The World Health Organization STEPwise Approach to Noncommunicable Disease Risk-Factor Surveillance: Methods, Challenges, and Opportunities.

OBJECTIVES: We sought to outline the framework and methods used by the World Health Organization (WHO) STEPwise approach to noncommunicable disease (NCD) surveillance (STEPS), describe the development and current status, and discuss strengths, limitations, and future directions of STEPS surveillance. METHODS: STEPS is a WHO-developed, standardized but flexible framework for countries to monitor the main NCD risk factors through questionnaire assessment and physical and biochemical measurements. It is coordinated by national authorities of the implementing country. The STEPS surveys are generally household-based and interviewer-administered, with scientifically selected samples of around 5000 participants. RESULTS: To date, 122 countries across all 6 WHO regions have completed data collection for STEPS or STEPS-aligned surveys. CONCLUSIONS: STEPS data are being used to inform NCD policies and track risk-factor trends. Future priorities include strengthening these linkages from data to action on NCDs at the country level, and continuing to develop STEPS' capacities to enable a regular and continuous cycle of risk-factor surveillance worldwide.

Diet and physical activity in schools: perspectives from the implementation of the WHO global strategy on diet, physical activity and health.

Non-communicable diseases (NCD), such as heart disease, stroke, cancer and diabetes, are by far the leading cause of mortality in the world, representing 60% of all deaths. Unhealthy diets and physical inactivity are well-established risk factors for overweight and the major NCD. In response to the rapid global growth of the NCD burden, the 2008 Action Plan on Prevention and Control of NCD and the 2004 Global Strategy on Diet, Physical Activity and Health (DPAS) have been developed and endorsed as key international policy instruments. As part of the work of the World Health Organization (WHO) to implement these resolutions, a framework describing the core elements for the development and implementation of a national school policy focused on diet and physical activity has been developed. This framework is included in the "DPAS implementation tool box", and it aims to guide policy-makers in the development and implementation of policies that promote healthy eating and physical activity in the school setting through changes in environment, behaviour and education. The article describes the key elements of the framework and details how this tool is integrated into other WHO activities to provide leadership, guidance, capacity building, evidence-based recommendations and advocacy for action to improve dietary practices and increase physical activity globally.

The contribution of physical activity and sedentary behaviours to the growth and development of children and adolescents: implications for overweight and obesity.

The obesity epidemic is a global trend and is of particular concern in children. Recent reports have highlighted the severity of obesity in children by suggesting: "today's generation of children will be the first for over a century for whom life expectancy falls." This review assesses the evidence that identifies the important role of physical activity in the growth, development and physical health of young people, owing to its numerous physical and psychological health benefits. Key issues, such as "does a sedentary lifestyle automatically lead to obesity" and "are levels of physical activity in today's children less than physical activity levels in children from previous generations?", are also discussed.Today's environment enforces an inactive lifestyle that is likely to contribute to a positive energy balance and childhood obesity. Whether a child or adolescent, the evidence is conclusive that physical activity is conducive to a healthy lifestyle and prevention of disease. Habitual physical activity established during the early years may provide the greatest likelihood of impact on mortality and longevity. It is evident that environmental factors need to change if physical activity strategies are to have a significant impact on increasing habitual physical activity levels in children and adolescents. There is also a need for more evidence-based physical activity guidelines for children of all ages. Efforts should be concentrated on facilitating an active lifestyle for children in an attempt to put a stop to the increasing prevalence of obese children.

Physical activity and television viewing in relation to risk of undiagnosed abnormal glucose metabolism in adults.

