Leisure-time physical activity and all-cause mortality and cardiovascular disease in adults with type 2 diabetes:Cross-country comparison of cohort studies

Purpose:This study aimed to quantify the dose-response association and the minimal effective dose of leisure-time physical activity(PA)to prevent mortality and cardiovascular disease in adults with type 2 diabetes.Methods:Cross-country comparison of 2 prospective cohort studies including 14,913 and 17,457 population-based adults with type 2 diabetes from the UK and China.Baseline leisure-time PA was self-reported and categorized by metabolic equivalent hours per week(MET-h/week)according to World Health Organization recommendations:none,below recommendation(>0-7.49 MET-h/week);at recommended level(7.5-14.9 MET-h/week);above recommendation(>15 MET-h/week).Mortality and cardiovascular disease data were obtained from national registries.Results:During a median follow-up of 12.4 and 9.7 years,in the UK and China cohorts,repectively,higher levels of leisure-time PA were inversely associated with all-cause(1571 and 2351 events)and cardiovascular mortality(392 and 1060 events),mostly consistent with a linear dose-response relationship.PA below,at,and above recommendations,compared with no activity,yielded all-cause mortality hazard ratios of0.94(95%confidence interval(95%CI):0.79-1.12),0.90(95%CI:0.74-1.10),and 0.85(95%CI:0.70-1.02)in British adults and 0.87(95%CI:0.68-1.10),0.88(95%CI:0.74-1.03),and 0.77(95%CI:0.70-0.85)in Chinese adults.Associations with cardiovascular mortality were more pronounced in British adults(0.80(95%CI:0.58-1.11),0.75(95%CI:0.52-1.09),and 0.69(95%CI:0.48-0.97))but less pronounced in Chinese adults(1.06(95%CI:0.76-1.47),1.01(95%CI:0.80-1.28),and 0.79(95%CI:0.69-0.92)).PA at recommended levels was not associated with lower rates of major adverse cardiovascular events(2345 and 4458 events).Conclusion:Leisure-time PA at the recommended levels was not convincingly associated with lower mortality and had no association with risk of major adverse cardiovascular events in British or Chinese adults with type 2 diabetes.Leisure-time PA above current recommendations may be needed to prevent cardiovascular disease and premature mortality in adults with type 2 diabetes.

Association between acute peripancreatic fluid collections and early readmission in acute pancreatitis:A propensity-matched analysis

BACKGROUND Patients with acute pancreatitis(AP)frequently experience hospital readmissions,posing a significant burden to healthcare systems.Acute peripancreatic fluid collection(APFC)may negatively impact the clinical course of AP.It could worsen symptoms and potentially lead to additional complications.However,clinical evidence regarding the specific association between APFC and early readmission in AP remains scarce.Understanding the link between APFC and readmission may help improve clinical care for AP patients and reduce healthcare costs.AIM To evaluate the association between APFC and 30-day readmission in patients with AP.METHODS This retrospective cohort study is based on the Nationwide Readmission Database for 2016-2019.Patients with a primary diagnosis of AP were identified.Participants were categorized into those with and without APFC.A 1:1 propensity score matching for age,gender,and Elixhauser comorbidities was performed.The primary outcome was early readmission rates.Secondary outcomes included the incidence of inpatient complications and healthcare utilization.Unadjusted analyses used Mann-Whitney U andχ2 tests,while Cox regression models assessed 30-day readmission risks and reported them as adjusted hazard ratios(aHR).Kaplan-Meier curves and log-rank tests verified readmission risks.RESULTS A total of 673059 patients with the principal diagnosis of AP were included.Of these,5.1%had APFC on initial admission.After propensity score matching,each cohort consisted of 33914 patients.Those with APFC showed a higher incidence of inpatient complications,including septic shock(3.1%vs 1.3%,P<0.001),portal venous thrombosis(4.4%vs 0.8%,P<0.001),and mechanical ventilation(1.8%vs 0.9%,P<0.001).The length of stay(LOS)was longer for APFC patients[4(3-7)vs 3(2-5)days,P<0.001],as were hospital charges($29451 vs$24418,P<0.001).For 30-day readmissions,APFC patients had a higher rate(15.7%vs 6.5%,P<0.001)and a longer median readmission LOS(4 vs 3 days,P<0.001).The APFC group also had higher readmission charges($28282 vs$22865,P<0.001).The presence of APFC increased the risk of readmission twofold(aHR 2.52,95%confidence interval:2.40-2.65,P<0.001).The independent risk factors for 30-day readmission included female gender,Elixhauser Comorbidity Index≥3,chronic pulmonary diseases,chronic renal disease,protein-calorie malnutrition,substance use disorder,depression,portal and splenic venous thrombosis,and certain endoscopic procedures.CONCLUSION Developing APFC during index hospitalization for AP is linked to higher readmission rates,more inpatient complications,longer LOS,and increased healthcare costs.Knowing predictors of readmission can help target high-risk patients,reducing healthcare burdens.

