Diet quality is a modifiable determinant of healthy aging, potentially influencing physical and cognitive functioning through inflammatory and metabolic pathways. Although healthier dietary patterns have been linked to reduced frailty and cognitive decline, findings remain inconsistent. The interrelationships among diet quality, physical frailty, and incident cognitive impairment, including potential modification by specific dietary components, remain poorly understood. We analyzed 1,636 cognitively normal participants in 2016 from the Health and Retirement Study, a longitudinal study of adults in the United States (U.S.), with diet assessed in 2013, frailty in 2016, and cognitive follow-up through 2022. Cognitive impairment was assessed with cognitive tests and used the Langa–Weir classification; diet quality was measured using the Healthy Eating Index–2015 (HEI-2015); and physical frailty used a modified Fried phenotype. Survey-weighted regression, Cox models, four-way decomposition, competing-risk and multistate models, and additive Bayesian network (ABN)–informed generalized structural equation models (GSEM) were applied. Higher HEI-2015 scores were associated with lower frailty (β = −0.13, P < 0.001), but not with incident cognitive impairment. Frailty was associated with higher cognitive risk in minimally adjusted models (Hazard Ratio (HR) = 2.27, 95
Financial incentives and nudges are increasingly used to promote preventive activities, but little is known about individuals’ preferences for their design characteristics or how these characteristics are valued relative to other components of preventive interventions. We conducted a systematic review of discrete choice experiments (DCEs) examining preferences for financial incentives and nudges in health promotion and disease prevention. We searched PubMed, Web of Science, and Scopus for DCEs published between January 2000 and May 2025 and conducted in upper-middle- and high-income countries. Eligible studies examined health-promotion or disease prevention interventions and included at least one financial incentive- or nudge-related attribute. Data were extracted at the DCE level, adherence to methodologically good research practices was assessed using the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) checklist. We tabulated attribute frequencies and how often attributes ranked first by behavioral target. Relative attribute importance was extracted or calculated as each attribute’s range of level coefficients divided by the sum of attribute ranges within each DCE. Pairwise comparison matrices summarized the proportion of within-DCE comparisons in which financial incentive or nudge attributes outranked other attributes. Fifty-two studies, corresponding to 64 DCEs, were included. Financial incentive attributes accounted for 91 of the 300 identified attributes (30
Low- and middle-income countries (LMICs) face a growing burden of cardiovascular disease (CVD) that is not fully explained by traditional risk factors like hypertension. Anemia is highly prevalent in LMICs and may be an important non-traditional CVD risk factor. We evaluated the association between anemia and preclinical CVD, including left ventricular hypertrophy (LVH) and other echocardiographic measures, in two diverse LMIC settings. This was a cross-sectional analysis of data from two separate cohorts of adults in Mwanza, Tanzania (n = 999; data collected 2022–2023) and Port-au-Prince, Haiti (n = 3,005; data collected 2019–2021). Participants underwent clinical examinations, laboratory testing, and echocardiography. Models assessing the relationship between anemia and echocardiographic outcomes were adjusted for age, sex, HIV status, blood pressure, and body mass index. Anemia prevalence was 23
Impact assessment surveys (IAS) are central to monitoring and evaluating the effectiveness of mass drug administration (MDA) programs targeting soil-transmitted helminths (STH). Current survey designs often follow guidelines that lack flexibility and spatial representativeness. There is a need for more efficient and context-adaptable methodologies that can guide programmatic decision-making using available data. We developed a three-step geostatistical framework for optimal IAS design that integrates baseline prevalence data, environmental covariates, and treatment history. A geostatistical model is used to estimate baseline prevalence. A Markov model, coupled with a local spatial thinning algorithm, is then applied to forecast post-MDA prevalence surfaces. These projections guide the simulation and evaluation of candidate survey designs across different sampling intensities and spatial configurations. Design performance was assessed based on classification accuracy and survey cost. The methodology was applied to datasets from Kenya, Sierra Leone, and Zimbabwe. Compared to conventional survey designs, our model-based approach achieved similar classification accuracy with 60–90
The promotion of brain health has generally been undertaken at the level of individuals, for instance, in the quest for precision treatments for persons with, or at high risk of, neurological disorders. But the growing global burden of neurological conditions and the increasing understanding of the brain’s central role in all facets of human life have spurred interest in public health approaches to the brain that emphasise population-level strategies benefitting everyone as part of a “brain health for all” vision of society. This article defines the emerging concept of public brain health as intersectoral action to establish brain health priorities, empower communities, and reduce health inequities, with the ultimate goal of improving brain health at the population level across the lifetime. We propose a framework to promote and safeguard population brain health with the following key elements: co-defining priorities with communities, balancing prevention strategies, and reducing global gaps in brain health through ambitious policy-making. Public brain health calls for collective responsibility to maximise brain health equity across the life course.
