Trends and disparities in non-communicable diseases in the Western Pacific region.

The WHO Western Pacific region bears disproportionate deaths from non-communicable diseases (NCDs), with increased overall NCD proportional mortality over the past two decades. The disease burden of mental health increased, resulting from rapid ageing, enhanced stress, and the COVID-19 pandemic, but it was largely neglected. The highly diverse cultures, religions, political systems, socioeconomic contexts, lifestyles, and environmental factors probably have led to massive disparities across countries in NCD mortality, risk factors, and NCD management. Geographically, East Asia had the lowest NCD mortality whilst Pacific islands had the highest. Economic booms, ageing, nutrition transition, social stress, prevalent tobacco use, and fast-increasing obesity and hyperglycaemia are important drivers of NCDs. Men tended to have more adverse behavioural and metabolic risk factors. Rural residents are catching up with their urban counterparts in metabolic risk factors and conditions. Sustainable strategies tailored to NCD patterns are needed to fight the NCD epidemic and related disparities.

A systematic review and narrative synthesis of physical activity referral schemes' components.

BACKGROUND: Physical activity referral schemes (PARS) are complex multicomponent interventions that represent a promising healthcare-based concept for physical activity (PA) promotion. This systematic review and narrative synthesis aimed to identify the constitutive components of PARS and provide an overview of their effectiveness. METHODS: Following a published protocol, we conducted a systematic search of PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE from 1990 to January 2023. We included experimental, quasi-experimental, and observational studies that targeted adults participating in PARS and reported PA outcomes, scheme uptake, or adherence rates. We performed an intervention components analysis using the PARS taxonomy to identify scheme components and extracted data related to uptake, adherence, and PA behavior change. We combined these to provide a narrative summary of PARS effectiveness. RESULTS: We included 57 studies reporting on 36 PARS models from twelve countries. We identified 19 PARS components: a patient-centered approach, individualized content, behavior change theory and techniques, screening, brief advice, written materials, a written prescription, referral, baseline and exit consultation, counselling support session(s), PA sessions, education session(s), action for non-attendance, structured follow-up, a PA network, feedback for the referrer, and exit strategies/routes. The PARS models contained a mean of 7 ± 2.9 components (range = 2-13). Forty-five studies reported PA outcome data, 28 reported uptake, and 34 reported adherence rates. Of these, approximately two-thirds of studies reported a positive effect on participant PA levels, with a wide range of uptake (5.7-100.0%) and adherence rates (8.5-95.0%). CONCLUSIONS: Physical activity referral scheme components are an important source of complexity. Despite the heterogeneous nature of scheme designs, our synthesis was able to identify 19 components. Further research is required to determine the influence of these components on PARS uptake, adherence, and PA behavior change. To facilitate this, researchers and scheme providers must report PARS designs in more detail. Process evaluations are also needed to examine implementation and increase our understanding of what components lead to which outcomes. This will facilitate future comparisons between PARS and enable the development of models to maximize impact.

Public awareness of the alcohol-cancer link in the EU and UK: a scoping review.

BACKGROUND: Alcohol increases cancer risk, but less is known about public awareness of this link. This scoping review summarizes recent findings on the public awareness of alcohol as a cancer risk factor in European Union and UK. METHODS: Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched for papers containing data on awareness of alcohol as cancer risk factor in EU or UK published between January 2017 and December 2022, and complemented with grey literature searches. RESULTS: In total, 45 studies were included covering 18 EU countries (Austria, Belgium, Cyprus, Czechia, Denmark, Finland, France, Germany, Hungary, Ireland, Italy, Netherlands, Poland, Romania, Slovakia, Slovenia, Spain, Sweden) and UK, presenting data collected between 2009 and 2022. Studies covered general population (17 studied a nationally representative sample), women, health professionals, patients and young people. Awareness of alcohol causing cancer in general was higher and studied more often than awareness of alcohol's impact on specific cancers. Among the EU general population, awareness of the link between alcohol and breast cancer ranged between 10% and 20%, head and neck cancer 15-25%, colorectal and oesophagus cancer 15-45% and liver cancer 40%. Awareness was higher among young people and specialized health professions and lower among women (the latter specifically for the breast cancer). CONCLUSIONS: While awareness rates varied depending on the exact question wording, many studies showed low awareness of the alcohol-cancer link, especially for specific types such as breast and colon cancer. Public should be better informed about alcohol consumption-related cancer risk.

Do restaurants comply with reduced salt requests from consumers ordering on meal delivery apps?

