Design of a Social Marketing Plan on Salt Reduction for the Control and Treatment of Noncommunicable Diseases in Costa Rica

High blood pressure and other non-communicable diseases associated with excessive salt/sodium consumption represent a major challenge to the health of the world’s population. Consumption is a human behavior that is usually influenced by significant factors, internal and external to people. The design of a national social marketing intervention is described. The whole process was developed by a national interdisciplinary team over the course of a decade (2011-2022). Its purpose is to promote changes in this behavior, through gradual reduction of salt/sodium consumption in the target populations of Costa Rica, for the prevention and control of associated diseases. The process includes four phases: research, situation analysis, creation of a proposal for the social marketing strategy, and implementation and evaluation. Last phase was not developed by the research team. The main inputs used to design this intervention were the data generated in three qualitative researchers carried out by the national work team and the social marketing regional plan for salt consumption reduction in Latin America. By analyzing these research data, marketing mix components were determined for designing the intervention. The marketing strategy is promotional and is based on encouraging a natural diet with less sodium using natural seasonings and adding less discretional salt and industrialized products high in sodium, in the preparation of food and dishes. The primary key audience is the mother of the school-aged child, and the secondary is the adult caregivers of this child. It is expected that in the short term, health promoters from different government and non-state sectors will contribute to the implementation of the national social marketing plan, to achieve, in the medium or long term, a consumption that approaches five grams of salt per person per day. This plan is a country initiative to position the value of a natural diet with less sodium and to contribute to the prevention and treatment of HT and NCD associated diseases.

Governance of noncommunicable diseases in Afghanistan

Background Noncommunicable diseases(NCDs)are the main reasons of mortality worldwide.One of every two person is dying due to NCDs in Afghanistan.International policy actors,mainly the World Health Organization(WHO),published several reports and declarations on controlling and preventing NCDs.This study aimed to provide a situation for governance of NCDs in Afghanistan and proper solutions for identified challenges.Methods We conducted qualitative research utilizing interpretive phenomenology.A self-developed questionnaire was developed to conduct the semi-structured interviews with 39 experts from Afghanistan.The results were analyzed using a deductive framework analysis.Six building block framework of health system developed by the WHO was used as predefined framework for this study.Results The governance building block of health system consists of five subthemes including policy making,planning,organizing,stewardship,and control.We identified main strengths,weaknesses,opportunities,and challenges for these subthemes.The experts also provided key recommendations to address the challenges.Conclusions Management of NCDs is a neglected part of the health system in Afghanistan.Strengthening evidence-based policy making with technical and indigenous planning,establishing responsive units with adequate financial and human resources within different ministries to address“health in all policies”concept,passing and implementing national laws and regulations to support national strategies for prevention and control of NCDs,and establishing decentralized monitoring systems to control the implementation of these strategies are the main recommendations of this study.Local government and international policy actors should invest and support the development of a multisectoral coordination system at national level for Afghanistan.

Trend analysis of noncommunicable diseases and their risk factors in Afghanistan

Background:Afghanistan is suffering from 40-year chronic conflicts,displacement,and demolition of its infrastructure.Afghanistan mortality survey 2010 shows nearly 46%of all deaths in the country were attributed to noncommunicable diseases(NCDs).In this study,we aimed to understand the differences in mortality and premature death due to NCDs by sex and the trend for the next 8 years.Methods:We applied trend analysis using the secondary data from the Institute for Health Metrics and Evaluation,Global Burden of Diseases 2019.The information on NCD mortality,NCD deaths attributed to its risk factors,NCD percent of total years lived with disability(YLDs)attribution to each risk factor extracted from this database from 2008 to 2019.We investigated the trend from 2008 to 2019 for the mentioned factors and then forecast their trends until 2030.Results:Our study shows that Afghanistan has had an increasing death number due to NCDs from 2008 to 2019(50%for both sexes)and this will reach nearly 54%by 2030.Currently,half of NCDs deaths are premature in Afghanistan.The mortality rate and prevalence of risk factors are higher among women.More than 70%of YLDs will be due to NCDs in Afghanistan till 2030.Five risk factors including high systolic blood pressure(28.3%),high body mass index(23.4%),high blood glucose(20.6%),high low-density lipoprotein cholesterol(16.3%),and smoking(12.3%)will have the highest contribution to NCDs death in 2030,respectively.Conclusions:In general,our study indicates that without any specific intervention to address NCDs in Afghanistan,not only the Sustainable Development Goal target for NCDs will not be met,but an increase in almost all risk factors prevalence,as well as NCD mortality,will be seen in Afghanistan.

