cognitive strategies more difficult to use, while those with greater frequency of self-talk found them easier to use. By contrast, autistic adults with greater visual thinking found guided imagery strategies easier to use. There were no associations between alexithymia or inner thinking and perceived helpfulness or ease of use of behavioral strategies (exposure, behavioral activation), mind-body relaxation strategies (deep breathing, progressive muscle relaxation), or mindfulness meditation. The findings suggest that some mental health strategies may be more difficult to implement for some autistic adults, depending on individual thinking profiles. However, alexithymia and inner thinking patterns were unrelated to the perceived helpfulness of mental health strategies. Overall, this highlights the importance of providing individualized supports and accommodations to optimize mental health therapy for autistic adults.

The association between anthocyanin intake and myopia in adolescents: a cross-sectional study of NHANES

AimThe study aimed to explore the relationship of anthocyanin and its subtypes with myopia in adolescents aged 12–17 years.MethodsAdolescents data for this cross-sectional study were extracted from the National Health and Nutrition Examination Survey (NHANES) 2007–2008. Anthocyanin and subtypes were obtained using the Nutrient Database for Dietary Studies codes. Myopia was defined as a spherical equivalent of −1.0 diopters or less. The relationships between anthocyanin and subtypes intake and myopia were determined utilizing weighted univariate and multivariate logistic regression models. The relationships were also explored in gender, leisure time, physical activity, sedentary activity, BMI, and serum cotinine subgroups.ResultsA total of 839 adolescents were included for further analysis, among them 245 have myopia. Malvidin (34.98%) was the subtype with the largest anthocyanin intake, followed by cyanidin (22.94%). Compared to adolescents without anthocyanin intake, total anthocyanin intake was related to a lower incidence of myopia (OR = 0.69, 95%CI: 0.51–0.92). Higher intake of cyanidin (OR = 0.69, 95%CI: 0.52–0.92), petunidin (OR = 0.64, 95%CI: 0.42–0.97), and delphinidin (OR = 0.71, 95%CI: 0.51–0.99) were associated with lower odds of myopia in adolescents. Higher total anthocyanin intake was related to lower odds of myopia in those females, leisure time physical activity ≥60 min/day, sedentary time <8 h/day, overweight or obese, and serum cotinine ≥0.05 ng/ml.ConclusionHigher total anthocyanin intake, particularly cyanidin, petunidin, and delphinidin, was related to a lower incidence of myopia in adolescents. Increasing dietary anthocyanin intake may be an effective prevention strategy for ocular health.

Harnessing AI for advancing pathogenic microbiology: a bibliometric and topic modeling approach

IntroductionThe integration of artificial intelligence (AI) in pathogenic microbiology has accelerated research and innovation. This study aims to explore the evolution and trends of AI applications in this domain, providing insights into how AI is transforming research and practice in pathogenic microbiology.MethodsWe employed bibliometric analysis and topic modeling to examine 27,420 publications from the Web of Science Core Collection, covering the period from 2010 to 2024. These methods enabled us to identify key trends, research areas, and the geographical distribution of research efforts.ResultsSince 2016, there has been an exponential increase in AI-related publications, with significant contributions from China and the USA. Our analysis identified eight major AI application areas: pathogen detection, antibiotic resistance prediction, transmission modeling, genomic analysis, therapeutic optimization, ecological profiling, vaccine development, and data management systems. Notably, we found significant lexical overlaps between these areas, especially between drug resistance and vaccine development, suggesting an interconnected research landscape.DiscussionAI is increasingly moving from laboratory research to clinical applications, enhancing hospital operations and public health strategies. It plays a vital role in optimizing pathogen detection, improving diagnostic speed, treatment efficacy, and disease control, particularly through advancements in rapid antibiotic susceptibility testing and COVID-19 vaccine development. This study highlights the current status, progress, and challenges of AI in pathogenic microbiology, guiding future research directions, resource allocation, and policy-making.

The protective role of basal metabolic rate in cognitive decline: evidence from epidemiological and genetic studies.

