A higher dietary diversity score (DDS) and a lower energy-adjusted dietary inflammatory index (E-DII) may be associated with lower risks of type 2 diabetes (T2D) and mortality. This cohort study aimed to investigate the associations of DDS and E-DII with all-cause mortality, incidence of T2D, and mortality of T2D, as well as the joint effects of these two dietary factors. A total of 181,360 participants without all types of diabetes at baseline from the UK Biobank and 42,139 participants from the US NHANES were included. Cox proportional hazards models were used to assess the associations of DDS and E-DII with outcomes. In the UK Biobank data, 8338 deaths, 3416 incident T2D cases, and 353 T2D deaths occurred during a median follow-up of 12.5 years. In the US NHANES data, 6803 all-cause deaths and 248 T2D-specific deaths were recorded during a median follow-up of 9.6 years. We observed that higher DDS and lower E-DII were significantly associated with lower risks of total mortality and incident T2D. Compared with low DDS, the hazard ratios (HRs) and 95% confidence intervals (CIs) of high DDS were 0.69 (0.64, 0.74) for all-cause mortality, 0.79 (0.70, 0.88) for incident T2D in the UK Biobank, and 0.69 (0.61, 0.78) for all-cause mortality in the US NHANES. Compared with participants in tertile 3 of E-DII, those in tertile 1 had a lower risk of overall death [HR 0.86 (95% CI: 0.81, 0.91) in UK Biobank; 0.83 (0.77, 0.88) in US NHANES] and incident T2D [0.86 (0.79, 0.94)] in UK Biobank. No evidence was observed of the interactive effects of DDS and E-DII on either all-cause mortality or the incidence and mortality of T2D. There was no significant association found between any exposure and T2D mortality in this study. In conclusion, our results revealed that higher DDS and lower E-DII were associated with both total mortality and incident T2D in UK and US adults.

Research regarding the interaction of ambient air pollution and overweight on prehypertension is scarce. We aimed to test whether overweight modifies the association between long-term exposure to ambient air pollution and prehypertension in Chinese adults. A total of 16,188 Chinese adults, aged 18–74 years old, from 33 communities in 3 Northeastern Chinese cities were evaluated. Three-year average levels of particles with an aerodynamic diameter ≤ 10 μm (PM10), sulfur dioxides (SO2), nitrogen dioxides (NO2), and ozone (O3) were calculated at monitoring stations. Generalized additive models and 2-level regression analyses were applied. We observed significant interactions between air pollutants and overweight on prehypertension and blood pressure. The associations of PM10, SO2, NO2, and O3 with prehypertension were significant among overweight participants (Prevalence Rate Ratios (PRRs) per interquartile range (IQR) of air pollutants: 1.14–1.20), but not among normal weight participants (PRRs: 0.98–1.04). PM10, SO2, and O3 were significantly associated with systolic blood pressure (SBP), and the magnitudes of these associations were higher among overweight adults (increases in SBP per IQR of air pollutants: 1.82–4.53 mmHg) than those among normal weight adults (increases in SBP: 0.42–0.61 mmHg). For diastolic blood pressure (DBP), significant associations were mainly observed in overweight participants (increases in DBP: 0.80–1.63 mmHg). Further stratified analyses showed that all these interactions were stronger in women, the older, and participants living in areas with lower income levels or higher population density. Being overweight may enhance the effects of ambient air pollution on prehypertension and blood pressure in Chinese adults.

Background: Value-based healthcare (VBHC), which can be viewed as a strategy to organize and improve healthcare services, has far-reaching organizational and managerial consequences. It is common managerial practice to support the execution of a strategy by monitoring the ensuing activities. Such monitoring provides feedback and guidance on the execution of these activities to the management of an organization and helps to realize organizational strategies. Monitoring of activities is commonly done by performance management systems. Given the rising attention in the literature and in practice for VBHC, we ask to what extent VBHC is supported by performance management systems in practice, and how we can explain what we find to support further successful implementation of VBHC. Methods: In our scoping review of financial and performance management at the organization or unit-level of healthcare organizations that apply value-based approaches, we identified 1267 unique papers in Embase, Medline, OVID, and Web of Science. After the (double-blinded) title and abstract screening, 398 full-text articles were assessed for further analysis. Results: Our review reveals only eleven original papers discussing specifically the integration of VBHC and performance management systems. Almost all the featured applications in these papers focus on a specific project or medical specialty. Only one paper exemplifies how VBHC has been integrated with the performance management systems of a medical institution, and no paper provides a clear link with strategy execution. We ask why this is the case and propose several explanations by studying the extant performance management literature. We see these explanations as issues for further reflection for VBHC practitioners and researchers. Conclusion: We conclude that one of the reasons for the absence of papers integrating VBHC and performance management systems is formed by the tensions that exist between striving for "the best care" or even for providing "all care that is viably possible" and pursuing greater (financial) efficiency. Implementing VBHC as an important organizational strategy and explicating this strategy in the performance management systems requires that these tensions need to be brought into the fore. When this is not done, we believe that VBHC adoptions that are fully integrated with performance management systems will remain limited in practice.