Universidad de Almería

Therapeutic nucleic acids (TNAs) are gaining increasing interest in the treatment of severe diseases including viral infections, inherited disorders, and cancers. However, the efficacy of intracellularly functioning TNAs is also reliant upon their delivery into the cellular environment, as unmodified nucleic acids are unable to cross the cell membrane mainly due to charge repulsion. Here we show that TNAs can be effectively delivered into the cellular environment using engineered nanoscale metal-organic frameworks (nanoMOFs), with the additional ability to tailor which cells receive the therapeutic cargo determined by the functional moieties grafted onto the nanoMOF's surface. This study paves the way to integrate the highly ordered programmable nucleic acids into larger-scale functionalized nanoassemblies.

This research paper aims to demonstrate that relationships play a pivotal role in fostering inter-organizational cooperation, both at the corporate and individual levels, within the fast-moving consumer goods (FMCG) distribution industry. Despite the extensive body of literature on relationship management, its impact on such a unique and important channel as FMCG remains undetermined. To achieve this objective, we designed a questionnaire for a survey targeting Spanish FMCG distributors, from which we collected 204 responses. We analyzed this data using partial least squares structural equation modeling (PLS-SEM), an emerging methodology in business research that enables us to assess the model's explanatory power and predictive capacity in understanding the relationships between various constructs. Our findings indicate the efficacy of governing inter-organizational relationships to facilitate cooperation. Additionally, we uncover links between corporate and individual relationships that contribute significantly to cooperation. In terms of practical implications for businesses, our results emphasize the importance for managers to prioritize relationships as an integral aspect of efficient channel management. This pertains to relationships within the distribution channel among partners and also individual relationships among business managers. Notably, the existing academic literature has not yet established the effectiveness of relationships in governing channels within the FMCG marketing channel, nor has it established a direct connection between inter-organizational and individual relationships among business managers. 7512

Food security depends on the implementation of sustainable development in agri-food. It is essential to determine the sustainability of the main production systems in order to establish specific measures for each territory, by virtue of correcting their negative externalities and improving the commitment of stakeholders. Therefore, this article assessed the economic, social, environmental and global sustainability of the Spanish primary sector based on a synthetic indicator proposed in previous research. The results suggest the existence of a moderate degree of sustainability of the food production system in Spain (0.5019), with the regions of Arag on (0.5482), Castile and Leon (0.5473), Extremadura (0.5438) and Andalucía (0.5399) standing out. An inverse relationship between the economic and the environmental subcomponents of sustainability was obtained. The cluster analysis revealed the need to apply a customized territorial policy in order to meet sustainability goals due to the diversity of agricultural subsectors identified in them. K E Y W O R D S agriculture, circular economy, stockbreeding, sustainability indicators, sustainable development

Background Health professionals witness pain and suffering when they care for sick people and their families. Compassion is a necessary quality in their work as it combines the will to help, alleviate suffering and promote the well‐being of both the people they are attending and the professionals themselves. The aim of the study was to design and evaluate the psychometric properties of the Capacity for Compassion Scale (CCS). Design A quantitative, descriptive and cross‐sectional study was carried out to evaluate the psychometric properties of the scale (reliability, temporal stability, content validity, criterion validity and construct validity). Methods The study was carried out in two phases: pilot study and final validation. The data were collected between April and May 2022. The sample was selected by convenience sampling and was made up of a total of 264 participants, 59 in the pilot phase and 205 in the final validation. Results The Capacity for Compassion Scale has been shown to have good psychometric properties in relation to reliability, temporal stability, and content, criterion, and construct validity. Factor analysis showed that there were four subdimensions of the scale: motivation/commitment, presence, shared humanity and self‐compassion. The results also indicate that compassionate ability is significantly correlated with age and work experience. Conclusions The Capacity for Compassion Scale shows adequate psychometric properties. This instrument measures the compassion capacity of health professionals, which is a valuable discovery for new lines of research in this field. Impact Through this scale, low levels of capacity for compassion can be detected that negatively influence the quality of care provided by health professionals. The Capacity for Compassion Scale can therefore contribute to the identification of needs and promote training around compassion for health professionals. Patient or Public Contribution No patient or public contribution. What Problem did the Study Address? Compassion in health professionals has positive effects on improving the quality of care, the satisfaction of professionals and the work environment. There are compassion cultivation programmes whose validity has been proven for the development of the dimensions of compassion. There is no specific instrument that measures capacity for compassion in healthcare professionals. What were the Main Findings? A scale is designed to measure capacity for compassion in health professionals. This is the only such scale available up until now. The scale measures four dimensions of compassion: motivation/commitment, presence, shared humanity and self‐compassion. Where and on Whom will the Research Have an Impact? The development of specific programmes that can increase the compassion of health professionals with all the benefits that this can bring to health care is encouraged. It will be possible to analyse the effects of training programmes on the cultivation of compassion.

