Allied health clinicians need strong death literacy to navigate loss, grief, dying, and death. Their roles include system navigation, advocacy, and psychosocial support, often bridging healthcare, community, and social services. Adequate death literacy is essential for holistic, compassionate care. This study assessed death literacy among allied health clinicians in the Central Coast region of New South Wales, Australia. An anonymous, cross-sectional online survey conducted between February and March 2025 collected demographic, professional, and 29-item Death Literacy Index-Revised (DLI-R) data. Subsequent analyses compared overall and subscale death literacy scores across Central Coast allied health disciplines and against published Australian norms for the (a) general population, (b) health professionals, and (c) end-of-life and bereavement care volunteers. A total of 144 allied health clinicians completed the survey, including nutrition and dietetics, physiotherapy, podiatry, psychology, occupational therapy, speech pathology, social work, oral health, counselling, allied health assistants, and other disciplines. There were significant differences in the overall death literacy scores across allied health disciplines, with differences in mean scores ranging from 0.280 to 1.238 (p < 0.01). These differences extended to most subscales; however, after adjusting for potentially confounding characteristics, only social work remained significantly different from the "other" group in overall scores. Subscale differences persisted, including higher hands-on care scores in physiotherapy and occupational therapy, and higher factual and community knowledge scores in social work, compared with the "other" group. Overall, allied health clinicians' death literacy (mean = 5.671) was significantly higher than Australian Online Research Panel norms for the general population (mean = 4.830; p < .001); and lower than health professionals (mean = 6.510; p < .001); end of life care volunteers (mean = 6.640; p < .001); and grief and bereavement care volunteers (mean = 6.590; p < .001). Allied health clinicians appear to hold some discipline-specific strengths in death literacy subscales. Although overall death literacy was higher than that of the general population, it remained lower than that of health professionals, end-of-life care volunteers, and volunteers in grief and bereavement. These findings highlight gaps in allied health workers' ability to understand, access, and act on end-of-life care options. This study focuses on allied health clinicians, a group that plays an important role in everyday health and palliative care but has rarely been included in research on death literacy. It offers new information about who makes up this workforce and the roles they perform. By providing what is believed to be the first benchmarked death literacy profile for this group, the study shows where allied health workers feel confident and where they need more support and training. It also highlights gaps in clinical practice, tertiary allied health education programs, and ongoing professional development, while providing a clear starting point for future research and workforce planning to improve death literacy, end-of-life, and bereavement care.
Eradicating malnutrition among children by the year 2030 is a key objective of Sustainable Development Goals adopted by the UNDP. However, child malnutrition continues to pose a pressing public health concern in India, with malnutrition indicators being far above acceptable limits. The challenge of addressing the problem is further compounded by significant disparities in the levels of under-nutrition among under-five children across rural and urban areas. Understanding the extent and the contributing factors to these disparities are important for designing effective policies and targeted interventions. The study aims to explore the rural-urban disparities in child malnutrition in India as demonstrated by the composite index of anthropometric failure, a combined measure that incorporates multiple anthropometric indicators. The study uses the unit level data from National Family Health Survey-5, 2019-2021 and employs the Fairlie decomposition technique to determine the relative contributions of various factors, including individual, maternal and socio-economic status, to the rural-urban malnutrition gap. The findings reveal that mother's health and education are the key factors contributing to the gap, accounting for about 37.4% and 29.3%, respectively, of the total variance. The results emphasize the importance of targeted interventions that focus on socio-economic and maternal factors to bridge the disparities.