COVID-19 and liver injury in individuals with obesity

Coronavirus disease 2019 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 that manifests as a variety of clinical manifestations,including liver damage commonly detected by a hepatocellular pattern from liver function tests.Liver injury is associated with a worse prognosis overall.Conditions associated with the severity of the disease include obesity and cardiometabolic comorbidities,which are also associated with nonalcoholic fatty liver disease(NAFLD).The presence of NAFLD,similarly to obesity,is associated with an unfavourable impact on the coronavirus disease 2019 outcome.Individuals with these conditions could present with liver damage and elevated liver function tests due to direct viral cytotoxicity,systemic inflammation,ischemic or hypoxic liver damage or drug side effects.However,liver damage in the setting of NAFLD could also be attributed to a pre-existing chronic low-grade inflammation associated with surplus and dysfunctional adipose tissue in these individuals.Here we investigate the hypothesis that a pre-existing inflammatory status is exacerbated after severe acute respiratory syndrome coronavirus 2 infection,which embodies a second hit to the underestimated liver damage.

Set pair three-way overlapping community discovery algorithm for weighted social internet of things

There are many problems in Social Internet of Things(IoTs),such as complex topology information,different degree of association between nodes and overlapping communities.The idea of set pair information grain computing and clustering is introduced to solve the above problems so as to accurately describe the similarity between nodes and fully explore the multi-community structure.A Set Pair Three-Way Overlapping Community Discovery Algorithm for Weighted Social Internet of Things(WSIoT-SPTOCD)is proposed.In the local network structure,which fully considers the topological information between nodes,the set pair connection degree is used to analyze the identity,difference and reverse of neighbor nodes.The similarity degree of different neighbor nodes is defined from network edge weight and node degree,and the similarity measurement method of set pair between nodes based on the local information structure is proposed.According to the number of nodes'neighbors and the connection degree of adjacent edges,the clustering intensity of nodes is defined,and an improved algorithm for initial value selection of k-means is proposed.The nodes are allocated according to the set pair similarity between nodes and different communities.Three-way community structures composed of a positive domain,boundary domain and negative domain are generated iteratively.Next,the overlapping node set is generated according to the calculation results of community node membership.Finally,experiments are carried out on artificial networks and real networks.The results show that WSIoT-SPTOCD performs well in terms of standardized mutual information,overlapping community modularity and F1.