Developing a medical device or solution involves gathering biomedical data from different devices, which can have different communication protocols, characteristics and limitations. Thus, deploying a test lab to record experiments can be challenging, requiring the synchronisation of the source signals, processing of the information, storing it and extracting conclusions. In this work, we face this problem by developing an edge Internet of Things (IoT) system composed of a Raspberry Pi and an NVIDIA Jetson TX2 device (integrating an NVIDIA Pascal GPU). The information from two biomedical devices (Biosignals Plux and Polar Verity Sense) is synchronised and fused, interpolating the information and extracting features such as mean and standard deviation in real-time. In parallel, the Jetson TX2 device is able to execute a Deep Learning (DL) model in real-time as new data is received using the Message Queuing Telemetry Transport (MQTT) protocol. Also, an online learning approach involving a loss function that takes into account past predictions is proposed, as well as a density-based clustering algorithm that selects the most representative samples of the most repeated class. The system has been deployed in the Smart Home of the University of Almería. Results show that the proposed fusion scheme accuracy represents the intrinsic information of the received data and enables the DL model to run in real time. The next steps involve the deployment of the system in a hospital, in order to monitor epilepsy patients, create a robust dataset and detect epileptic seizures in real-time.

Development of composite indicators is a challenging task given that sustainability indices are strongly dependent on how the sub-indicators are weighted. This is because relative indicator weights may significantly differ based on the chosen weighting methods used in the analysis. There is hardly any study that has paid attention to this issue so far. Therefore, this paper aims to fill this gap in the literature by searching the robustness of selected weighting methods, i.e. entropy-weight (EW), principal component analysis (PCA), machine learning approaches (random forest-RF), regression analysis (RA) and benefit-of-the-doubt (BOD) when constructing a composite indicator. To research the current sustainability performance of European regions, the present study focuses on the Territorial Quality of Life Index—initially proposed by the ESPON Programme—that are aligned with the specific targets of the Sustainable Development Goals of the 2030 Agenda. The methods to construct composite indicators include stages of data preparation (including the estimation of missing values with random forest method), normalization, statistical transformation of raw data, reduction of indicators in order to ease public communication (using the PCA method) and data interpretation, weighting of the sub-indicators using EW, PCA, RF, RA and BOD methods and their linear weighted aggregation, and checking for robustness and sensitivity. The results suggest that there are significant differences in the rank and spatial distribution of composite indicators based on the use of different weighting methods considered in the analysis. The results from sensitivity analysis support the robustness of entropy-weight method among others. The methodology used in the current analysis can be adapted to other study areas and regions internationally. The findings showed that Eastern European countries and some Mediterranean countries have relatively lower index values compared to other European regions; therefore, policy and planning actions are needed covering these regions specifically.

The treatment and utilization of cheese whey (W) represents one of the major challenges facing the dairy industry. In this work the production of Chlorella vulgaris and its potential use in recovering the main nutrients (N, P and C) from cheese whey was evaluated in batch and continuous mode. Four different treatments were evaluated: Fertilizers-control (100% freshwater plus chemical fertilizers); Fertilizers-2.5%W (v/v), Fertilizers-5%W (v/v) and Fertilizers-10%W (v/v). The biomass productivity was affected by the percentage of cheese whey added, resulting in a 2.8-fold increase when adding 10% cheese whey to the culture medium. In addition, the cheese whey concentration in the culture medium also affected the overall macromolecular composition of the biomass along with the appearance and growth of aerobic mesophilic bacteria. Despite the high concentration of organic matter in the cheese whey (COD, 60.000 mg L⁻¹), C.vulgaris was able to recover more than 80% of COD in continuous mode, along with 94 % and 60% of TN and TP, respectively. These promising results can be explained by the mixotrophic activity of C.vulgaris, which was demonstrated by the decrease in the chlorophyll content when cheese whey was added to the culture medium and by photo-respirometric assays. The use of cheese whey for microalgal biomass production represents a sustainable alternative to revaluate this by-product stream and contribute to the circular economy.

