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Item Recent-onset atrial fibrillation: challenges and opportunities(2025-08-28) Svennberg, Emma; Freedman, Ben; Andrade, Jason G; Anselmino, Matteo; Biton, Yitschak; Boriani, Giuseppe; Brandes, Axel; Buckley, Claire M; Cameron, Alan; Clua-Espuny, J L; Crijns, Harry J G M; Diederichsen, Søren Zöga; Doehner, Wolfram; Dominguez, Helena; Duncker, David; Fauchier, Laurent; Glotzer, Taya; Guo, Yutao (Sheila); Haeusler, Karl Georg; Haim, Moti; Healey, Jeff S; Hendriks, Jeroen M; Hills, Mellanie True; Hindricks, Gerhard; Hobbs, F D Richard; Johnson, Linda S; Joung, Boyoung; Kamel, Hooman; Kirchhof, Paulus; Lane, Deirdre A; Levin, Lars-Åke; Lip, Gregory Y H; Liu, Shaowen; Lobban, Trudie; Macfarlane, Peter W; Mairesse, Georges H; Marcus, Gregory M; Noseworthy, Peter A; Ntaios, George; Orchard, Jessica J; Passman, Rod; Reidpath, Daniel; Reiffel, James A; Ribeiro, Antonio Luiz; Rivard, Lena; Sanders, Prashanthan; Sandhu, Roopinder K; Schnabel, Renate B; Siontis, Konstantinos C; Sposato, Luciano A; Stavrakis, Stavros; Steinhubl, Steven R; Svendsen, Jesper H; Teh, Andrew W; Themistoclakis, Sakis; Tieleman, Robert G; Camm, A JohnAtrial fibrillation (AF) is increasingly diagnosed early, close to its first occurrence due to: (i) increased public awareness with self-screening; (ii) health care initiatives including population screening and opportunistic case finding; and (iii) increased use and surveillance of implantable cardiac devices. At its onset, AF is often low burden, and cardiovascular co-morbidities may be absent or at an early stage. Thus, the management of recent-onset AF has become an issue of growing importance. Professional guidelines have traditionally focused on anticoagulant thromboprophylaxis, generally recommending a cautious approach to rhythm control, and priority has been given to rate control to alleviate symptoms. In recent guidelines, the importance of managing lifestyle and co-morbidities has increased. The AF-SCREEN collaboration proposes that a vigorous approach to active management of recent-onset AF may be warranted. This includes addressing co-morbidities and promoting healthy lifestyles to prevent the emergence or progression of AF and associated cardiovascular disease, as well as the initiation of active rhythm control ± anticoagulation to prevent AF-related morbidity and mortality, including stroke and heart failure (HF). Intuitively, intervention early after AF onset would be beneficial since lifestyle and co-morbidity management, plus rhythm control and anticoagulation, are important contributors to improved outcomes in patients with established AF, but robust evidence is lacking for recent-onset AF. There is a delicate balance between achieving favourable outcomes such as preventing strokes, HF and AF progression vs the complications and potential adverse effects of interventions. Given the serious long-term consequences, innovative approaches are necessary to determine the value and risks of initiating active therapy very early in the course of AF. More data are needed to guide the best management of recent-onset AF, bearing AF burden in mind. Long-term studies using large national databases linked to electronic medical records and rhythm monitoring devices offer excellent opportunities. Shorter-term studies focusing on reducing AF burden to slow AF progression and studies focusing on outcomes such as HF could be used in both randomized clinical trials and observational cohort studies.Item Sexual and reproductive health (SRH) knowledge of women: a cross-sectional study among the women experienced abortion in urban slums, Dhaka, Bangladesh(BioMed Central, 2025-05-10) Billah, Md Arif; Koly, Kamrun Nahar; Begum, Farzana; Naima, Shakera; Sultana, Quazi Suraiya; Sarker, Tithi Rani; Mustary, Elvina; Haque, Md. Mahbubul; Reidpath, Daniel; Hanifi, Syed Manzoor AhmedBackground: Women in urban slums are particularly susceptible due to a lack of knowledge about sexual and reproductive health (SRH), and abortion is frequently performed. Our study investigates the level and predictors of SRH knowledge among the reproductive-aged women who have had abortions and lived in urban slums in Dhaka, Bangladesh. Methods: We adopted a cross-sectional survey among the reproductive-aged women who experienced any kind of abortion from July 2020 to January 2022 living in the UHDSS sites, applying a predefined interviewer-assisted survey questionnaire. Data were analyzed using descriptive statistics (i.e., mean, standard error, and 95% confidence interval (CI)) for continuous and percentage distribution for categorical variables. Bi-variate analysis was used to examine for associations. After checking the assumptions, multinomial regression analysis was used to confirm the determinants with 95% CIs. Results: A total of 338 women