Tuberculosis remains a major public health problem in low- and middle-income countries and is closely associated with poor nutritional status among patients. Undernutrition in patients with tuberculosis contributes to adverse treatment outcomes, increased morbidity, and delayed recovery. However, evidence on the magnitude of undernutrition and its associated factors among patients with tuberculosis in Somalia is limited. This study aimed to assess the prevalence of undernutrition and identify associated factors among adults with tuberculosis. An institution-based cross-sectional study was conducted among 362 patients with tuberculosis who attended selected tuberculosis treatment facilities. Data were collected using a structured questionnaire covering sociodemographic, household, dietary, clinical, and treatment-related factors. Anthropometric measurements were obtained using standardized procedures, and body mass index was calculated to assess nutritional status. Undernutrition was defined as a body mass index of <18.5 kg/m². Bivariate and multivariable logistic regression analyses were performed to identify factors associated with undernutrition, and adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were reported. The prevalence of undernutrition among patients with tuberculosis was 37.6% (95% CI, 31.5-41.2). In the multivariable analysis, female sex (AOR = 3.93; 95% CI, 1.84-4.81), household size of 5 or more members (AOR = 3.15; 95% CI, 1.92-5.17), rural residence (AOR = 5.49; 95% CI, 3.16-9.28), extrapulmonary tuberculosis (AOR = 3.56; 95% CI, 1.93-6.27), continuation phase of treatment (AOR = 3.10; 95% CI, 1.92-4.11), treatment duration (AOR = 3.82; 95% CI, 2.09-5.30), and poor treatment adherence (AOR = 4.71; 95% CI, 2.81-8.02) were significantly associated with undernutrition. Undernutrition was highly prevalent among adults with tuberculosis. Both sociodemographic and treatment-related factors were independently associated with undernutrition. These findings highlight the importance of integrating routine nutritional assessments and targeted nutritional support into tuberculosis care services.
Age-related cognitive decline is a major public health challenge and has a significant impact on a country's economy and economic growth. Evidence suggests dietary patterns such as the Mediterranean Diet (MeDi), Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), Alternative Health Eating Index (AHEI) and plant-based diets are associated with reduced cognitive decline and improved brain health. The main objective of this review is to summarize recent data and provide a literature-based evaluation of the effects of popular dietary patterns associated with cognitive health. An in-depth evaluation of the current literature suggests that adherence to healthy dietary patterns-including the MeDi, DASH, MIND, AHEI, and plant-based diets-can play an important role in preserving cognitive function and delaying cognitive aging. However, gaps remain in understanding the effects of long-term dietary adherence, specific food constituents, culturally diverse dietary practices, and the underlying molecular and neurophysiological mechanisms. These factors warrant further investigation to identify causal relationships between dietary patterns and beneficial effects on cognitive health. Literature-based evaluation offers a strong correlation between diet, nutrition, and age-related cognitive health. Despite these observations, studies affirm that new research incorporating well-powered longitudinal studies and culturally adaptable interventions are equally necessary. Furthermore, public health officials and global health entities should implement evidence-based and well-researched nutritional policies that are aimed at preserving cognitive health.
We examined the effects of price interventions on the healthiness of a hypothetical food order in a simulated online out-of-home food delivery app. The design was a randomised controlled trial, with four conditions (10% taxation of less healthy menu items; 10% subsidy of healthier menu items; a combination of taxation and subsidy; standard pricing) and recruitment was stratified by socioeconomic position (SEP). Primary outcomes were healthier vs less healthy main meal selected and total kilocalories (kcals) selected. Participants selected a hypothetical evening meal from out of home food outlets on a simulated online food delivery app. N=3107 adult participants from the UK were randomised into taxation (n=750), subsidies (n=808), a combination of taxation and subsidies (n=769), and standard pricing (n=779). 57-58% of participants were higher SEP. There were no statistically significant effects of the pricing interventions on whether a healthy vs less healthy main meal was selected (e.g. taxation vs control OR 0.91 (95% CI 0.74, 1.12); subsidies vs control OR 1.08 (95% CI 0.89, 1.31)) or on total kcals selected (e.g. taxation vs control regression coefficient -44.31 (95% CI -95.90, 7.28); subsidies vs control regression coefficient -7.94 (95% CI -60.23, 44.35)). There was no evidence that effects differed by SEP. We found no convincing evidence that 10% changes in price of healthy and less healthy food in a simulated out of home food delivery app impacted on healthiness of food selected. Further research may benefit from examining effects of larger price changes and in real-world purchasing conditions.