Prevalence and sociodemographic determinants of selected noncommunicable diseases among the general population of Cyprus:A large population-based cross-sectional study

Background:Noncommunicable diseases(NCDs)are the leading cause of morbidity and mortality worldwide.The aim of this study was to determine the prevalence of NCDs among the population of Cyprus and to identify the distribution of the socioeconomic and demographic determinants among individuals with the most frequent NCDs.Methods:A cross-sectional study was conducted using stratified sampling.Socioeconomic and demographic characteristics and the presence of NCDs were collected through a standardized questionnaire.The diseases were classified using the 10th revision of the International Classification of Diseases(ICD-10).Results:In total,1140 individuals participated in the study,among whom 590(51.7%)had at least one chronic disease.The most prevalent NCDs were hyperlipidemia(17.4%),hypertension(12.9%),and thyroid diseases(8.4%).We identified more males than females with hyperlipidemia aged 25–44 years old and>65 years old(p=0.024),more males compared to females with hypertension(p=0.001)and more females compared to males with thyroid diseases(p<0.001).Individuals with hypertension and hyperlipidemia were more likely to be married,to have completed a higher education,and to have a high annual income.Discussion:In Cyprus,the majority of the general population had at least one NCD.Hyperlipidemia,hypertension,and thyroid disease are relatively common,even at younger ages,highlighting the need for the development of public health programs aimed at addressing and preventing NCDs.

Countrywide“best buy”interventions for noncommunicable diseases prevention and control in countries with different level of socioeconomic development

Background:Noncommunicable diseases(NCDs)place a heavy burden on populations globally and in particular,on lower-income countries(LIC).WHO identified a package of 16“best buy”lifestyle and management interventions that are cost-effective and applicable in all settings.The purpose of this study was to evaluate and compare NCD risk factors in all WHO countries and make preliminary assessment of“best buy”interventions.Methods:Risk factors estimation was made in 188 countries.NCD attributable“best buys”concern tobacco use,unhealthy diet,physical inactivity,and harmful use of alcohol.Management issues are based on the availability of the national NCD guidelines and provision of drug therapy.Results:Every fourth adult in high-income countries(HIC)has raised blood pressure(RBP).Prevalence of RBP in lower-middle-income countries(LMIC)and LIC is 22%–23%(HIC/LMIC:t=3.12,p<0.01).Prevalence of diabetes in LIC is less than half of that in HIC and upper-middle-income countries(UMIC)UMIC/LIC:t=8.37,p<0.001.Obesity prevalence is gradually decreasing from HIC to LIC(HIC/LIC:t=11.48,p<0.001).Highest level of physical inactivity is seen in HIC,which then gradually declines to LIC(17%).Tobacco prevalence in LIC is almost less than half of that in HIC and UMIC(HIC/LIC:t=7.2,p<0.0001).There is a gradual decline in the implementation of“best buys”from HIC to LIC.Conclusion:Wealthier countries have better implementation of the WHO NCD prevention strategy.