Use of various MgO resources for high-purity Mg metal production through molten salt electrolysis and vacuum distillation

A green and effective electrolytic process was developed to produce high-purity Mg metal using primary and secondary resources containing Mg O as a feedstock. The electrolysis of various Mg O resources was conducted using a Cu cathode in MgF2– LiF – KCl molten salt at 1043 K by applying an average current of 1.44 A for 12.5 h. The electrolysis of calcined North Korean magnesite and seawater Mg O clinker yielded Mg alloys of MgCu2and(Cu) phases with current efficiencies of 89.6–92.4%. The electrolysis of oxidized Mg O-C refractory brick, aged ferronickel slag, and ferronickel slag yielded Mg alloys of MgCu2and(Cu) phases with current efficiencies of 59.3–92.3%. The vacuum distillation of Mg alloys obtained was conducted at 1300 K for 10 h to produce high-purity Mg metal. After vacuum distillation, Mg metal with a purity of above 99.994% was obtained. Therefore, this study demonstrates the feasibility of the production of high-purity Mg metal from various Mg O resources using a novel electrolytic process with a Cu cathode, followed by vacuum distillation.

Common susceptibility variants of KDR and IGF-1R are associated with poststroke depression in the Chinese population

Background Depression,one of the most frequent complications after stroke,increases the disease’s burden and physical disability.Poststroke depression(PSD)is a multifactorial disease with genetic,environmental and biological factors involved in its occurrence.Genetic studies on PSD to date have mainly focused on the monoamine system and brain-derived neurotrophic factors.However,understanding is still limited about the influence of the single nucleotide polymorphism(SNP)of other neurotrophic factors on PSD.Aims The present study aimed to investigate the relationship between seven vascular endothelial growth factor(VEGF)family gene variants that occur with PSD.Methods A multicentre candidate gene study from five hospitals in Jiangsu Province from June 2013 to December 2014 involved 121 patients with PSD and 131 patients with non-PSD.Demographic characteristics and neuropsychological assessments were collected.Theχ^(2)test was used to evaluate categorical variables,while the independent t-test was applied to continuous variables.SNPs in seven genes(VEGFA,VEGFB,KDR,FLT-1,IGF-1,IGF-1R and PlGF)were genotyped.Single-marker association for PSD was analysed byχ^(2)tests and logistic regression using SPSS and PLINK software.Results Patients with PSD included more women and those with lower education levels,lower body mass indexes,lower Mini-Mental State Examination scores,and higher scores on the 17-item Hamilton Depression Rating Scale than non-PSD patients.Ninety-two SNPs with seven genes were genotyped and passed quality control.The rs7692791 CC genotypes,the C allele of KDR and the rs9282715 T allele of IGF-1R increased the risk for PSD(χ^(2)=7.881,p=0.019;χ^(2)=4.259,p=0.039;χ^(2)=4.222,p=0.040,respectively).In addition,the SNP rs7692791 of KDR was significantly associated with PSD by the logistic regression of an additive model(p=0.015,OR=9.584,95%CI:1.549 to 59.31).Conclusions Patients with rs7692791 C allele carriers or the CC genotype of KDR and the rs9282715 T allele of IGF-1R may have PSD susceptibility.Findings such as these may help clinicians to identify the high-risk population for PSD earlier and,thus,enable them to provide more timely interventions.

Human Personality Assessment Based on Gait Pattern Recognition Using Smartphone Sensors

Human personality assessment using gait pattern recognition is one of the most recent and exciting research domains.Gait is a person’s identity that can reflect reliable information about his mood,emotions,and substantial personality traits under scrutiny.This research focuses on recognizing key personality traits,including neuroticism,extraversion,openness to experience,agreeableness,and conscientiousness,in line with the bigfive model of personality.We inferred personality traits based on the gait pattern recognition of individuals utilizing built-in smartphone sensors.For experimentation,we collected a novel dataset of 22 participants using an android application and further segmented it into six data chunks for a critical evaluation.After data pre-processing,we extracted selected features from each data segment and then applied four multiclass machine learning algorithms for training and classifying the dataset corresponding to the users’Big-Five Personality Traits Profiles(BFPT).Experimental results and performance evaluation of the classifiers revealed the efficacy of the proposed scheme for all big-five traits.