Deficient muscle-specific strength has been recognized as a key component of sarcopenia. However, the impact of various interventions on muscle-specific strength has not been systematically reviewed. This study aims to provide a systematic summary of research examining the effects of exercise, nutrition, and other interventions on muscle-specific strength in older adults. Randomized controlled trials (RCTs) were identified through comprehensive searches of major databases. Eligible studies included adults aged 60 years or older, with interventions lasting at least 8 weeks. Studies were required to assess muscle strength normalized by muscle mass. Standardized mean differences (SMDs) were calculated using random-effects meta-analyses, and heterogeneity was evaluated using I² statistics. A total of 41 RCTs with 3,141 participants were included in the analysis. Interventions included resistance exercise, nutritional supplementation, aerobic exercise, concurrent training, combined exercise and nutrition, caloric restriction, and other therapies. Resistance exercise significantly improved muscle-specific strength (SMD = 0.61, 95% confidence interval: 0.27 to 0.94), although heterogeneity was observed (I² = 81%). In contrast, interventions such as aerobic exercise, concurrent training, combined exercise and nutrition, and nutritional supplementation did not lead to significant improvements in muscle-specific strength. High heterogeneity was observed across all included studies. Resistance exercise is the most effective intervention for improving muscle-specific strength in older adults. The effects of other interventions, such as nutritional supplementation and aerobic exercise, remain inconclusive. Further well-designed RCTs exploring diverse exercise regimens and nutritional interventions are needed to confirm these findings and identify the most effective strategies for enhancing muscle-specific strength in older populations.
Postmenopausal osteoporosis is a major public health issue affecting over one billion people worldwide. However, limited evidence exists on how different formulations with enhanced bioavailability compare in clinical outcomes with one another, even if there is extensive research on vitamin D tablets. Post-menopausal women's bone mineral density (BMD), bone turnover markers, and fracture risk over a 24-month period were evaluated using regular cholecalciferol, micronized cholecalciferol, and liposomal vitamin D3 combined with calcium supplements. Using age and baseline 25-hydroxyvitamin D [25(OH)D] levels, 612 post-menopausal women (ages 50-75 years) with T-scores ranging from -1.5 to -2.5 on dual-energy X-ray absorptiometry (DXA) were randomly assigned to one of four groups: regular cholecalciferol (1200 IU/day + 1000 mg calcium, n = 153), micronized cholecalciferol (1200 IU/day + 1000 mg calcium, n = 153), liposomal vitamin D3 (800 IU/day + 1000 mg calcium, n = 153), or placebo (n = 153). Other results were changes in femoral neck, lumbar spine, total hip bone mineral density (BMD), bone-specific alkaline phosphatase (BSAP), C-terminal telopeptide of type I collagen (CTX), serum 25(OH)D levels, and incidence of new fragility fractures. Mean serum 25(OH)D levels were substantially higher (p = 0.003) in the liposomal group (38.2 ± 7.5 ng/mL) than those in the control cholecalciferol group (28.5 ± 6.8 ng/mL). The liposomal vitamin D3 group exhibited somewhat higher femoral neck BMD (2.8% ± 1.2%; p = 0.012) and lumbar spine BMD (2.8% ± 1.2%; p = 0.008) enhancement than did the placebo group (1.1% ± 0.9%). The liposomal form showed the highest ratio (2.4 ± 0.6 versus 1.8 ± 0.5 placebo; p = 0.001); hence, BSAP/CTX ratios were significantly better in all the active treatment groups. Eight patients (5.2%) in the placebo group had fresh fragility fractures; two (1.3%), three (2.0%), and one (0.7%) in the conventional, micronized, and liposomal groups, respectively; χ² = 7.42; p = 0.059. Greater success in raising bone mineral density and lowering indicators of bone turnover with recent bioavailability-enhanced vitamin D3 formulas was observed in post-menopausal women, especially those on liposomal delivery systems. These results suggest that public health guidelines and clinical practice have to take into account a rather important element impacting the efficacy of vitamin D supplements: formulation technology. ClinicalTrials.gov identifier: NCT04987654.
Emerging evidence suggests that choline plays a significant role in mediating metabolic disease beyond the regulation of hepatic triglycerides. The aim of this article is to present a current, brief synthesis focused on the impact of choline intake on metabolic health and to identify future directions in this research space. Recent work has linked low choline intake to obesity, metabolic dysfunction-associated steatotic liver disease (MASLD), type 2 diabetes, and obesity-associated cognitive decline. A new methodology now enables more precise discrimination of choline intake in clinical populations. Emerging evidence reframes circulating trimethylamine N-oxide (TMAO) as a marker of metabolic dysfunction driven by obesity and a high-fat diet, rather than a direct consequence of dietary choline intake. Preclinical and clinical studies further suggest that adequate choline intake may be protective against obesity-related disease progression, particularly when established early in life. Choline is emerging as an important mediator of metabolic health and disease progression. A deeper understanding of the mechanisms regulating choline metabolism is critical to tailor nutritional therapies and mitigate metabolic disease progression. The impact of new antiobesity medications, including GLP-1 receptor agonists, on choline requirements also warrants investigation.