SEEDi^(1.0-3.0) strategies for major noncommunicable diseases in China

The purpose of this article is to briefly introduce the status and challenges of major noncommunicable diseases （mNCDs）, which include cardiovascular disease, diabetes and cancer, as well as related risk factors, such as environmental pollution, smoking, obesity and sleep disorders. ＂S-E-E-D＂ rules or the strategies of ＂S-E-E-D＂ intervention （SEEDi） consist of four core healthy elements： sleep, emotion, exercise and diet. The history of SEEDi1.0-3.0 is also introduced, which includes versions 1.0, 1.5, 2.0 and 3.0 of the program. These guidelines are suitable for prevention and control of mNCDs. Not only the ＂Healthy China＂ initiated in China＇s ＂13th Five-year Plan,＂ but also the ＂Healthy World＂ philosophy needs SEEDi1.0-3.0 strategies for control of mNCDs.

Prevalence of risk factors for noncommunicable diseases among rural women in Yemen

Objective:The objective of this study was to expand the evidence base on the prevalence of risk factors for the main noncommunicable diseases(such as diabetes mellitus,blood pressure,and obesity)among rural women in Yemen.Methods:A descriptive cross-sectional study was conducted among 450 rural women in the age range from 18 to 60 years who presented in the targeted health centers of Sana’a and Al-Mah-weet governorates during the time of the study.Data were collected by a structured questionnaire developed as per World Health Organization STEPS guidelines.Body mass index,blood pressure,and biochemical measurements of fasting blood glucose were recorded.Results:Ninety-four percent of the respondents were physically inactive.Only 3.5% of re-spondents were smokers,while 66.3% were qat chewers.Forty-seven percent watched TV.Thirty-nine percent of respondents ate vegetables daily,while 19.5% consumed fruits daily.Among the respondents,31.3% were obese,15.0% were hypertensive,and 7.8% had diabetes mellitus.Age group,marital status,and education level were significantly associated with obesity,blood pres-sure,and diabetes mellitus.There were significant associations between obesity and blood pres-sure,as well as between blood pressure and diabetes mellitus.Conclusion:Frequent campaigns and educational programs are to be encouraged for the adoption of healthy lifestyle practices and health promotion.

Distribution and disparities of healthy lifestyles and noncommunicable diseases risk factors between men and women aged 20-59 years in Bangladesh:Evidence from a nationwide survey

Background:Noncommunicable diseases(NCDs)are public health threats globally and recognized impediments to socioeconomic development.This study aimed to identify the prevalence and clustering of NCDs risk factors among Bangladeshi men and women aged 20-59 years using nationally representative data.Methods:This study was conducted in 82 rural,nonslum urban,and slum clusters across all eight administrative divisions of Bangladesh using multistage cluster sampling.A total of 4917 men and 4905 women aged 20-59 years were included in the study.Descriptive analyses were performed to report the prevalence and distribution of behavioral and clinical risk factors.Multivariable binary logistic regression was performed to identify factors associated with the coexistence of three or more NCD risk factors.Results:The prevalence of tobacco use(any form),insufficient physical activity,inadequate fruit and vegetable consumption,overweight and obesity,and central obesity were 38.3%,13.6%,87.1%,42.3%,and 36.0%,respectively.Furthermore,21.9%and 4.9%participants had hypertension and self-reported diabetes,respectively.Regarding the clustering of risk factors,37.1%men and 50.8%women had at least three NCD risk factors.Only 3.0%men and 1.8%women reported no NCD risk factors.Age,place of residence,education,and wealth status were associated with the presence of at least three risk factors for both sexes.Conclusion:Since a large proportion of Bangladeshi 20-59 years old population had multiple risk factors,population-based programs with multisectoral approaches are essential to reduce NCDs among Bangladeshi women and men.