Wood Density Determination with the Perspective to Decarbonisation of Tropical Forest Species from the Luki Biosphere Reserve in the Democratic Republic of the Congo

Specimens of the forest species such as Pentaclethra macrophylla, Petersianthus macrocarpus, Pycnanthus angolensis and Terminalia superba have been sampled from LUKI Biosphere reserve in the Democratic Republic of the Congo in order to determine their wood density with the perspective to decarbonisation. These parameters have been found out experimentally utilizing a drying technique in an oven including techniques of immersion in an Erlenmeyer full of water. The corresponding results indicated that the four species wood density is respectively 0.85, 0.80, 0.77 and 0.51. These preliminary results will be useful in our ongoing project on carbon dioxide absorption capacity of Congo rainforest tree species.

Prediction of Flash Flood Susceptibility of Hilly Terrain Using Deep Neural Network:A Case Study of Vietnam

Flash floods are one of the most dangerous natural disasters,especially in hilly terrain,causing loss of life,property,and infrastructures and sudden disruption of traffic.These types of floods are mostly associated with landslides and erosion of roads within a short time.Most of Vietnamis hilly and mountainous;thus,the problem due to flash flood is severe and requires systematic studies to correctly identify flood susceptible areas for proper landuse planning and traffic management.In this study,three Machine Learning(ML)methods namely Deep Learning Neural Network(DL),Correlation-based FeatureWeighted Naive Bayes(CFWNB),and Adaboost(AB-CFWNB)were used for the development of flash flood susceptibility maps for hilly road section(115 km length)of National Highway(NH)-6 inHoa Binh province,Vietnam.In the proposedmodels,88 past flash flood events were used together with 14 flash floods affecting topographical and geo-environmental factors.The performance of themodels was evaluated using standard statisticalmeasures including Receiver Operating Characteristic(ROC)Curve,Area Under Curve(AUC)and Root Mean Square Error(RMSE).The results revealed that all the models performed well(AUC>0.80)in predicting flash flood susceptibility zones,but the performance of the DL model is the best(AUC:0.972,RMSE:0.352).Therefore,the DL model can be applied to develop an accurate flash flood susceptibility map of hilly terrain which can be used for proper planning and designing of the highways and other infrastructure facilities besides landuse management of the area.

Fear of hypoglycemia,a game changer during physical activity in type 1 diabetes mellitus patients

Hypoglycemia limits optimal glycemic management of patients with type 1 diabetes mellitus(T1DM).Fear of hypoglycemia(FoH)is a significant psychosocial consequence that negatively impacts the willingness of T1DM patients to engage in and profit from the health benefits of regular physical activity(e.g.,cardiometabolic health,improved body composition,cardiovascular fitness,quality of life).Technological advances,improved insulin regimens,and a better understanding of the physiology of various types of exercise could help ameliorate FoH.This narrative review summarizes the available literature on FoH in children and adults and tools to avoid it.

Method of high-density seismic imaging exploration and application samples

The paper introduces the method of high-density seismic imaging exploration, discusses its features different from conventional shallow seismic reflection wave technique, and illustrates the application effect of the method using three samples of engineering geological explorations on land and in water exploration of underground cavity, location survey of sunk ship and investigation of channel silt depth.

Look into my eyes:What can eye-based measures tell us about the relationship between physical activity and cognitive performance?