The first year of university is a critical period for the consolidation of lifestyle habits and has been associated with an increased risk of developing eating disorders (EDs). This study aimed to assess the prevalence of ED risk among first-year Spanish university students and to develop a composite score based on ten unhealthy lifestyle habits to explore its potential association with ED risk. A serial cross-sectional study was conducted using data from 11,500 university students. ED risk was assessed with the SCOFF questionnaire. An Unhealthy Habit Score (UHS) was created by summing ten lifestyle factors. Descriptive, bivariate and multivariate analyses were performed stratified by sex. Associations between ED risk and lifestyle factors were examined using logistic regression models. The overall prevalence of ED risk was 21.4%, significantly higher in women (24.8%) than in men (12.3%). The UHS ranged from 0 to 9 with a median of 3 and no significant sex differences. Most lifestyle factors showed significant associations with ED risk. A strong relationship was found between the UHS and ED risk, with each additional point in the UHS increasing the odds of ED risk by 31% in men (OR = 1.31) and 23% in women (OR = 1.23). The risk of EDs was high among first-year university students, particularly among women, and was associated with multiple unhealthy lifestyle habits. The UHS developed in this study could serve as a valuable tool for predicting ED risk, especially in contexts where only general lifestyle information is available.
Despite advances in managing traditional cardiovascular risk factors and promoting healthy lifestyles, recurrence of cardiovascular events remains high in patients with established coronary heart disease. Daytime napping, or siesta, has been associated with potential health benefits, but evidence in this population is still limited. This study aimed to evaluate associations between siesta habit and cardiometabolic health over a seven-year follow-up in patients with coronary heart disease from the CORDIOPREV study (NCT00924937). A total of 872 participants from the CORDIOPREV study were included with sufficient information collected throughout the 7-year follow-up to evaluate the siesta habit. The participants were stratified as "non-nappers", "short nappers" (≤30 min), and "long nappers" (>30 min). Blood pressure, anthropometric measures, and biological samples were taken at baseline and during yearly visits. Linear mixed models were performed to assess the evolution of cardiometabolic parameter over the follow-up. Habitual short nappers showed lower weight, body mass index, and abdominal circumference, as well as lower fasting glucose, glycated hemoglobin, HOMA-IR, apolipoprotein B and triglyceride levels throughout the seven-year follow-up period with the most consistent differences observed in comparison with long nappers (p < 0.05). Stratified analyses by baseline diabetes status revealed in individuals without diabetes showed more favorable anthropometric measures than long nappers while within those with diabetes, short nappers showed more favorable glucose metabolism and triglyceride levels than long nappers. Short siesta habit (≤30 min) was associated with a more favorable cardiometabolic profile in patients with CHD. Further studies are needed to assess its potential clinical relevance.
Background: Stunting is a pervasive issue in low‑ and middle‑income countries, reflecting biological processes that adversely affect childhood cognitive development and increase the risk of chronic disease in adulthood. Nutritional intake is an important causative factor in stunting. Understanding the nutritional intake patterns of children with stunting can help inform nutrition program development. Objective: To characterize breastfeeding and dietary patterns from a clinical cohort of children with stunting in Guatemala and identify factors associated with linear growth. Methods: We included children with at least one diet record and one length/height‑for‑age z‑score below -2 from ages 0-5 years. We excluded children enrolled in complex care for severe non‑nutritional illness and records from prior to 6 months of age. We described adherence to World Health Organization infant and young child feeding indicators upon program enrollment. We longitudinally characterized breastfeeding and complementary feeding patterns of the cohort using generalized additive mixed modeling. We identified and quantified associations between various nutritional factors and linear growth using linear mixed effects models. Results: The final analytical dataset included 19,476 patient encounters from 2,352 children. Most children did not meet World Health Organization standards for dietary adequacy upon enrollment in the program. Dietary intakes were predominantly carbohydrate‑based. The factors most strongly associated with linear growth were food insecurity (negatively associated), portion size, and continued breastfeeding from 12 to 23 months. Adherence to the infant and young child feeding indicators was positively associated with linear growth. The intake of most food groups was also positively associated with linear growth. Conclusions: These findings suggest that the nutritional focus of interventions should be on adequate dietary diversity, earlier introduction and higher frequency of the less frequently consumed food groups, age‑appropriate portion sizes, and breastfeeding through 2 years of age. Public policy measures to address food insecurity are also necessary.