Inflammation/bioenergetics-associated neurodegenerative pathologies and concomitant diseases:a role of mitochondria targeted catalase and xanthophylls

Various inflammatory stimuli are able to modify or even"re-program"the mitochondrial metabolism that results in generation of reactive oxygen species.In noncommunicable chronic diseases such as atherosclerosis and other cardiovascular pathologies,type 2 diabetes and metabolic syndrome,these modifications become systemic and are characterized by chronic inflammation and,in particular,"neuroinflammation"in the central nervous system.The processes associated with chronic inflammation are frequently grouped into"vicious circles"which are able to stimulate each other constantly amplifying the pathological events.These circles are evidently observed in Alzheimer's disease,atherosclerosis,type 2 diabetes,metabolic syndrome and,possibly,other associated pathologies.Furthermore,chronic inflammation in peripheral tissues is frequently concomitant to Alzheimer's disease.This is supposedly associated with some common genetic polymorphisms,for example,Apolipoprotein-Eε4 allele carriers with Alzheimer's disease can also develop atherosclerosis.Notably,in the transgenic mice expressing the recombinant mitochondria targeted catalase,that removes hydrogen peroxide from mitochondria,demonstrates the significant pathology amelioration and health improvements.In addition,the beneficial effects of some natural products from the xanthophyll family,astaxanthin and fucoxanthin,which are able to target the reactive oxygen species at cellular or mitochondrial membranes,have been demonstrated in both animal and human studies.We propose that the normalization of mitochondrial functions could play a key role in the treatment of neurodegenerative disorders and other noncommunicable diseases associated with chronic inflammation in ageing.Furthermore,some prospective drugs based on mitochondria targeted catalase or xanthophylls could be used as an effective treatment of these pathologies,especially at early stages of their development.

Ecological correlates of sport and exercise participation among Thai adolescents:A hierarchical examination of a cross-sectional population survey

Background:Understanding factors influencing adolescents’ sport/exercise participation(S/EP) is vital to developing effective interventions,but currently,evidence from less developed countries is limited.The purpose of this study was to examine correlates of S/EP across individual,interpersonal,and environmental levels in a nationally representative sample of Thai adolescents.Methods:Data from 4617 Thai adolescents aged 14-17 years old were obtained from recruited schools across Thailand.Data on S/EP(outcome variable),and psychosocial,home,and community environment covariates were collected from individual adolescents using the Thailand Physical Activity Children Survey,Student Questionnaire.School environmental data were collected at the school level using a School Built Environment Audit.Hierarchical regressions taking into account school clustering effects were applied for data analysis.Results:At the individual level,age and body mass index were independently and strongly correlated with S/EP.Adolescents with high preference for physical activity(PA)(odd ratio(OR)=1.71,p <0.001) and at least a moderate level of self-efficacy(OR=1.33,p=0.001) were more likely to have high S/EP.At the interpersonal level,adolescents whose parents joined their sports/exercise at least 1-2 times/week(OR=1.36,p=0.003) received>3 types of parental support(OR=1.43,p=0.005) and who received siblings’(OR=1.26,p=0.004) and friends’(OR=1.99,p <0.001) support had a greater chance of high S/EP.At the environmental level,adolescents’ S/EP was greater when there were at least 3-4 pieces of home sport/exercise equipment(OR=2.77,p=0.003),grass areas at school(OR=1.56,p <0.001),and at least 1-2 PA facilities in the community(OR=1.30,p=0.009).Conclusion:Multiple factors at different levels within an ecological framework influencing Thai adolescents’ S/EP were generally similar to those found in developed countries,despite some differences.For those interested in promoting and supporting Thai adolescents’ engagement in sports/exercise,further exploration of the influence of self-efficacy and attitude toward PA is required at the individual level;parental and peer support at the interpersonal level;and home sport equipment,school grass areas,and neighborhood PA facilities at the environment level.