participated (221 spontaneous abortions and 117 induced abortions) with an average age of 26.59 ± 0.355, age at first marriage of 16.69 ± 0.173, and marital length of 9.45 ± 0.386. Except for the use of emergency contraceptives (32%), many women correctly identified condom effectiveness for preventing pregnancy (89%), STDs and HIV/AIDS prevention (79–80%), and abortion (98%). About 34 to 64% of them experienced stigmas attached to sexually explicit items. Few of them knew about abortion complications (9 to 57%), with the exception of bleeding associated with abortion (91.7%). Overall, 3 out of 4 women lacked sufficient SRH knowledge, with a mean score of 58.28 (95% CI: 56.70, 59.87), which was slightly higher for women who had spontaneous abortions 58.90 (95% CI: 57.02, 60.78) and lower for women who had induced abortions 57.69 (95% CI: 54.94, 60.45). Women aged 20–29 and 30 + years had high level of SRH knowledge than those of under 20 years. Women with higher education, longer marriages, and who availed post abortion care had high level of SRH knowledge than respective counterparts. However, employed slum women other than garment workers had lower levels of SRH knowledge than housewives. Conclusion: Our findings can be used in the abortion policies and strategies for vulnerable women and we recommend an intervention to increase awareness and knowledge on SRH, which is essential for those women to achieve the maternal reproductive health parameters.Item A comparison of health-related quality of life using the World Health Organization Quality of Life-BREF and 5-Level EuroQol-5 Dimensions in the Malaysian population.(2025-03-31) Liem, Andrian; Chih, Hui Jun; Velaithan, Vithya; Norman, Richard; Reidpath, Daniel; Su, Tin TinThis study aimed to describe and compare health-related quality of life (QoL) as measured by the World Health Organization Quality of Life-BREF (WHOQoL-BREF) and the EuroQol-5 Dimensions (EQ-5D) among the Malaysian population, examining differences by sociodemographic characteristics including age, income, sex, ethnicity, educational level, and occupation. This cross-sectional study used data from 19,402 individuals collected as part of a health and demographic surveillance system survey conducted in the Segamat district of Malaysia in 2018-2019. Descriptive statistics and measures of central tendency were produced. Differences in QoL among demographic sub-groups were examined using the t-test and analysis of variance, while the correlations between the WHOQoL-BREF and EQ-5D were evaluated using Pearson correlation coefficients. Based on complete case analysis (n=19,129), the average scores for the 4 WHOQoL-BREF domains were 28.2 (physical), 24.1 (psychological), 12.0 (social relationships), and 30.4 (environment). The percentages of participants not in full health for each EQ-5D dimension were 12.8% (mobility), 3.1% (self-care), 6.9% (usual activities), 20.9% (pain/discomfort), and 6.8% (anxiety/depression). Correlations between the 4 WHOQoL-BREF domains and the 5 EQ-5D dimensions were relatively weak, ranging from -0.06 (social relationships with self-care and pain/discomfort; p<0.001) to -0.42 (physical with mobility; p<0.001). Although health-related QoL as measured by the WHOQoL-BREF and the EQ-5D are correlated, these 2 measures should not be considered interchangeable. The choice between them should be guided by the specific research questions and the intended use of the data.Item P-2068. Assessing New York City’s COVID-19 Vaccine Rollout Strategy: A Case for Risk-Informed Distribution [Poster](Oxford University Press, 2025-01-29) Schwalbe, Nina; Nunes, Marta C; Cutland, Clare; Wahl, Brian; Reidpath, DanielBackground: This study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City (NYC). Methods: A retrospective ecological study was conducted assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and NYC Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in NYC. Population data were obtained from Census Bureau and NYC Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors. Results: Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8%; maximum coverage 67.9%) than wealthier areas (mean vaccination rate 74.6%; maximum coverage 99% in the wealthiest quintile) in the first 3 months of vaccine rollout and higher mortality over the year. Despite vaccine shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas (mean coverage rate 60% among those 45–64 years in the wealthiest quintile). Conclusion: A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower. Disclosures: All Authors: No reported disclosuresItem Users' Perceived Service Quality of National Telemedicine Services During the COVID-19 Pandemic in Bangladesh: Cross-Sectional Study.