Primary health care played a critical role during the COVID-19 pandemic by adapting care delivery to maintain essential services and reduce transmission risks. Home visits were used to monitor individuals in isolation, support vulnerable populations at increased risk, and sustain community-based care. However, their organization and operationalization varied across settings, and the available evidence remains fragmented. This protocol outlines the methods for a scoping review that will systematically map how in-person or hybrid home visits linked to primary, community-based, or first-contact care were organized and operationalized during the COVID-19 response, including the operational approaches, reported outcomes, and remaining knowledge gaps. This protocol follows the Joanna Briggs Institute methodological framework and will be reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) statement. Eligibility was defined using the Population, Concept, and Context framework. Searches will be conducted in seven electronic databases (Scopus, Web of Science Core Collection, MEDLINE/PubMed, Embase, Cochrane Library, CINAHL, and LILACS) without language restrictions and will include eligible studies published from 2020 onward. Conditional supplementary procedures may include backward citation searching and citation mapping of included studies and relevant reviews, as well as targeted searches and limited gray literature searching, if database searches yield limited evidence or leave relevant questions insufficiently represented. Records will be managed in Rayyan. Two reviewers will independently assess eligibility, with disagreements resolved by a third reviewer. All included sources will undergo descriptive mapping. Operational configurations will be classified by provider configuration, delivery modality, and targeting logic. Basic qualitative content analysis will be limited to explicitly reported implementation experiences, barriers, facilitators, contextual adaptations, and recommendations. Pilot searches were conducted solely to assess feasibility and refine the search strategy; formal searching, screening, data extraction, and synthesis have not yet begun. The review will commence after acceptance of the protocol and is expected to be completed within approximately 6 months. The review will provide a structured evidence map of home-visit practices during the COVID-19 response and may identify transferable operational lessons and evidence gaps relevant to preparedness for future public health emergencies. Reported outcomes will not be interpreted as evidence of comparative effectiveness or causal effects.
PurposeTo determine whether the specificity of mandates in Wisconsin's state comprehensive planning statute is associated with the inclusion and actionability of healthy eating and active living items in local comprehensive plans.DesignRetrospective, cross-sectional, multilevel policy content analysis.SettingWisconsin.Sample93 local comprehensive plans, stratified by urbanicity and regional planning commission area.MeasuresLocal comprehensive plans were scored using the Healthy Living and Active Design Scorecard for Comprehensive Plans. Wisconsin's state comprehensive planning statute was evaluated for general or specific mandates for each item in the Scorecard.AnalysisDifference in weighted percentage of municipalities scoring for items not mandated, mandated with general language, and mandated with specific language; one-sided Welch difference of means tests.ResultsMandating an item with general language is associated with a 33.6 percentage point higher inclusion rate in local plans and mandating an item with specific language is associated with a 50.2 percentage point higher inclusion rate in local plans. All differences are statistically significant at the 0.05 confidence level.ConclusionHealthy eating and active living items that are mandated by state statute are more likely to be included in local comprehensive plans than items that are not mandated. Mandated items are also more likely to be included in local comprehensive plans in an actionable manner, which may make them more likely to be implemented.