Background:There is a growing interest to understand the neurobiological mechanisms that drive the positive associations of physical activity and fitness with measures of cognitive performance.To better understand those mechanisms,several studies have employed eye-based measures(e.g., eye movement measures such as saccades,pupillary measures such as pupil dilation,and vascular measures such as retinal vessel diameter)deemed to be proxies for specific neurobiological mechanisms.However,there is currently no systematic review providing a comprehensive overview of these studies in the field of exercise-cognition science.Thus,this review aimed to address that gap in the literature.Methods:To identify eligible studies,we searched 5 electronic databases on October 23,2022.Two researchers independently extracted data and assessed the risk of bias using a modified version of the Tool for the assEssment of Study qualiTy and reporting in EXercise(TESTEX scale,for interventional studies) and the critical appraisal tool from the Joanna Briggs Institute(for cross-sectional studies).Results:Our systematic review(n=35 studies) offers the following main findings:(a) there is insufficient evidence available to draw solid conclusions concerning gaze-fixation-based measures;(b) the evidence that pupillometric measures,which are a proxy for the noradrenergic system,can explain the positive effect of acute exercise and cardiorespiratory fitness on cognitive performance is mixed;(c) physical training-or fitness-related changes of the cerebrovascular system(operationalized via changes in retinal vasculature) are,in general,positively associated with cognitive performance improvements;(d) acute and chronic physical exercises show a positive effect based on an oculomotor-based measure function(operationalized via antisaccade tasks);and(e) the positive association between cardiorespiratory fitness and cognitive performance is partly mediated by the dopaminergic system(operationalized via spontaneous eye-blink rate).Conclusion:This systematic review offers confirmation that eye-based measures can provide valuable insigt into the neurobiological mechanisms that may drive positive associations between physical activity and fitness and measures of cognitive performance.However,due to the limited number of studies utilizing specific methods for obtaining eye-based measures(e.g.,pupillometry,retinal vessel analysis,spontaneous eye blink rate) or investigating a possible dose-response relationship,further research is necessary before more nuanced conclusions can be drawn.Given that eye-based measures are economical and non-invasive,we hope this review will foster the future application of eye-based measures in the field of exercise-cognition science.

Comparative Toxicity of Nanomaterials to Air-blood Barrier Permeability Using an In Vitro Model

Objective To comparatively study the toxicity of four metal-containing nanoparticles(MNPs) and their chemical counterparts to the air-blood barrier(ABB) permeability using an in vitro model.Methods ABB model, which was developed via the co-culturing of A549 and pulmonary capillary endothelium, was exposed to spherical CuO-NPs(divided into CuO-40, CuO-80, and CuO-100 based on particle size), nano-Al2O3(sheet and short-rod-shaped), nano-ZnO, nano-Pb S, CuSO4, Al2(SO4)3, Zn(CH3COO)2, and Pb(NO3)2 for 60 min.Every 10 min following exposure, the cumulative cleared volume(ΔTCL) of Lucifer yellow by the model was calculated.A clearance curve was established using linear regression analysis of ΔTCL versus time.Permeability coefficient(P) was calculated based on the slope of the curve to represent the degree of change in the ABB permeability.Results The results found the increased P values of CuO-40, CuO-80, sheet, and short-rod-shaped nano-Al2O3, Al2(SO4)3, and Pb(NO3)2.Among them, small CuO-40 and CuO-80 were stronger than CuO-100 and CuSO4;no difference was observed between Al2(SO4)3 and sheet and short-rod-shaped nano-Al2O3;and nano-Pb S was slightly weaker than Pb(NO3)2.So clearly the MNPs possess diverse toxicity.Conclusion ABB permeability abnormality means pulmonary toxicity potential.More studies are warranted to understand MNPs toxicity and ultimately control the health hazards.

Low utilization of skilled birth attendants in Ngorongoro Conservation Area, Tanzania: A complex reality requiring action