The tautomerism of a series of 5-alkyl substituted 3-(2-pyridyl)-1,2,4-triazoles in DMSO-d6-containing water has been investigated by 1H, 13C and 15N NMR spectroscopy. The populations of the three possible regioisomers in the tautomeric equilibrium (A [3-alkyl-5-(2-pyridyl)-1H], B [5-alkyl-3-(2-pyridyl)-1H] and C [5-alkyl-3-(2-pyridyl)-4H]) were determined. Isomers A (17-40%) and B (54-79%) are the major components and their ratio is insensitive to the substitution pattern, except for the unsubstituted and the methoxymethyl substituted derivatives. The isomer C (3-5%) has been fully characterised for the first time by NMR spectroscopy. Activation energies of tautomerisation (14.74-16.78 kcal mol-1) were determined by EXSY experiments, which also supported the involvement of water in the tautomerisation. Substituent effects on the 15N chemical shifts are relatively small. The DFT study of the tautomerism in DMSO-water showed that both A/B and B/C interconversions are assisted by the pyridine substituent and catalysed by solvent molecules. The NH-A/NH-B tautomerisation takes place via a relayed quadruple proton transfer mediated by three water molecules in the hydrogen-bonded cyclic substructure of a triazole·4H2O complex. The equilibrium B ⇄ C involves three steps: NH-B transfer to the pyridyl nitrogen mediated by a water molecule in a 1 : 1 cyclic complex, rotamerisation to bring the pyridinium NH close to N4 of the triazole catalysed by complexation to a DMSO molecule and transfer of the NH from the pyridinium donor to the N4 acceptor via a 1 : 1 complex with a bridging water molecule. This mechanism of 1,3-prototropic shift in triazoles is unprecedented in the literature.

Objectives: Fatigue is prevalent in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and recognised as one of the most challenging symptoms to manage. The existence of multiple factors associated with driving and maintaining fatigue, and the evidence about what improves fatigue has led to a multifaceted approach to its management. However, there are no recommendations for fatigue management in people with I-RMDs. This lack of guidance is challenging for those living with fatigue and health professionals delivering clinical care. Therefore, our aim was to develop EULAR recommendations for the management of fatigue in people with I-RMDs. Methods: A multidisciplinary taskforce comprising 26 members from 14 European countries was convened, and two systematic reviews were conducted. The taskforce developed the recommendations based on the systematic review of evidence supplemented with taskforce members’ experience of fatigue in I-RMDs. Results: Four overarching principles (OAPs) and four recommendations were developed. OAPs include health professionals’ awareness that fatigue encompasses multiple biological, psychological and social factors which should inform clinical care. Fatigue should be monitored and assessed, and people with I-RMDs should be offered management options. Recommendations include offering tailored physical activity and/or tailored psychoeducational interventions and/or, if clinically indicated, immunomodulatory treatment initiation or change. Patient-centred fatigue management should consider the individual’s needs and preferences, their clinical disease activity, comorbidities and other psychosocial and contextual factors through shared decision-making. Conclusions: These 2023 EULAR recommendations provide consensus and up-to-date guidance on fatigue management in people with I-RMDs.

The relationship between multiple sclerosis (MS) and females is a crucial aspect in the development of the disease, with the ovarian hormonal cycle being a sensitive stage, especially in females with relapsing-remitting multiple sclerosis. The objectives of the study are to identify moderating variables that modify satisfaction with physical activity practice throughout the menstrual cycle (MC) in females in or out of their MC, during high-intensity interval training (HIIT) and strength training sessions and to compare the acute effects of different types of physical activity sessions in females with and without MS. This protocol is the methodology used in the EMMA Study, a randomised, single-blind crossover trial study conducted in females with MS who were matched 1:1, based on age, lifestyle factors and country of residence, with females without MS, to analyse the effect of physical activity practice on satisfaction, functionality, fatigue and inflammatory profile through their MC. Participants will visit the facilities approximately 10 times (4 preliminary familiarisation visits and 6 visits to carry out a physical activity session in each phase of the MC) for 3–4 months. A total sample of 30 females (15 females without MS and 15 with MS) is necessary for the study. The evaluation will comprise clinical, nutritional and psychological interviews, including different variables. It is hypothesised during the luteal phase, females with MS are expected to exhibit different acute responses to HIIT and strength training sessions as compared with females without the disease. Before starting the study, all participants will read and sign an informed consent form. Trial registration number: This research protocol is registered with ClinicalTrials.gov to ensure transparency and accessibility of study information ( NCT06105463 ). The university’s ethics committee number for this study is UALBIO2022/048.