Underserved pregnant individuals experience high risk for weight gain outside clinical guidelines and adverse perinatal outcomes. The Women, Infants, and Children (WIC) federal program assists underserved pregnant individuals with supplemental nutrition. WIC is positioned to disseminate interventions promoting recommended gestational weight gain, increasing access to efficacious programs and complementing clinical care. Pregnant WIC participants were randomly assigned (2019-2023) to a co-developed multicomponent e-health intervention for gestational weight gain management or usual care between 10 and 16 weeks gestation. The primary outcome (analyzed 2025) was gestational weight gain guideline attainment. Secondary weight outcomes included study-observed weight gain, weekly weight gain, deviation from guidelines, fat mass gain, and change in energy balance behaviors. Adverse perinatal outcomes were exploratory. Pregnant participants (n=351; 57% non-Hispanic Black) were enrolled (179 Intervention; 172 Usual Care) across 31 WIC clinics. The incidence of guideline attainment was not different between groups (both groups 17%; adjusted odds ratio, 1.05; 95% CI, 0.55 to 2.01; P=0.89). Study-observed weight gain (adjusted mean difference, -1.4 kg; 95% CI, -2.8 to -0.1; P=0.04), rate of weight gain (-0.07 kg/wk; 95% CI, -0.13 to -0.01; P=0.02), deviation from guidelines (-0.05 kg/wk; 95% CI, -0.10 to -0.00; P=0.03), and fat mass gain (-1.3 kg; 95% CI, -2.1 to -0.6; P<0.001) were lower in the Intervention Group compared to Usual Care. Change in energy intake was lower in the Intervention Group (306 kcals/day; 95% CI, -500 to -112; P=0.002). There were 43 cases (9% Intervention, 16% Usual Care) of preterm birth and 30 NICU admissions (7% Intervention, 11% Usual Care). A remotely delivered lifestyle intervention concomitant with WIC care reduced gestational weight and fat mass gain. This approach demonstrates the potential for scalable interventions integrated into existing public health systems to expand access and inform public health strategies targeting maternal health disparities. Trial registration: This study is registered at www. gov NCT04028843.
Maternal anaemia affects 35.5% of pregnant women globally and represents a persistent public health challenge with significant maternal and neonatal health consequences. Despite substantial research investment, progress towards anaemia reduction remains limited, suggesting potential misalignment between research priorities and translation to guidance and/or implementation of recommended interventions. Understanding the knowledge structure and thematic evolution of maternal anaemia research is essential for identifying gaps and informing future research strategies and guideline development. This study aimed to map the knowledge structure and evolution of research on anaemia in pregnant and postpartum women from 2000 to 2024, analyse global collaboration networks and geographic distribution, and identify emerging themes and research gaps using bibliometric analysis and topic modelling. A comprehensive bibliometric analysis was conducted using Web of Science Core Collection database, encompassing 1,007 articles published between 2000 and 2024. Standard bibliometric indicators were calculated using VOSviewer and CiteSpace software. Latent Dirichlet Allocation topic modelling identified thematic clusters. Linear regression analysis examined temporal trends and geographic patterns. Publication output demonstrated exponential growth (R2 = 0.9054), increasing from 12 articles in 2000 to 110 in 2024. Research output was concentrated amongst authors from high-income countries, with 68.5% of publications having first or corresponding authors based in high-income countries. Geographic disparities revealed substantial regional research gaps, particularly in Sub-Saharan Africa and South Asia. Topic modelling revealed nine clusters dominated by health outcomes research (77.4%), with less attention to management (21.6%), prevention (20.8%) and diagnosis (6.3%). This bibliometric analysis reveals substantial growth in maternal anaemia research over 25 years, with publications increasing nearly ten-fold. However, the research landscape shows thematic imbalances. Sustained attention is needed on prevention and diagnosis as well as the integrated delivery of anaemia interventions within multisectoral approaches to generate evidence and address remaining knowledge gaps.