OBJECTIVE: The goal of this study was to assess the associations of physical activity time and television (TV) time with risk of "undiagnosed" abnormal glucose metabolism in Australian adults. RESEARCH DESIGN AND METHODS: This population-based cross-sectional study using a stratified cluster design involving 42 randomly selected Census Collector Districts across Australia included 8,299 adults aged 25 years or older who were free from new type 2 diabetes and self-reported ischemic disease and did not take lipid-lowering or antihypertensive drugs. Abnormal glucose metabolism (impaired fasting glycemia [IFG], impaired glucose tolerance [IGT], or new type 2 diabetes) was based on an oral glucose tolerance test. Self-reported physical activity time and TV time (previous week) were assessed using interviewer-administered questionnaires. RESULTS: After adjustment for known confounders and TV time, the odds ratio (OR) of having abnormal glucose metabolism was 0.62 (95% CI 0.41-0.96) in men and 0.71 (0.50-1.00) in women for those engaged in physical activity >or=2.5 h/week compared with those who were sedentary (0 h/week). The ORs of having abnormal glucose metabolism were 1.16 (0.79-1.70) in men and 1.49 (1.12-1.99) in women who watched TV >14 h/week compared with those who watched 14 h/week) was also associated with an increased risk of new type 2 diabetes in men and women and IGT in women compared with those watching <14 h/week. Total physical activity of >or=2.5 h/week was associated with a reduced risk of IFG, IGT, and new type 2 diabetes in both sexes; however, only the association with IGT in women was statistically significant. CONCLUSIONS: These findings suggest a protective effect of physical activity and a deleterious effect of TV time on the risk of abnormal glucose metabolism in adults. Population strategies to reduce risk of abnormal glucose metabolism should focus on reducing sedentary behaviors such as TV time, as well as increasing physical activity.

Grain growth in nanocrystalline yttrium-stabilized zirconia thin films synthesized by spin coating of polymeric precursors.

This article reports results of experimental studies on the microstructural evolution of nanocrystalline yttrium-stabilized zirconia thin films synthesized on a Si substrate via a polymeric precursor spin-coating approach. Grain growth behavior has been investigated at different annealing temperatures (700-1200 degrees C) for periods of up to 240 h. A similar film thickness (approximately 120 nm) was maintained for all of the samples used in this study, to avoid variation in film thickness-dependent grain growth. The effects of the thermal history of the film and the annealing atmosphere on the grain growth were also studied. A simple semiempirical grain growth model has been developed to describe isothermal annealing data and to predict dynamic grain growth behavior during the sintering of polymeric precursor layers to form cubic-phase nanocrystalline yttrium-stabilized zirconia films.

Capacity building for an integrated noncommunicable disease risk factor surveillance system in developing countries.

For the first time, the World Health Organization (WHO) is recommending that countries implement noncommunicable disease (NCD) surveillance by focusing on the major risk factors that predict the most common NCDs. To achieve this goal, member states are being offered a surveillance framework that provides a first step toward an integrated approach to NCD prevention and control. The goal of this framework, the STEPwise approach to NCD surveillance (STEPS), is to increase and sustain a country's capacity to ensure ongoing surveillance. Using the data to develop interventions and policies is an integral part of the STEPS approach, which, in turn, increases capacity to influence policy. Ongoing support from donors is essential to meeting the goal of increasing a country's capacity to undertake the NCD surveillance activity required to provide the basic information from which to formulate policy that effectively reduces the burden of disease.

Physical activity in 22 African countries: results from the World Health Organization STEPwise approach to chronic disease risk factor surveillance.

BACKGROUND: Baseline physical activity data are needed to effectively plan programs and policies to prevent noncommunicable diseases, but for many African countries these data are lacking. PURPOSE: To describe and compare levels and patterns of physical activity among adults across 22 African countries. METHODS: Data from 57,038 individuals from 22 countries (11 national and 11 subnational samples) that participated in the STEPwise approach to chronic disease risk factor surveillance (2003-2009) were analyzed in 2010. The validated Global Physical Activity Questionnaire (GPAQ) was used to assess days and duration of physical activity at work, for transport, and during leisure time in a typical week. RESULTS: Overall, 83.8% of men and 75.7% of women met WHO physical activity recommendations (at least 150 minutes of moderate activity per week or equivalent). Country prevalence ranged from 46.8% (Mali) to 96.0% (Mozambique). Physical activity, both at work and for transport, including walking, had large contributions to overall physical activity, while physical activity during leisure time was rare in the analyzed countries. CONCLUSIONS: Physical activity levels varied greatly across African countries and population subgroups. Leisure time activity was consistently low. These data will be useful to inform policymakers and to guide interventions to promote physical activity.