Integrated Behavioral Healthcare in Thailand:A Case Study from Chiang Mai

Purpose:This study aims to examine the level of behavioral health integration in primary care clinics among patients with hypertension and type 2 diabetes in Chiang Mai,Thailand.It also aims to explore the provider perceived prevalence of behavioral problems and need for an expert behavioral health consultant on the primary care team and the risk and protective factors of the patients’psychological and cardio-metabolic health outcomes.Methodology:Using survey data between 2017 and 2018 regarding the level of integration as measured by a Practice Integration Profile,provider ratings of prevalence and need based on a Provider Survey,and patient lifestyle and behavioral problems with a Health Risk Assessment in six primary health care settings in Chiang Mai,Thailand(n=335).We conducted ordinary least squares regressions to explore the relationship between each of the patient psychological and cardio-metabolic health outcomes and physical,mental health and substance abuse variables while controlling for the demographics.Results:The results showed overall high levels of integration,but significant variability across clinics.Providers rated prevalence of health risk and need for a Behavioral Health Consultant as moderate.Results of the patient health risk assessment were variable,with some problems high severity,others low.Conclusion:The results reflect a need for integrated behavioral health into the health care system in Thailand especially for those who are in the chronic illness condition.Recommendations for future study include an evaluation of the translation quality and validity and reliability of the study measures under the Thai context.This study fills the research gap of lacking research on the level of integrated care in clinics in Thailand.

Vegetable and Fruit Consumption among Chinese Adults and Associated Factors： A Nationally Representative Study of 170,847 Adults

Objective This study examined vegetable and fruit （VF） consumption rate and its associated factors among Chinese adults. Methods Nationally representative data from the 2013 China Chronic Disease Surveillance survey were used. Dietary intake data, including VF consumption during the last 12 months, were collected. All analyses were weighted to obtain nationally representative estimates. Associations between VF consumption and other factors （e.g., meal frequency and physical activity） were examined through logistic regression analysis. Results The average fruit consumption was 102.3 g/day （95% CI： 97.0-107.6） and the average vegetable consumption was 350.6 g/day （95% CI： 339.3-361.8）. Over half （53.2%, 95% CI： 50.9-55.4） of Chinese adults met the VF consumption of 400 g/day recommended by the World Health Organization （WHO）. Rural residents had a higher prevalence of low VF consumption rate than urban residents [49.20% （95% CI： 46.2%-52.2%） vs. 44.0% （95% CI： 41.7%-46.3%） P 〈 0.01]. Old age （OR = 1.01, 95% CI： 1.00-1.01）, low educational level, low income, minority ethnicity （OR = 1.41, 95% CI： 1.15-1.74）, underweight （OR = 1.17, 95% CI： 1.03-1.33）, single marital status （OR = 1.20, 95% CI： 1.08-1.33）, low health literacy, irregular breakfast （OR = 1.20, 95% CI： 1.04-1.38） or lunch （OR = 1.58, 95% CI： 1.26-1.99） habits, and no leisure-time physical activity were associated with low VF consumption. Conclusion Only half of Chinese adults met the VF consumption recommended by the WHO. Low socio-economic status, irregular diet, and poor health literacy were likely associated with low VF consumption. National efforts and programs are needed to promote VF consumption.

Physical activity,exercise,and chronic diseases:A brief review

Chronic diseases are the leading cause of death worldwide with increasing prevalence in all age groups,genders,and ethnicities.Most chronic disease deaths occur in middle-to low-income countries but are also a significant health problem in developed nations.Multiple chronic diseases now affect children and adolescents as well as adults.Being physically inactive is associated with increased chronic disease risk.Global societies are being negatively impacted by the increasing prevalence of chronic disease which is directly related to rising healthcare expenditures,workforce complications regarding attendance and productivity,military personnel recruitment,and academic success.However,increased physical activity(PA)and exercise are associated with reduced chronic disease risk.Most physiologic systems in the body benefit positively from PA and exercise by primary disease prevention and secondary disease prevention/treatment.The purpose of this brief review is to describe the significant global problem of chronic diseases for adults and children,and how PA and exercise can provide a noninvasive means for added prevention and treatment.