This study aims to explore the relationship between basal metabolic rate (BMR) and cognitive impairment and assess the potential of BMR as a protective factor against cognitive decline. This investigation initially conducted a cross-sectional study of American adults from 2011 to 2014 using data from the National Health and Nutrition Examination Survey. It examined the correlation between participants' BMR and cognitive functions, exploring the association with cognitive impairment. Subsequently, publicly available genome-wide association study data was used to examine potential causal links between genetically determined BMR and specific cognitive disorders using Mendelian randomization. Cross-sectional findings revealed a significant positive correlation between higher BMR and cognitive scores. In Mendelian randomization analysis, BMR demonstrated an inverse causal relationship with Alzheimer's disease and Parkinson's dementia, suggesting BMR as a potential protective factor against these diseases. No causal links were found with vascular dementia, Lewy body dementia, and frontotemporal dementia. This study supports the role of BMR as a potential protective factor against Alzheimer's disease and Parkinson's dementia, suggesting that BMR may play an important role in preventing cognitive decline. However, due to the limitations of cross-sectional studies, further prospective studies and broader demographic samples are necessary to verify these results and explore underlying biological mechanisms. Key messages What is already known on this topic: Existing knowledge suggests a close relationship between BMR and health and cognitive functions, but detailed studies on its connection with specific cognitive impairments are still needed. What this study adds: This study found a significant positive correlation between higher BMR and cognitive improvement, potentially aiding in the prevention of Alzheimer's and Parkinson's dementia. How this study might affect research, practice, or policy: This finding guides public health strategies and personalized medicine, emphasizing the necessity for further research to validate BMR's protective effects.

Environmental Antimicrobial Resistance: Implications for Food Safety and Public Health

Antimicrobial resistance (AMR) is a serious global health issue, aggravated by antibiotic overuse and misuse in human medicine, animal care, and agriculture. This study looks at the different mechanisms that drive AMR, such as environmental contamination, horizontal gene transfer, and selective pressure, as well as the severe implications of AMR for human and animal health. This study demonstrates the need for concerted efforts across the scientific, healthcare, agricultural, and policy sectors to control the emergence of AMR. Some crucial strategies discussed include developing antimicrobial stewardship (AMS) programs, encouraging targeted narrow-spectrum antibiotic use, and emphasizing the significance of strict regulatory frameworks and surveillance systems, like the Global Antimicrobial Resistance and Use Surveillance System (GLASS) and the Access, Watch, and Reserve (AWaRe) classification. This study also emphasizes the need for national and international action plans in combating AMR and promotes the One Health strategy, which unifies environmental, animal, and human health. This study concludes that preventing the spread of AMR and maintaining the effectiveness of antibiotics for future generations requires a comprehensive, multidisciplinary, and internationally coordinated strategy.

Addressing heatwave impacts on hospital admissions in an Italian region.

This study explores the dynamic of emergency department (ED) access during heat waves. Given the importance of avoiding overcrowding and long waits in an ED, it is important to explore all the possible determinants of ED inflows. We shed some light on the impact that heat waves have on this dynamic, via a quantitative analysis of the number of ED visits in the Campania region of Italy during the summers between 2016 and 2019. Aggregating individual-level data, we examine the relationship between extreme heat events and number of ED visits, controlling for social, demographic and economic characteristics. Our findings, obtained through Random Effects Poisson and fractional probit estimations, show that heat waves above 39 perceived degrees Celsius significantly increase the number of ED visits, revealing the impact that heat waves have on ED utilization in Campania. Insights for local public health strategies and emergency preparedness initiatives are discussed.

A new clinical entity bridging the cardiovascular system and the kidney: The Chronic Cardiovascular-Kidney Disorder.

Background The complex relationship between heart and kidney dysfunction has been a subject of medical inquiry since the 19th century. The term "cardio-renal syndrome" (CRS) was introduced in the early 2000s and has since become a focal point of research. CRS is typically categorized into five subtypes based on the sequence of cardiovascular and kidney disease events. Summary The Cardiovascular-Kidney-Metabolic (CKM) syndrome, as defined by the American Heart Association (AHA), describes a set of interrelated metabolic risk factors and their effects on the kidneys and cardiovascular system. This syndrome emphasizes the complexity of managing patients with combined conditions and identifies several knowledge gaps, including disease mechanisms, clinical phenotype variability, and the impact of social determinants of health. The Chronic Cardiovascular-Kidney Disorder (CCKD) framework proposes a shift from the term "syndrome" to "disorder," focusing on concurrent cardiovascular and kidney problems regardless of their sequence. Key messages • The CCKD concept calls for simplification and conceptual clarity, arguing that understanding the bidirectional acceleration of disease progression between heart and kidney dysfunction can lead to more effective treatment strategies. • Both CKM and CCKD share common pathophysiological mechanisms and risk factors, including hypertension, diabetes, obesity, and dyslipidemia. Managing these conditions requires a comprehensive approach that addresses the underlying risk factors and pathophysiological mechanisms. • Future directions include embracing precision medicine, public health strategies, interdisciplinary care models, and ongoing research and innovation. Both frameworks underscore the need for comprehensive, interdisciplinary care models and innovative treatment strategies to address the complex interplay between cardiovascular and kidney diseases.