(2024-12-23) Khatun, Fatema; Das, Novel Chandra; Hoque, Md Rakibul; Saqeeb, Kazi Nazmus; Rahman, Monjur; Park, Kyung Ryul; Rasheed, Sabrina; Reidpath, DanielCOVID-19 created an opportunity for using teleconsultation as an alternative way of accessing expert medical advice. Bangladesh has seen a 20-fold increase in the use of teleconsultation during the pandemic. The aim of our study was to assess the influence of service quality and user satisfaction on the intention to use teleconsultation in the future among users of national teleconsultation services during the pandemic. A cross-sectional survey was conducted in 2020 among users of the national teleconsultation service-Shastho Batayon for acute respiratory infection. A validated mobile health service quality model based on structural equation modeling and confirmatory factor analysis was used to analyze the data with SmartPLS (version 3.0). Among the 2097 study participants, 1646 (78.5%) were male, 1416 (67.5%) were aged 18-39 years, 1588 (75.7%) were urban residents, 1348 (64.2%) had more than 10 years of schooling, and 1657 (79%) were from middle-income households. From a consumer perspective, the quality of the service platform (β=.946), service interaction (β=.974), and outcome (β=.955) contributed to service quality. Service quality was positively associated with user satisfaction (β=.327; P<.001) and intention to use teleconsultation services (β=.102; P<.001). User satisfaction was positively associated with the intention to use teleconsultation services (β=.311; P<.001). The increase in the use of teleconsultation during the pandemic indicated that such services were potentially used for emergencies. However, the future use of teleconsultation will be dependent on the quality of service and user satisfaction. Our findings are relevant for low-income contexts where teleconsultation services are used to address gaps in service delivery. [Abstract copyright: © Fatema Khatun, Novel Chandra Das, Md Rakibul Hoque, Kazi Nazmus Saqeeb, Monjur Rahman, Kyung Ryul Park, Sabrina Rasheed, Daniel D Reidpath. Originally published in JMIR Human Factors (https://humanfactors.jmir.org).]Item Multimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system study(BioMed Central, 2025-01-06) Tan, Michelle M. C.; Hanlon, Charlotte; Muniz-Terrera, Graciela; Benaglia, Tatiana; Ismail, Roshidi; Mohan, Devi; Konkoth, Ann Breeze Joseph; Reidpath, Daniel; Pinho, Pedro José M. Rebello; Allotey, Pascale; Kassim, Zaid; Prina, Matthew; Su, Tin TinBackground: We aimed to identify specific multimorbidity latent classes among multi-ethnic community-dwelling adults aged ≥ 18 years in Malaysia. We further explored the risk factors associated with these patterns and examined the relationships between the multimorbidity patterns and 11-year all-cause mortality risk, as well as health-related quality of life (HRQoL). Methods: Using data from 18,101 individuals (aged 18–97 years) from the baseline Census 2012, Health Round 2013, and Verbal Autopsies 2012–2023 of the South East Asia Community Observatory (SEACO) health and demographic surveillance system, latent class analysis was performed on 13 chronic health conditions to identify statistically and clinically meaningful groups. Multinomial logistic regression and Cox proportional hazards regression models were conducted to investigate the adjusted association of multimorbidity patterns with the risk factors and mortality, respectively. HRQoL was analyzed by linear contrasts in conjunction with ANCOVA adjusted for baseline confounders. Results: Four distinct multimorbidity latent classes were identified: (1) relatively healthy (n = 10,640); (2) cardiometabolic diseases (n = 2428); (3) musculoskeletal, mobility and sensory disorders (n = 2391); and (4) complex multimorbidity (a group with more severe multimorbidity with combined profiles of classes 2 and 3) (n = 699). Significant variations in associations between socio-demographic characteristics and multimorbidity patterns were discovered, including age, sex, ethnicity, education level, marital status, household monthly income and employment status. The complex multimorbidity group had the lowest HRQoL across all domains compared to other groups (p < 0.001), including physical health, psychological, social relationships and environment. This group also exhibited the highest mortality risk over 11 years even after adjustment of confounders (age, sex, ethnicity, education and employment status), with a hazard of death of 1.83 (95% CI 1.44–2.33), followed by the cardiometabolic group (HR 1.42, 95% CI 1.18–1.70) and the musculoskeletal, mobility and sensory disorders group (HR 1.29, 95% CI 1.04–1.59). Conclusions: Our study advances the understanding of the complexity of multimorbidity and its implications for health outcomes and healthcare delivery. The findings suggest the need for integrated healthcare approaches that account for the clusters of multiple