The stearoyl‐ACP desaturase (SACPD) is a key enzyme in the regulation of saturated to unsaturated fatty acid ratio, playing a crucial role in regulating membrane stability and fluidity, as well as photosynthesis efficiency, which makes it an important research focus in crop species. This study reports the characterization and molecular cloning of pale dwarf ( pad ), a new tomato ( Solanum lycopersicum L.) T‐DNA recessive mutant, which exhibits a dwarf and chlorotic phenotype. Functional studies of the T‐DNA tagged gene were conducted, including phylogenetic analysis, expression and metabolomic analyses, and generation of CRISPR/Cas9 knockout lines. The cloning of T‐DNA flanking genomic sequences and a co‐segregation analysis found the pad phenotype was caused by a T‐DNA insertion disrupting the tomato homologue of the Arabidopsis SUPPRESSOR OF SALICYLIC ACID INSENSITIVITY 2 ( SlSSI2 ), encoding a plastid localized isoform of SACPD. The phenotype of CRISPR/Cas9 SlSSI2 knockout lines confirmed that the morphological abnormalities in pad plants were due to SlSSI2 loss of function. Functional, metabolomic and expression analyses proved that SlSSI2 disruption causes deficiencies in 18:1 fatty acid desaturation and leads to diminished jasmonic acid (JA) content and increased salicylic acid (SA) levels. Overall, these results proved that SSI2 plays a crucial role in the regulation of polyunsaturated fatty acid profiles in tomato, and revealed that SlSSI2 loss of function results in an inhibited JA‐responsive signalling pathway and a constitutively activated SA‐mediated defence signalling response. This study lays the foundation for further research on tomato SACPDs and their role in plant performance and fitness.

Microplastics (MPs) are a significant threat to soils. However, there is scarce information on the impact of MPs on soil properties, particularly in volcanic ash‐derived soils. The objective of this study was to evaluate the impact of polyamide (PA) and low‐density polyethylene (LDPE) MPs on the biological and chemical characteristics of an Andisol from central Chile. Twenty‐one parameters were evaluated, including pH, electrical conductivity (EC), total organic carbon (TOC), dissolved organic carbon (DOC), total phosphorus (TP), available phosphorous (AP), available nitrogen (AN), inorganic nitrogen forms (NH 4 ⁺ , NO 2 ‐ , and NO 3 ), carbohydrates (CHO), polyphenols (POL), humic substances, soil basal respiration (SBR), and activities of soil enzymes such as dehydrogenase, β‐glucosidase, phosphatase, and urease. For this, a microcosm was set up in clay pots in an incubation chamber at 21°C and 60% soil moisture, with the addition of PA and LDPE at doses of 1 % and 3 % w/w; a control treatment consisting of microcosm without MPs was also included. After six weeks of incubation, PA addition resulted in an increase in TOC and NH 4 ⁺ by up to 32% and 26%, respectively, and a decrease in NO 3 ‐ by 22%. AP decreased by 15% ‐ 19% with the addition of PA and LDPE. Similarly, acid phosphatase and β‐glucosidase activities decreased by 15% and 26% with PA and LDPE, respectively. The distance‐based linear model (DistLM) was used to analyze relationships in chemical and biological datasets. The analysis revealed that TOC and TP were primary components in the best model for predicting microbiological changes (R ² = 0.469, AICs = 16.026), indicating that MPs accumulation affects soil carbon cycling and P content. Overall, the results show that MPs addition alters soil chemical and microbiological properties in Andisols, with varying effects depending on the type and dose of MPs, with the highest dose (3%) producing the most marked negative effects.