BACKGROUND: Chinese urban residents consume more salt from meals prepared outside home than in the past. The purpose of this study is to understand Chinese consumer demand for salt reduction as expressed through their orders on meal delivery apps (MDAs), restaurants' willingness to promote salt reduction, and the extent to which restaurants comply with reduced salt requests. METHODS: We analyzed consumer comments extracted from 718 restaurants on a Chinese MDA called ELEME for orders made in the July-December 2020 timeframe. A self-designed questionnaire was distributed to the restaurant managers to assess restaurants' attitude towards salt reduction upon signing up for the study, and laboratory validation was conducted to test whether dishes ordered with reduced salt requests by consumers actually contained less salt. RESULTS: A total of 25,982 (0.7%) orders out of 3,630,798 orders contained consumer comments. Of the consumer comments, 40.6% (10,549) were about requests for less salt in dishes. Totally 91.5% of 421 surveyed restaurants showed a willingness to respond to consumers' reduced salt requests. The median sodium content measured in the reduced-salt dishes by the laboratory was significantly lower than that in their regular salt counterparts (P < 0.05). CONCLUSIONS: We observed substantial consumer demand for salt reduction while ordering meals on the MDA and that restaurants did, in response, reduce the sodium content in the meals they provided. As meals delivered via MDAs comprise an increasing proportion of outside foods consumed, there is an opportunity for public health experts and policy makers to work with MDAs and restaurants to promote healthier food selections. TRIAL REGISTRATION: ChiCTR2100047729.

The Development and Potential of a Digital out of Home Food Environment Monitoring Platform.

The rapidly growing field of digital meal delivery platforms has transformed the out of home (OOH) food environment, presenting both opportunities and challenges for public health. This paper introduces the development and potential of a novel digital platform designed for monitoring the OOH food environment. Drawing on publicly available data from meal delivery applications, this platform provides valuable insights into the landscape of digital food offerings, such as the most common restaurants per region, average caloric content per meal type, and energy value per monetary unit. This research addresses the current void in regulations for this digital environment, particularly around food labeling and provision of nutrition information. Even though the platform has significantly improved our understanding of the digital food ecosystem, it highlights gaps, primarily due to the lack of publicly available individual data and inconsistencies in provided information. Despite these challenges, the proposed digital platform holds considerable promise for better understanding the digital food environment, supporting healthier food choices, and informing future policy interventions aimed at regulating the online food environment. This research advocates for mandatory regulations in the digital food sector to ensure comprehensive, comparable, and transparent nutrition information and equality in access to nutritious foods.

Towards digital healthy ageing: the case of Agatha and priorities moving forward.

Digital tools have an important role to play in meeting the health demands of ageing societies. However, current technological design paradigms often marginalize older people. We adopted a lean, user-centred approach to prototype the Avatar for Global Access to Technology for Healthy Ageing (Agatha), an interactive one-stop shop for healthy ageing promotion. Building on this experience, we present a vision for an integrated approach to "digital healthy ageing". Older people consulted predominantly associated "healthy ageing" with disease avoidance. Digital healthy ageing should take a more holistic approach, covering self-care, prevention, and active ageing. It should also consider social determinants of health in old age, including access to information and digital health literacy, as they interact with poverty, education, access to health services and other structural factors. We use this framework to map out key areas of innovation and explore policy priorities and opportunities for innovation practitioners.

Systematic scoping review of the implementation, adoption, use, and effectiveness of digital contact tracing interventions for COVID-19 in the Western Pacific Region.

A systematic scoping review of digital contact tracing (DCT) interventions for COVID-19 was conducted to describe the implementation, adoption, use and effectiveness of DCT interventions implemented as part of the COVID-19 response in the Western Pacific Region (WPR). A systematic search identified 341 studies and 128 grey literature sources, of which 18 studies and 41 grey literature sources were included. 17 (46%) WPR countries and areas implemented DCT interventions. Adoption ranged from 14.6% to 92.7% in different adult populations and epidemiological contexts. Trust in authorities, and privacy concerns and beliefs, were the most frequent determinants of adoption and use. Only two studies analysed DCT effectiveness, which showed limited to no effectiveness of DCT interventions in low transmission settings. Overall, there is limited evidence available to evaluate the contribution of DCT to mitigating COVID-19 in the WPR. Preparedness for future health emergencies should include developing robust frameworks for DCT effectiveness evaluations.

Digital health interventions for COVID-19 in China: a retrospective analysis.