Limited integration of contextual factors in maternal care contributes to slow progress towards achieving MDG5 in sub-Sahara Africa. In Ngorongoro, rural Tanzania, the maternal mortality ratio is high with 642 maternal deaths/100,000 live births. Skilled birth attendants (SBAs) assist only 7% of deliveries. This study, undertaken from 2009 to 2011, used Participatory Action Research involving local stakeholders (Maasai women and men, traditional birth attendants (TBAs), hospital staff) to examine reasons for low utilization of SBAs and moreover to develop proposals how to integrate contextual factors and local needs in the health care system. Interviews, observations and literature study were also conducted. Thaddeus and Maine’s Three Delays model is used to structure the analysis. Delaying factors in decision making at home: negative perceptions by the community on availability and quality of care in the hospital;discontinuity of care by TBAs;food and financial insecurity;desired nearness to cattle and family;limited recognition of maternal deaths;limited male health education and suboptimal birth preparedness. Delaying factors in reaching the hospital: vehicle and road limitations. Delaying factors in receiving hospital care: limited (human) resources and limited knowledge sharing at the hospital. Community members and health workers proposed: increasing food/financial security;tailoring male health education;combining TBA/SBA care to provide continuous, culturally appropriate labour support;creating separate maternity wards;increasing the number and training of staff;ensuring continuous availability of Emergency Obstetric Care. Applying solutions to increase hospital utilization seems complex as collaborative actions by multiple actors and institutions are needed to create both a needs based and clinically sound continuum of maternal care. To follow-up this process of integrating local solutions into the maternal care system, we suggest to adapt the WHO Strategic Approach—a top-down framework for the implementation of innovations—to fit this bottom-up approach.

Betaine accumulation and the change of betaine-aldehyde dehydrogenase activity in barley seedlings under KCl and NaCl stress

The changes in growth status, ion contents, betaine levels and betaine\|aldehyde dehydrogenase (BADH) activity in seedlings of nonhalophyte barley treated with different concentrations of NaCl and KCl were studied. Results showed that the inhibition of growth in barley seedlings increased as enhancing NaCl and KCl for 96h and NaCl inhibitory degree was higher than that of KCl. The K\++ content of barley seedlings in NaCl was lower than the control, while the Na\++ content was higher, the levels of Na\++ fell in the seedlings treated with KCl, but K\++ levels rose, and K\++ content was higher than that of Na\++. The betaine levels of barley shoots rose with the increase in both external salt concentration and treatment time. Higher BADH activity was observed in low\|salt concentration but lower slightly in high\|salt concentration.

Genetic diversity center of cultivated soybean(Glycine max) in China——New insight and evidence for the diversity center of Chinese cultivated soybean

Information on the center of genetic diversity of soybean（Glycine max） will be helpful not only for designing efficient strategies for breeding programs, but also for understanding the domestication and origin of this species. Here, we describe an analysis of genetic diversity based on simple-sequence repeat（SSR） variations within a core collection of 2 111 accessions of Chinese soybean landraces. Prior to the diversity assessment, the geographic origin of each accession was mapped. The map was then divided into grids each 2.5° in latitude and 5° in longitude. We found two regions that had higher number of alleles（NA） and greater polymorphic information content（PIC） values than the others. These regions are adjacently located within grid position of 30°–35°N×105°–110°E, which includes the valley of the middle and lower reaches of the Wei River, and the valley of the upper reaches of the Hanjiang River. It was also observed that in many regions, genetic diversity decreased with the increase in distance from the center. Another region, in northern Hebei Province（115°–120°E×40°–42.5°N）, was observed having higher diversity than any surrounding regions, indicating that this is a sub-center of soybean diversity. Based on the presented results, the domestication and origin of soybean are also discussed.

The sound velocity and bulk properties of sediments in the Bohai Sea and the Yellow Sea of China

In order to investigate the correlation between a sound velocity and sediment bulk properties and explore the influence of frequency dependence of the sound velocity on the prediction of the sediment properties by the sound velocity, a compressional wave velocity is measured at frequencies of 25-250 kHz on marine sediment samples collected from the Bohai Sea and the Yellow Sea in laboratory, together with the geotechnical parameters of sediments. The results indicate that the sound velocity ranges from 1.232 to 1.721 km/s for the collected sediment samples with a significant dispersion within the series measuring frequency. Poorly sorted sediments are highly dispersive nearly with a positive linear relationship. The porosity shows a better negative logarithmic correlation with the sound velocity compared with other geotechnical parameters. Generally, the sound velocity increases with the increasing of the average particle size, sand content, wet and dry bulk densities, and decreasing of the clay content, and water content. An important point should be demonstrated that the higher correlation can be obtained when the measuring frequency is low within the frequency ranges from 25 to 250 kHz since the inhomogeneity of sediment properties has a more remarkably influence on the laboratory sound velocity measurement at the high frequency.