(1) Background: endobronchial ultrasound-guided mediastinal transbronchial cryo-node biopsy, previously assisted by fine-needle aspiration, is a novel technique of particular interest in the field of lung cancer diagnosis and is of great utility for extrathoracic tumor metastases, lymphomas, and granulomatous diseases. An integrated histological and molecular diagnosis of small samples implies additional difficulty for the pathologist. Additionally, emerging tumor biomarkers create the need to search for new approaches to better manage the tissue sample; (2) Methods: An analytical observational study of 32 mediastinal node cryobiopsies is carried out in 27 patients (n = 27). Statistical analysis using the t-student and Wilcoxon signed-rank tests for paired data is performed with SPSS 26 and R Statistical software. The significance level is established at p < 0.05; (3) Results: cryobiopsies were valid for diagnosis in 25 of 27 patients, with a maximum average size of 3.5 ± 0.7 mm. A total of 18 samples (66.67%) were positive for malignancy and 9 (33.33%) were benign. The tumor percentage measured in all neoplastic samples was greater than 30%. The average DNA and RNA extracted in nine non-small cell lung cancer cases was 97.2 ± 22.4 ng/µL and 26.6 ± 4.9 ng/µL, respectively; (4) Conclusions: the sample size obtained from an endobronchial ultrasound-guided mediastinal transbronchial cryo-node biopsy facilitates the morphological and histo-architectural assessment of inflammatory and neoplastic pathology. It optimizes molecular tests in the latter due to more tumor cells, DNA, and RNA.

Background: Stroke is a highly prevalent disease that can provoke severe disability. We evaluate a predictive model based on the Minimum Basic Data Set (MBDS) compiled by the Spain Health Ministry, obtained for the period 2008–2012 for patients with ischaemic stroke in Spain, to establish the model’s validity and to optimise its calibration. The MBDS is the main clinical-administrative database for hospitalisations recorded in Spain, and to our knowledge, no predictive models for stroke mortality have previously been developed using this resource. The main study aim is to perform an external validation and recalibration of the coefficients of this predictive model with respect to a chronologically later cohort. Material and Methods: External validation (testing the model on a different cohort to assess its performance) and recalibration (validation with optimisation of model coefficients) were performed using the MBDS for patients admitted for ischaemic stroke in the period 2016–2018. A cohort study was designed, in which a recalibrated model was obtained by applying the variables of the original model without their coefficients. The variables from the original model were then applied to the subsequent cohort, together with the coefficients from the initial model. The areas under the curve (AUC) of the recalibration and the external validation procedure were compared. Results: The recalibrated model produced an AUC of 0.743 and was composed of the following variables: age (odds ratio, OR:1.073), female sex (OR:1.143), ischaemic heart disease (OR:1.192), hypertension (OR:0.719), atrial fibrillation (OR:1.414), hyperlipidaemia (OR:0.652), heart failure (OR:2.133) and posterior circulation stroke (OR: 0.755). External validation produced an AUC of 0.726. Conclusions: The recalibrated clinical model thus obtained presented moderate-high discriminant ability and was generalisable to predict death for patients with ischaemic stroke. Rigorous external validation slightly decreased the AUC but confirmed the validity of the baseline model for the chronologically later cohort.

Background Microscopy continues to be the mainstay for the evaluation of parasitaemia in malaria but requires laboratory support and microbiological experience. Other fast and simple methods are necessary. Methods A retrospective observational study of imported malaria treated from July-2007 to December-2020 was carried out to evaluate the association between the degree of parasitaemia and both rapid diagnostic tests (RDT) reactivity patterns and haematological parameters. Plasmodium falciparum monoinfections diagnosed by peripheral blood smear and/or polymerase chain reaction (PCR),which also had a positive RDT result in the same blood sample, were included in the study. Results A total of 273 patients were included. Most of them were male (n = 256; 93.8%) and visiting friends and relatives (VFR) travellers (n = 252; 92.3%). Patients with plasmodial lactate dehydrogenase (pLDH) or aldolase and histidine-rich protein 2 (HRP-2) co-reactivity (Pan/Pf pattern) had a parasitaemia range between 0 and 37% while those with just HRP-2 reactivity (P. falciparum pattern) had ranges between 0 and 1%. Not a single case of P. falciparum pattern was found for parasitaemia ranges greater than 1%, showing a negative predictive value of 100% for high parasitaemia. All the correlations between haematological parameters and parasitaemia resulted to be weak, with a maximum rho coefficient of -0.35 for lymphocytes and platelets, and of 0.40 for neutrophils-to-lymphocytes count ratio. Multivariate predictive models were constructed reflecting a poor predictive capacity. Conclusions The reactivity pattern of RDT allows a rapid semi-quantitative assessment of P. falciparum parasitaemia in travellers with imported malaria, discriminating patients with lower parasite loads. Haematological parameters were not able to estimate parasitaemia with sufficient precision.