Typhoid fever remains a health threat in endemic countries. In Indonesia, it causes an estimated 470,000 cases and 6000 deaths annually. We assessed the cost-effectiveness and budget impact of introducing the typhoid conjugate vaccine (TCV) into Indonesia's routine National Immunisation Program (NIP) at 9 months of age, with or without a catch-up campaign up to 15 years of age. A validated dynamic model of typhoid transmission was used to project health outcomes over a 30-year analytical horison for each scenario. Cost-of-illness data were drawn from the Surveillance of Typhoid Fever in Indonesia study and published literature. Incremental cost-effectiveness ratios (ICERs) were estimated from healthcare sector and societal perspectives. Uncertainty was explored using one-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA). Budget impact analysis supported annual fiscal planning. Six-year budget impact costs were US$61 million (routine) and US$251 million (routine and catch-up), equivalent to 0.48%-2.95% and 2.97%-9.84% of the annual national immunisation budget, respectively. Compared to no vaccination, routine TCV yielded ICERs at US$240.6 and US$238.8 per DALY averted from the healthcare sector and societal perspectives, respectively, corresponding to 5% of GDP per capita. Compared with routine immunisation alone, adding a catch-up campaign yielded ICERs of US$521.3 and US$519.5 per DALY averted from the healthcare sector and societal perspective, respectively, corresponding to approximately 11% of GDP per capita. OWSA showed that both strategies remained very cost-effective at a willingness-to-pay threshold of 1xGDP. PSA estimated probabilities of cost-effectiveness of 99.7% (routine and catch-up vs. routine) and 99.2% (routine vs. no vaccination). The multi-strategy cost-effectiveness acceptability curve identified the combined routine and catch-up campaign as the optimal strategy. Introducing TCV into Indonesia's NIP is projected to be very cost-effective. A routine-only program requires a lower budget, but adding a catch-up campaign is an optimal strategy with greater public health impact while remaining very cost-effective. Gates Foundation grants to Murdoch Children's Research Institute in collaboration with Universitas Gadjah Mada [ref. no. INV-003867] and to TyVAC 2.0 [ref. no. INV-030857].
Type 2 diabetes (T2DM) is a growing public health concern, particularly in the Middle East and North Africa (MENA) region, where prevalence rates continue to rise. Social determinants of health, including material needs security and food security, play a critical role in diabetes management, yet their interrelated effects remain underexplored. This study aims to examine the relationship between material needs security and food security among Lebanese adults with T2DM of low socioeconomic status. A cross-sectional study was conducted on 299 Lebanese adults with T2DM recruited from three primary health care centers. Participants completed validated questionnaires assessing sociodemographic factors and food security. Material needs security score was computed based on ownership and access for certain house utilities, as well as car ownership. Unadjusted and adjusted logistic regression models were conducted to evaluate associations between material needs security and food security. Higher material needs security was significantly associated with food security in both the unadjusted and adjusted regression models (odds ratio = 1.26, 95% confidence interval: 1.06-1.49, p = 0.007). Food and material needs insecurities were more prevalent among females and individuals with lower income, lower education, and lack of health insurance. This study highlights the strong association between material needs security and food security in Lebanese adults with T2DM, emphasizing the importance of addressing social determinants in diabetes management. Policies targeting financial stability, food security interventions, and access to health care are essential to improving health outcomes in vulnerable populations.
Nonnutritive sweeteners (NNS) are increasingly incorporated into ultraprocessed foods and beverages, yet psychosocial drivers of NNS consumption across age groups in low- and middle-income settings remain poorly characterized. Understanding how knowledge, attitudinal beliefs, and information sources shape NNS consumption is essential for designing effective nutrition interventions. This study examined age-related patterns of NNS consumption among adolescents and adults and evaluated how knowledge, attitudes, and sources of nutrition information interact to influence consumption practices. A cross-sectional study was conducted among 2769 adolescents (10-19 y) and adults (≥20 y) in southeast Nigeria. Data were collected using a structured questionnaire assessing sociodemographic characteristics, NNS-related knowledge, attitudinal beliefs, consumption practices, and information sources. Mediation and conditional process analyses evaluated whether attitudinal beliefs mediated the knowledge-practice relationship and whether this mediation varied by knowledge level, age group, and information source. Logistic regression identified predictors of high NNS consumption. Adolescents (83.1%) showed a significantly higher prevalence of NNS consumption than adults (16.9%) (P < 0.001). Results from the logistic regression revealed that being an adolescent was strongly associated with higher NNS consumption [adjusted odds ratio (AOR) = 19.45; 95% confidence intervals (CI): 15.43, -24.51]. Information sources from health professionals (AOR = 0.67; 95% CI: 0.47, -0.95) and the presence of underlying disease (AOR = 0.50; 95% CI: 0.31, -0.82) were significantly associated with lower consumption. Mediation analysis indicated that positive attitudes partially mediated the relationship between knowledge and consumption practice (indirect effect P < 0.05). NNS consumption patterns exhibited significant age-related variance and are shaped by a complex interplay between knowledge, belief-based attitudes, and the prevailing information environment. Public health nutrition interventions must evolve beyond traditional knowledge dissemination and adopt a multifaceted approach that addresses information quality, food environments, and age-targeted programs.
暂无摘要（点击查看详情）