conditions and prioritize the complex multimorbidity cohort. Further longitudinal studies are warranted to explore the underlying mechanisms and evolution of multimorbidity patterns.Item Assessment of socioeconomic and health vulnerability among urban slum dwellers in Bangladesh: a cross-sectional study(BioMed Central, 2024-10-24) Hasan, Md Zahid; Rabbani, Md Golam; Ahmed, Mohammad Wahid; Mehdi, Gazi Golam; Tisha, Khadija Islam; Reidpath, Daniel; Hanifi, Syed Manzoor Ahmed; Mahmood, Shehrin ShailaBackground: Bangladesh is rapidly urbanizing and approximately half of its urban population resides in deprived slums with limited access to basic needs. However, there is a dearth of information on vulnerability levels among slum dwellers. We aimed to assess the level of vulnerability within and between slums via various socioeconomic and health indicators. Methods: A cross-sectional survey of 810 randomly selected households was conducted in two purposively selected slums, Korail and Shyampur, in Dhaka from November to December 2021. Data was collected on various indicators, including demographics, education, employment, access to utility, and healthcare services. Principal component factor analysis was employed to identify the key indicators to construct the socioeconomic and health vulnerability index for the urban slums of Bangladesh (SEHVI-BD). Kaiser-Meyer-Olkin, Bartlett’s test, and Cronbach’s alpha coefficient test were used to assess indicators’ suitability. The selected indicators were used to generate an index on a scale of 100, with a higher index value indicating a higher level of vulnerability. The estimated scores were used to categorize the vulnerability status into three levels: mild, moderate, and severe vulnerability. The Mann-Whitney-U test and Kruskal-Wallis test were applied between the generated index and other socioeconomic variables to validate the relationship. Results: A total of 27 socioeconomic and health indicators were identified that explained 60% of the variance. The indicators were then grouped into six domains on the basis of their relevance. The prevalence of severe vulnerability in the Korail slum was approximately 9% and moderate vulnerability was 30% whereas these values were approximately 58% and 37%, respectively, in the Shyampur slum. The difference in the vulnerability level between the two slums was also evident across the domains. Households in the poorest wealth quintile, with lower education levels of household heads, and having irregular income experienced higher levels of vulnerability. Conclusions: The SEHVI-BD offers a critical tool for policymakers to identify and address vulnerabilities, facilitating more targeted public health interventions in urban Bangladesh and similar low-income settings. This study further emphasizes the importance of integrating comprehensive vulnerability assessments into public health policies to reduce inequalities and improve well-being, especially for the urban marginalized slum population.Item Knowledge of gendered needs among the planners and policy makers for prevention of NCDs in Bangladesh: a qualitative exploration(BioMed Central, 2024-05-27) Akhter, Sadika; Kamruzzaman, Mohammed; Anwar, Iqbal; Banu, Mahmud Shaila; Reidpath, Daniel; Cameron, Adrian JBackground: Globally, non-communicable diseases (NCDs) are increasingly the primary cause of mortality and morbidity among women. Like many developing countries, Bangladesh also faces a growing burden of NCDs. The “Multisectoral Action Plan for Prevention and Control of Non-communicable Diseases, 2018–2025” signifies Bangladesh’s commitment to comprehensively combating the rising burden of NCDs. This study investigates the perceptions of those involved in developing the action plan and if/how a gender lens was incorporated into its implementation. Methods: In-depth interviews were conducted with 25 key individuals involved in a high-level committee to develop and implement Bangladesh’s multisectoral action plan to address the burden of NCDs. Data were collected between July and November 2021, and thematic analysis was conducted. Results: The findings revealed that interviewees believed the multisectoral action plan adopted a population-wide approach without considering gender-specific needs. This study presents the explanations for this inattention under five themes: (1) A population-level approach to NCD prevention; (2) Understanding women’s health beyond reproductive health; (3) Absence of gender-specific programs; (4) Lack of consideration of gender constraints on physical activity; and (5) Lack of collaborative efforts to address NCDs beyond the health ministry. Conclusion: In conclusion, governments in countries like Bangladesh can develop more effective strategies to reduce the disease burden of NCDs among women by recognizing and addressing