Global physical activity questionnaire (GPAQ): nine country reliability and validity study.

PURPOSE: Instruments to assess physical activity are needed for (inter)national surveillance systems and comparison. METHODS: Male and female adults were recruited from diverse sociocultural, educational and economic backgrounds in 9 countries (total n = 2657). GPAQ and the International Physical Activity Questionnaire (IPAQ) were administered on at least 2 occasions. Eight countries assessed criterion validity using an objective measure (pedometer or accelerometer) over 7 days. RESULTS: Reliability coefficients were of moderate to substantial strength (Kappa 0.67 to 0.73; Spearman's rho 0.67 to 0.81). Results on concurrent validity between IPAQ and GPAQ also showed a moderate to strong positive relationship (range 0.45 to 0.65). Results on criterion validity were in the poor-fair (range 0.06 to 0.35). There were some observed differences between sex, education, BMI and urban/rural and between countries. CONCLUSIONS: Overall GPAQ provides reproducible data and showed a moderate-strong positive correlation with IPAQ, a previously validated and accepted measure of physical activity. Validation of GPAQ produced poor results although the magnitude was similar to the range reported in other studies. Overall, these results indicate that GPAQ is a suitable and acceptable instrument for monitoring physical activity in population health surveillance systems, although further replication of this work in other countries is warranted.

Validation of the intensity of walking for pleasure in obese adults.

BACKGROUND: Despite evidence that 'walking for pleasure' represents the most common leisure-time physical activity, the exercise intensity associated with 'walking for pleasure' in the obese has not been established. METHODS: Heart rate (HR), perceived exertion (RPE) and walking speed were assessed for 30 obese and 20 non-obese adults as they completed two 2 km-walk tests on alternate days and were compared with a third 2 km walk with subjects walking 'as fast as possible'. RESULTS: Despite both obese (O) and non-obese (NO) groups rating the intensity of 'walking for pleasure' as 'light', HR and RPE data for only the NO group complied with definitions of 'light' intensity effort. 'Walking for pleasure' was characterised by a higher absolute (15 bpm, P < 0.05) and relative (70% of predicted maximum, P < 0.01) HR in the O group, which was representative of the transition between 'moderate' and 'hard' intensity exercise. The findings in the third, maximal trial were comparable across groups for all variables. CONCLUSION: Adiposity exerts a relative elevation-of-intensity effect on the cardiovascular system at walking speeds consistent with 'walking for pleasure'. 'Walking for pleasure' is sufficient to improve cardiovascular fitness in obese, but not normal-weight, individuals.

Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome.

A double-blinded placebo-controlled trial was performed to evaluate the use of steroid injections beneath the transverse carpal ligament in the treatment of carpal tunnel syndrome (CTS) refractory to nonsurgical therapy. Forty-three patients received 6 mg betamethasone and lidocaine and 38 patients received 1 ml saline placebo and lidocaine. The primary outcome measure was satisfaction with symptom relief. Thirty patients (70%) in the steroid-treated group were satisfied or highly satisfied compared with 13 (34%) of placebo-treated patients (P < 0.001). Patients receiving steroids also showed significant improvement in median nerve conduction parameters and scores on validated symptom/function questionnaires. Forty-six patients were treated with serial injections for recurrent CTS symptoms. After 18 months, 17 patients reported adequate symptom relief with steroid injection, and 18 patients with unsatisfactory symptom relief were referred for carpal tunnel release surgery. We conclude that although steroid injections are safe and effective for temporary relief of CTS, most patients will eventually require surgery for long-term control of their symptoms.