Ideal cardiovascular health and mortality:pooled results of three prospective cohorts in Chinese adults

Background: Evidence on the relations of the American Heart Association’s ideal cardiovascular health (ICH) with mortality in Asians is sparse, and the interaction between behavioral and medical metrics remained unclear. We aimed to fill the gaps. Methods: A total of 198,164 participants without cancer and cardiovascular disease (CVD) were included from the China Kadoorie Biobank study (2004-2018), Dongfeng-Tongji cohort (2008-2018), and Kailuan study (2006-2019). Four behaviors (i.e., smoking, physical activity, diet, body mass index) and three medical factors (i.e., blood pressure, blood glucose, and blood lipid) were classified into poor, intermediate, and ideal levels (0, 1, and 2 points), which constituted 8-point behavioral, 6-point medical, and 14-point ICH scores. Results of Cox regression from three cohorts were pooled using random-effects models of meta-analysis. Results: During about 2 million person-years, 20,176 deaths were recorded. After controlling for demographic characteristics and alcohol drinking, hazard ratios (95% confidence intervals) comparing ICH scores of 10-14 vs. 0-6 were 0.52 (0.41-0.67), 0.44 (0.37-0.53), 0.54 (0.45-0.66), and 0.86 (0.64-1.14) for all-cause, CVD, respiratory, and cancer mortality. A higher behavioral or medical score was independently associated with lower all-cause and CVD mortality among the total population and populations with different levels of behavioral or medical health equally, and no interaction was observed. Conclusions: ICH was associated with lower all-cause, CVD, and respiratory mortality among Chinese adults. Both behavioral and medical health should be improved to prevent premature deaths.

Novel strategies halt cardiovascular, diabetes, and cancer strips

In this article, we introduce briefly several strategies for preventing atherosclerotic cardiovascular disease and promoting healthcare for non-communicable diseases (NCDs). These novel strategies include four core elements of health-sleep, emotion, exercise, and diet-and consist of SEED intervention (SEEDi) and E(e)SEEDi due to supplementation of the environment as a core element, and Hu's healthy lifestyles intervention (HHLi) which originates from E(e)SEED-BasED healthy lifestyles. They are suitable for the early evaluation of risk factors, and play a key role in the prevention and management of human NCDs when combined with the RT-ABCDEF strategy and the Grade 210 prevention, which include obesity-OSA-hypertension syndrome and C-type hypertension, especially in halting cardiovascular, diabetes and cancer (CDC) strips we first discovered. After successful clinical practice, we may expect our novel strategies for controlling these chronic diseases according to the conception of mass prevention and treatment.

Countrywide cardiovascular disease prevention and control in 49 countries with different socio-economic status

Background: Cardiovascular disease (CVD) is the major noncommunicable disease (NCD) accounting for 17.9 million deaths. If current trends continue, the annual number of deaths from CVD will rise to 22.2 million by 2030. The United Nations General Assembly adopted a sustainable development goal (SDG) by 2030 to reduce NCD mortality by one-third. The purpose of this study was to analyze the CVD mortality trends in different countries implementing World Health Organization (WHO) NCD Action Plan and emphasize effective ways to achieve SDG.Methods: WHO statistics, based on the Member-States unified mortality and causes-of-death reports were used for analyzing trends and different interventions.Results: Reduction of CVD mortality from 2000 to 2016 in 49 countries was achieved for stroke at 43% and ischemic heart disease at 30%. Smoking prevalence and raised blood pressure (RBP) decreased in 84% and 55% of the countries. Eighty-nine percent of high-income countries (HIC) demonstrated a decline in tobacco smoking against 67% in middle-income countries (MIC). Sixty-nine percent of HIC demonstrated a decline in RBP against 15% in MIC. CVD management, tobacco, and unhealthy diet reduction measures are significantly better in HIC. The air pollution level was higher in MIC.Conclusion: Building partnerships between countries could enhance their efforts for CVD prevention and successful achievement of SDG.