the gendered nature of preventive health. This can be achieved by promoting gender-responsive research, programs, and policy initiatives that consider women’s specific health concerns, ultimately leading to better health outcomes for all.Item Predicting higher child BMI z-score and obesity incidence in Malaysia: a longitudinal analysis of a dynamic cohort study(BioMed Central, 2024-05-27) Salway, Ruth; Armstrong, Miranda; Mariapun, Jeevitha; Reidpath, Daniel; Brady, Sophia; Yasin, Mohamed Shajahan; Su, Tin Tin; Johnson, LauraBackground: To target public health obesity prevention, we need to predict who might become obese i.e. predictors of increasing Body Mass Index (BMI) or obesity incidence. Predictors of incidence may be distinct from more well-studied predictors of prevalence, therefore we explored parent, child and sociodemographic predictors of child/adolescent BMI z-score and obesity incidence over 5 years in Malaysia. Methods: The South East Asia Community Observatory in Segamat, Malaysia, provided longitudinal data on children and their parents (n = 1767). Children were aged 6–14 years at baseline (2013-14) and followed up 5 years later. Linear multilevel models estimated associations with child BMI z-score at follow-up, adjusting for baseline BMI z-score and potential confounders. Predictors included parent cardiometabolic health (overweight/obesity, central obesity, hypertension, hyperglycaemia), and socio-demographics (ethnicity, employment, education). Logistic multilevel models explored predictors of obesity incidence. Results: Higher baseline BMI z-score predicted higher follow-up BMI z-score both in childhood to late adolescence (0.60; 95% CI: 0.55, 0.65) and early to late adolescence (0.76; 95% CI: 0.70, 0.82). There was inconsistent evidence of association between child BMI z-score at follow-up with parent cardiometabolic risk factors independent of baseline child BMI z-score. For example, maternal obesity, but not overweight, predicted a higher BMI z-score in childhood to early adolescence (overweight: 0.16; 95% CI: -0.03, 0.36, obesity: 0.41; 95% CI: 0.20, 0.61), and paternal overweight, but not obesity, predicted a higher BMI z-score in early to late adolescence (overweight: 0.22; 95% CI: 0.01, 0.43, obesity: 0.16; 95% CI: -0.10, 0.41). Parental obesity consistently predicted five-year obesity incidence in early to late adolescence, but not childhood to early adolescence. An adolescent without obesity at baseline with parents with obesity, had 3–4 times greater odds of developing obesity during follow-up (incidence OR = 3.38 (95% CI: 1.14–9.98, mother) and OR = 4.37 (95% CI 1.34–14.27, father) respectively). Conclusions: Having a higher BMI z-score at baseline was a stronger predictor of a higher BMI z-score at follow-up than any parental or sociodemographic factor. Targeting prevention efforts based on parent or sociodemographic factors is unwarranted but early childhood remains a key period for universal obesity prevention.Item Assessing Sodium Intake in Middle-Aged and Older Adults with Elevated Blood Pressure: Validation of Spot Urine Excretion and Dietary Survey-Derived Estimates(MDPI AG, 2024-05-13) Soh, Yee Chang; Fairley, Andrea; Alawad, Mawada; Lee, Siew Siew; Su, Tin Tin; Stephan, Blossom Christa Maree; Reidpath, Daniel; Robinson, Louise; Yasin, Shajahan; Siervo, Mario; Mohan, DeviThis cross-sectional study evaluated the validity of three alternative methods compared to the gold standard 24-h urine collection for estimating dietary sodium intake, a modifiable risk factor for hypertension, among middle-aged and older adults with elevated blood pressure. These included spot urine collection (using Kawasaki, Tanaka, and INTERSALT equations), 24-h dietary recall, and food frequency questionnaire responses, compared to 24-h urine collection in a subset of 65 participants (aged 50–75 years, 58.5% women, 61.6% hypertensive) from the DePEC-Nutrition trial. The validity of the methods was assessed using bias, the Spearman correlation coefficient (SCC), the intraclass correlation coefficient (ICC), and Bland–Altman analysis. Among the alternative methods, spot urine collection using the Kawasaki equation showed the strongest correlation (SCC 0.238; ICC 0.119, 95% CI −0.079 to 0.323), but it exhibited a significant bias (1414 mg/day, p-value < 0.001) relative to 24-h urine collection. Conversely, dietary surveys had a smaller bias but wider limits of agreement. These findings underscore the complexities of accurately estimating dietary sodium intake using spot urine collection or dietary surveys in this specific population, suggesting that a combination or the refinement of existing methodologies might improve accuracy. Further research with larger samples is necessary to develop more reliable methods for assessing sodium intake in this high-risk group.