Straw return (SR) plus nitrogen (N) fertilizer has become a practical field management mode to improve soil fertility and crop yield in North China. This study aims to explore the relationship among organic waste, mineral nutrient utilization, and crop yield under SRN mode. The fertilizer treatments included unfertilized (CK), SR (straws from wheat and corn), N fertilizer (N), and SR plus N fertilizer (SRN). SRN treatment not only significantly increased the grain yield, net photosynthetic rate, and transpiration rate but also enhanced the contents of chlorophyll, soluble sugar, and soluble protein and increased the activities of antioxidant enzymes but reduced intercellular CO2 concentration and malondialdehyde (MDA) content when compared to other treatments. There were 2572, 1258, and 3395 differentially expressed genes (DEGs) identified from the paired comparisons of SRvsCK, NvsCK, and SRNvsCK, respectively. The transcript levels of many promising genes involved in the transport and assimilation of potassium, phosphate, and nitrogen, as well as the metabolisms of sugar, lipid, and protein, were down-regulated by straw returning under N treatment. SRN treatment maintained the maximum maize grain yield by regulating a series of genes’ expressions to reduce nutrient shortage stress and to enhance the photosynthesis of ear leaves at the maize grain filling stage. This study would deepen the understanding of complex molecular mechanisms among organic waste, mineral nutrient utilization, crop yield, and quality.

Este artículo presenta el estado actual y las características del comercio electrónico, su relevancia y oportunidad para industrias situadas en una zona rural como es Shanxi. Se utiliza el método de búsqueda de referencias, tales como consultas de documentos y de información de internet. Además, mediante el uso de la metodología de marco lógico, se han analizado los problemas en el desarrollo del comercio electrónico en el medio rural de Shanxi y se han presentado soluciones. Por tanto, los resultados principales indican que el desarrollo de comercio electrónico en el medio rural tiene una gran importancia estratégica y que promover el desarrollo económico de Shanxi mediante el fomento del comercio electrónico rural se ha convertido en una sabia elección. No obstante, es necesario continuar una investigación en profundidad. El comercio electrónico del futuro enfrenta grandes oportunidades de desarrollo en las áreas rurales.

Para la supervivencia y el desarrollo local y empresarial se han creado figuras como los clústeres, los cuales permiten en una misma área geográfica compartir recursos y conocimientos, así como colaborar con el propósito de mejorar la competitividad y el desarrollo económico de la región. En este caso se ha realizado un análisis municipal de Lubrín para conocer las fortalezas y debilidades del municipio, identificar oportunidades y amenazas, y diseñar estrategias con miras al desarrollo local. Se utilizó la metodología ETPO para analizar el contexto actual y se comprobó que no hay un clúster de empresas caprinas, pero sí una figura afín. Este sistema se vería liderado por el Ayuntamiento y contaría con varias empresas que colaborarían en la distribución de productos bajo una marca común. Se recomienda por tanto fortalecer esta colaboración y estudiar otras acciones dirigidas a promover el consumo de productos locales y atraer visitantes al municipio.

High-prevalence non-communicable diseases (HNCDs) are an ongoing global public health problem, posing a risk to the continuity of the 2030 Agenda for Sustainable Development. The aim of this study is to describe the current situation in Spain regarding certain HNCDs, namely, ischaemic heart disease, type 2 diabetes mellitus and colorectal cancer, including their prevalence and incidence in recent years. A systematic review was conducted between October 2022 and February 2023 using the MEDLINE, ProQuest and Scopus databases. After an exhaustive search, a total of thirty-four articles were included, comprising fourteen articles on colorectal cancer, seven on ischaemic heart disease and thirteen on diabetes mellitus type 2. The main topics included risk factors, lifestyles, mortality and incidence, the importance of screening and patient empowerment. On analysing each disease, it can be gleaned that risk factors and lifestyle impact the incidence, prevalence and mortality of the diseases studied. In addition, responsible human behaviour, associated with lifestyle factors, is related to the occurrence of these three diseases.