Long-term rice-rice-green manure rotation changing the microbial communities in typical red paddy soil in South China

On the basis of a long-term（30 years） field experiment that involved four rotation systems, rice-rice-winter fallow（RRF）, rice-rice-ryegrass（RRG）, rice-rice-rape（RRP）, and rice-rice-milk vetch（RRV）, this study described the effects of green manure on the microbial communities in the red paddy soils using 454 pyrosequencing for the 16 S r RNA gene. The Chao1 richness and non-parametric Shannon＇s index increased in all soil samples that received green manure treatments. The communities＇ structures with the green manure applications were significantly dissimilar from that under the winter fallow. Using Metastats tests, many genera in the RRG, RRP and RRV soils were significantly different from those in the RRF soil, including a number of genera that functioned in the nitrogen and sulfur cycles. Analyses of the genera with these functions revealed the shifts in microbial ecosystem functions after long-term green manuring. Changes in the microbial communities increased the ammonium supply and decreased the soil acidification in green-manure-amended soils. Together, these data suggested powerful effects of green manure on both the microbial communities and the biogeochemical cycle driven by the shifts in bacterial functional groups.

Variability in Latent Heat Flux over the Tropical Pacific in Association with Recent Two ENSO Events

This paper analyzed the variations of latent heat flux (LHF) over the tropical Pacific in the period 1978-1988 by using COADS (Comprehensive Ocean and Atmospheric Data Set). It has been founded that the interannual variabili ty of LHF exhibits strong ENSO signal, with the significant increasing LHF during the recent two warm events, i.e., 1982 / 83 and 1986 / 87 and decreasing LHF in the cold episodes. However the longitudinal distribution of the LHF departures varies from event to event. In the eastern Pacific, the specific humidity difference at air-sea interface (qs -qa) makes a dominant contribution to the interannual variability of LHF ( r = 0.73 ), while in the western Pacific the surface wind speed, W and the qs - qa make nearly equal contribution to that of LHF.

Three Year Community Based Intervention for Chronic Disease Prevention in Epidemiological and Political Transition Context: Example of Tunisia

Objective: Our aim was to determine the effectiveness, feasibility, and necessary cultural adaptations of evidence-based interventions directed at tobacco use, unhealthy diet, and physical inactivity in adults and children in three different sectors: workplace, neighborhood and schools. Materials and Methods: We conducted in Sousse, Tunisia an interventional study through a quasi-experimental design (pre-post with intervention and control groups) to prevent non communicable disease risk factors. The intervention group included different settings and pre and post assessment concerned independent groups (schools with 1929 and 2170 participants, workplaces with 914 and 1098 participants and community with 940 and 1001 participants respectively at pre and post assessment). It was located in the delegation of Sousse Jawhara and Sousse Erriadh. The control group with similar settings (schools with 2074 and 2105 participants, workplaces with 861 and 1015 and community with 940 and 976 participants respectively at pre and post assessment) was located in the delegation of Msaken from the region of Sousse. Results: Tobacco use decreased among neighborhood (26.2% to 23.2%, p = 0.13) workplace (39.2% to 37.5%, p = 0.43) and schools (5.7% to 4.8%, p = 0.19) participants. In control group, it increased significantly in schools and neighborhood. Participants who consumed five fruits and vegetables daily increased significantly in all settings in intervention group (from 30% to 33.2% in schools, 47.5% to 52.1% in workplace and 39.4% to 58.4% in neighborhood). However in control group it increased only in schools and neighborhood. An improvement in physical activity practice was seen both in intervention and control group among adults participants but not in schools. Conclusion: The “Together in Health” project for the prevention of risk factors for NCD is an example of a loco-regional initiative. Such initiatives can only be beneficial with a structure organized by the government.