Prevalence, genotyping and phylogenetic analysis of HPV infecting Palestinian women.

Human Papillomavirus (HPV) is a significant global public health concern due to its association with cervical, other anogenital, and oropharyngeal cancers. This study aimed to evaluate the prevalence and the phylogenetic relationships of HPV among Palestinian in order to inform public health strategies. A cross-sectional study was conducted between September 2023 and April 2024 involving 379 Palestinian women over the age of 18 from 11 governorates in the West Bank. Cervical swabs were collected and analyzed using nested PCR and Sanger sequencing methods to detect and genotype HPV. The study also included phylogenetic analysis to understand the genetic relationships between HPV strains. The overall HPV prevalence was 14.5%. The highest prevalence was observed in the 20-29 age group (19.6%), the Middle region of the West Bank (19.0%), and lower educational attainment. Genotyping revealed a diverse distribution of HPV types, with HPV 11 and HPV 6 being the most common low-risk types, while HPV 16 was the most common high-risk type. About 21.8% of the detected strains were high-risk strains. Phylogenetic analysis indicated significant regional clustering of HPV strains. The study highlights the need for targeted public health interventions, including vaccination and regular screening, particularly for younger women and those with lower educational attainment. Continued surveillance and research are essential to reduce the burden of HPV-related diseases in the West Bank, Palestine.

Innovative Approaches for Sustainable Greenhouse Pest Management: Integrating Advanced Diagnostics and Preventive Strategies for Optimal Crop Health

Sustainable greenhouse pest management is critical for achieving good crop yields while reducing environmental impact. This paper investigates novel ways that incorporate improved diagnostic tools and preventive tactics into the framework of Integrated Pest Management (IPM) in greenhouse ecosystem. Understanding pest life cycles and utilizing cutting-edge tools such as DNA barcoding and enzyme-linked immunosorbent assays (ELISA) might help greenhouse managers achieve precise pest diagnosis and early responses. Preventive measures, such as tight cleanliness protocols, quarantine techniques, and the use of physical barriers, are critical in lowering pest incidence. Furthermore, biological controls, cultural methods such as crop rotation and intercropping, and the selective use of insecticides and biopesticides collectively help to ensure long-term pest management. This complete approach not only reduces insect damage but also creates a healthier, more resilient agricultural ecology. Furthermore, traditional diagnostic and preventive measures were also discussed in the article. The and recommendations are validated by recent studies and data, demonstrating the success of these integrated tactics in modern greenhouse operations.

Cardiorespiratory fitness, body mass index and mortality: a systematic review and meta-analysis

ObjectiveThe purpose of this review was to assess the joint relationship of cardiorespiratory fitness (CRF) and Body Mass Index (BMI) on both cardiovascular disease (CVD) and all-cause mortality risk.DesignA systematic review and meta-analysis was conducted. Pooled HR and 95% CI were calculated using a three-level restricted maximum likelihood estimation random-effects model with robust variance estimation. The reference group was normal weight-fit and was compared with normal weight-unfit, overweight-unfit and fit, and obese-unfit and fit.Data sourcesElectronic databases (PubMed/MEDLINE, Web of Science and SportDiscus) were searched following registration on PROSPERO.Eligibility criteriaArticles meeting the following criteria were included: (1) published between January 1980 and February 2023, (2) prospective cohort study, (3) CRF assessed using a maximal or VO2peak exercise test, (4) BMI reported and directly measured, (5) joint impact of CRF and BMI on all-cause mortality or CVD mortality were analysed, and (6) the reference group was normal weight, fit individuals.Results20 articles were included in the analysis resulting in a total of 398 716 observations. Compared with the reference group, overweight-fit (CVD HR (95% CI): 1.50 (0.82–2.76), all-cause HR: 0.96 (0.61–1.50)) and obese-fit (CVD: 1.62 (0.87–3.01), all-cause: 1.11 (0.88–1.40)) did not have a statistically different risk of mortality. Normal weight-unfit (CVD: 2.04 (1.32–3.14), all-cause: 1.92 (1.43–2.57)), overweight-unfit (CVD: 2.58 (1.48–4.52), all-cause: 1.82 (1.47–2.24)) and obese-unfit (CVD: 3.35 (1.17–9.61), all-cause: 2.04 (1.54–2.71)) demonstrated 2–3-fold greater mortality risks.ConclusionsCRF is a strong predictor of CVD and all-cause mortality and attenuates risks associated with overweight and obesity. These data have implications for public health and risk mitigation strategies.

Impact of Nutritional Minerals Biomarkers on Cognitive Performance Among Bangladeshi Rural Adolescents—A Pilot Study

Background: Nutritional metals (NM) are essential for neurodevelopment and cognitive performance during growth. Nevertheless, epidemiological evidence regarding the associations between NM and brain function remains understudied, particularly among adolescents. Therefore, the objective of this pilot study was to examine the effects of NM biomarkers such as iron (Fe), selenium (Se), zinc (Zn), magnesium (Mg), and copper (Cu) on neurobehavioral functions among a group of rural Bangladeshi adolescents. Methodology: We conducted a cross-sectional study involving 105 adolescents aged 13–17 from Araihazar, Bangladesh. Cognitive function was assessed using the computer-based Behavioral Assessment and Research System (BARS), focusing attention, memory, and executive function, and blood NM levels (Fe, Se, Zn, Mg, and Cu) were measured. Associations between individual minerals, NM composite scores, and cognition were analyzed using multiple linear regressions. Results: This study included 47 boys and 58 girls with an average age of 15 years. Fe levels were correlated with Continuous Performance Test (CPT) latency (r = −0.42, p < 0.05) and Se levels correlated with Match-to-Sample (MTS) correct count (r = 0.32, p < 0.01). Linear regressions showed that Se was associated with MTS correct count (b = 0.02, 95%CI: 0.01, −0.04), reflecting visual memory, and Fe was associated with CPT latency (b = −0.68, 95%CI: −1.11, −0.26), reflecting improved attention. The same BARS measures were also significantly associated with the 3-NM composite score. Conclusions: Our findings suggest that NM, particularly Fe, Se, and NM mixtures, could play a crucial role in brain development and neurocognitive function during adolescence. Further studies will help design national public health policies and strategies to address and mitigate brain health deficiencies among adolescents.

Global burden associated with rare infectious diseases of poverty in 2021: findings from the Global Burden of Disease Study 2021.

Rare infectious diseases of poverty (rIDPs) involve more than hundreds of tropical diseases, which dominantly affect people living in impoverished and marginalized regions and fail to be prioritized in the global health agenda. The neglect of rIDPs could impede the progress toward sustainable development. This study aimed to estimate the disease burden of rIDPs in 2021, which would be pivotal for setting intervention priorities and mobilizing resources globally. Leveraging data from the Global Burden of Disease Study 2021, the study reported both numbers and age-standardized rates of prevalence, mortality, disability-adjusted life-years (DALYs), years lived with disability, and years of life lost of rIDPs with corresponding 95% uncertainty intervals (UIs) at global, regional, and national levels. The temporal trends between 1990 and 2021 were assessed by the joinpoint regression analysis. A Bayesian age-period-cohort model was used to project the disease burden for 2050. In 2021, there were 103.76 million (95% UI: 102.13, 105.44 million) global population suffered from rIDPs with an age-standardized DALY rate of 58.44 per 100,000 population (95% UI: 42.92, 77.26 per 100,000 population). From 1990 to 2021, the age-standardized DALY rates showed an average annual percentage change of - 0.16% (95% confidence interval: - 0.22, - 0.11%). Higher age-standardized DALY rates were dominated in sub-Saharan Africa (126.35 per 100,000 population, 95% UI: 91.04, 161.73 per 100,000 population), South Asia (80.80 per 100,000 population, 95% UI: 57.31, 114.10 per 100,000 population), and countries with a low socio-demographic index. There was age heterogeneity in the DALY rates of rIDPs, with the population aged under 15years being the most predominant. Females aged 15-49years had four-times higher age-standardized DALY rates of rIDPs than males in the same age. The projections indicated a slight reduction in the disease burden of rIDPs by 2050. There has been a slight reduction in the disease burden of rIDPs over the past three decades. Given that rIDPs mainly affect populations in impoverished regions, targeted health strategies and resource allocation are in great demand for these populations to further control rIDPs and end poverty in all its forms everywhere.

Abstract 4113475: Association of Age at Diabetes Diagnosis and All-cause and Cardiovascular Mortality among 600,000 US Adults

Introduction: Diabetes is a leading cause of morbidity and mortality in the United States, causing an estimated 440,000 deaths among US adults in 2019. Establishing the relevance of diabetes diagnosis at various ages to mortality in the contemporary US population, both overall and among major demographic subgroups, may inform public health policy and strategy. Methods: We aimed to quantify the association between age at diabetes diagnosis and all-cause and cardiovascular mortality among US adults using publicly-available data from the National Health Interview Survey 1997-2018, linked to the National Death Index through 2019. We used Cox regression adjusted for age, sex, race and ethnicity, educational attainment, smoking status, body-mass index, physical activity, and insurance coverage to estimate all-cause and cardiovascular mortality rate ratios overall, by sex, and by race and ethnicity. Results: Among 601,467 included adults (56% female, 16% Hispanic and 14% non-Hispanic Black) there were 75,122 deaths during 6.6 million person-years of follow-up. Overall, the all-cause mortality rate ratio associated with diabetes diagnosed at ages 20-29, 30-39, 40-49, 50-59, 60-69, or 70-79 years were 3.87 (95% CI 3.47-4.32), 2.87 (2.68-3.07), 2.26 (2.16-2.36), 1.72 (1.65-1.79), 1.47 (1.41-1.53), and 1.26 (1.19-1.33), respectively. The corresponding cardiovascular mortality rate ratios were 5.02 (4.09-6.16), 3.37 (2.99-3.78), 2.88 (2.65-3.13), 1.94 (1.81-2.09), 1.53 (1.43-1.65), and 1.27 (1.15-1.40), respectively. Although these associations were similar by sex and by race and ethnicity, the age-specific prevalence of diabetes was greatest among non-White participants. Among individuals with diabetes diagnosed at ages 20-29, 30-39, 40-49, 50-59, 60-69, or 70-79 years, an estimated 74%, 65%, 56%, 42%, 32%, or 20% of deaths from any cause were attributable to diabetes. Conclusion: Age at diabetes diagnosis was associated with all-cause and cardiovascular mortality in a dose-dependent and approximately log-linear manner. Although associations were similar across diverse demographic groups, age-specific diabetes prevalence was greatest among non-White individuals, leading to greater mortality burden. If these associations were interpreted as largely causal, diabetes accounted for more than half of all deaths among those diagnosed before age 50 years. Preventing, delaying, and appropriately managing diabetes could prevent substantial excess mortality among US adults.

Recognising and responding to the community needs of gay and bisexual men around mpox.

In May 2022, a global surge in mpox cases, typically endemic to Western and Central Africa, particularly affected gay, bisexual, and other men who have sex with men (gbMSM). This study examines gbMSM communities' experiences and perceptions around Ireland's public health response to the outbreak. A cross-sectional mixed-methods online survey was conducted. Qualitative data were analysed using reflexive thematic analysis informed by critical realism. A total of 163 gay and bisexual men took part in the survey. Participants accessed information from diverse sources, reporting varying levels of trustworthiness. Overall, participants were well-informed. Four themes were developed from the qualitative data: (1) Perceptions of the mpox response: divergence in urgency, priority, and care; (2) The mpox outbreak as a sign of otherness for gbMSM; (3) The potential for othering through mpox prevention practices; and (4) mpox, memory and fear. While community-led initiatives were effective, significant challenges included stigmatisation, discrimination, and mistrust towards public health institutions, influenced by institutionalised homophobia. The study underscores the need for inclusive, culturally sensitive, and transparent public health strategies. The mpox outbreak highlights the importance of robust community collaboration in public health interventions. Future strategies must ensure equitable access to information, vaccination, and care, and address broader structural inequalities to foster trust and engagement within affected communities.