BACKGROUND: The use of digital health technologies was an integral part to China's early response to coronavirus disease 2019 (COVID-19). Existing literatures have analyzed and discussed implemented digital health innovations from the perspective of technologies, whereas how policy mechanisms contributed to the formulation of the digital health landscape for COVID-19 was overlooked. This study aimed to examine the contexts and key mechanisms in China's rapid mobilization of digital health interventions in response to COVID-19, and to document and share lessons learned. METHODS: Policy documents were identified and retrieved from government portals and recognized media outlets. Data on digital health interventions were collected through three consecutive surveys administered between 23 January 2020 and 31 March 2020 by China Academy of Information and Communication Technology (CAICT) affiliated to the Ministry of Industry and Information Technology (MIIT). Participants were member companies of the Internet Health alliance established by MIIT and the National Health Commission (NHC) in June 2016. Self-report digital interventions focusing on social and economic recovery were excluded. Two hundred and sixty-six unique digital health interventions meeting our criteria were extracted from 175 narratives on digital health interventions submitted by 116 participating companies. Thematic analysis was conducted to describe the scope and priority of policies advocating for the use of digital health technologies and the implementation pattern of digital health interventions. Data limitations precluded an evaluation of the impact of digital health interventions over a longer time frame. RESULTS: Between January and March 2020, national policy directives promoting the use of digital technologies for the containment of COVID-19 collectively advocated for use cases in emergency planning and preparedness, public health response, and clinical services. Interventions to strengthen clinical services were mentioned more than the other two themes (n = 15, 62.5% (15/24)). Using digital technologies for public health response was mentioned much less than clinical services (n = 5, 20.8% (5/24)). Emergency planning and preparedness was least mentioned (n = 4, 16.7% (4/24)). Interventions in support of clinical services disproportionately favored healthcare facilities in less resource-constraint settings. Digital health interventions shared the same pattern of distribution. More digital health technologies were implemented in clinical services (n = 103, 38.7% (103/266)) than that in public health response (n = 91, 34.2% (91/266)). Emergency planning and preparedness had the least self-reported digital health interventions (n = 72, 27.1% (72/266)). We further identified case studies under each theme in which the wide use of digital health technologies highlighted contextual factors and key enabling mechanisms. CONCLUSIONS: The contextual factors and key enabling mechanisms through the use of policy instruments to promote digital health interventions for COVID-19 in China include pathway of policy directives influencing the private sector using a decentralized system, the booming digital health landscape before COVID-19, agility of the public sector in introducing regulatory flexibilities and incentives to mobilize the private sector.

Forecasting Future Trends in Obesity across Europe: The Value of Improving Surveillance.

OBJECTIVE: To project the prevalence of obesity across the WHO European region and examine whether the WHO target of halting obesity at 2010 levels by 2025 is achievable. METHODS: BMI data were collected from online databases and the literature. Past and present BMI trends were extrapolated to 2025 using a non-linear categorical regression model fitted to nationally representative survey data. Where only 1 year of data was available, a flat trend was assumed. Where no data were available, proxy country data was used adjusted for demographics. RESULTS: By 2025, obesity is projected to increase in 44 countries. If present trends continue, 33 of the 53 countries are projected to have an obesity prevalence of 20% or more. The highest prevalence is projected for Ireland (43%, 95% confidence interval (CI): 28-58%). Lithuania, Finland, and the Netherlands were each estimated to have an absolute increase of 2 percentage points in the prevalence of obesity between 2015 and 2025. DISCUSSION: The quality of BMI data across Europe is highly variable, with fewer than 50% of the 53 countries having measured nationally representative data and often not enough data to interpret projections meaningfully. Nevertheless, the prevalence of obesity in the European Region appears to be increasing in most countries and, with it, the health and economic burden of its associated diseases. This paints a concerning picture of the future burden of obesity-related noncommunicable diseases across the region. Greater and continued effort for the implementation of effective preventive policies and interventions is required from governments.

The perspectives of politicians on tobacco control in Turkey.

Background: Tobacco use is a leading but preventable cause of non-communicable diseases and premature death. The legislature has a key role in setting tobacco control policies. Smoking trends are decreasing thanks to the introduction of effective tobacco control policies in Turkey and these policies may have been shaped by how politicians' interpreted social problems that were prominent during the development and implementation of tobacco regulations. Aim: This paper explores the long-term national relationship between tobacco consumption, tobacco control policies and the associated political discourse in Turkey, considering the varying influences through national leadership on this important public health agenda. This relationship is studied by comparing a time series analysis of tobacco consumption trends with a policy analysis of the minutes of deliberations at the Grand National Assembly of Turkey (GNAT). Methods: This study uses Bayesian time series analysis in order investigate whether the tobacco control policies and related activities influenced the annual per adult cigarette consumption in Turkey. We used a novel method to identify change points in tobacco trends and whether they correspond with key policy changes intended to alter usage after adjusting for the effect of other non-policy related covariates, such as the purchasing power. The policy analysis included an examination of the minutes of deliberations at the GNAT-which is the Turkish parliament and unicameral Turkish legislature-1 year before and 1 year after the break years associated with an increase or decrease in tobacco consumption. Results and recommendations: Tobacco consumption increased with the encouragement of tobacco production and the entrance of multinational companies in the country in 1976 and 1993, respectively. The National Tobacco Law of 1996 and comprehensive amendments in 2008, including smoke-free public places and tax increases, appear to have helped reduce tobacco consumption in Turkey. The focus of Parliamentary discussions throughout this period changed, becoming less supportive of tobacco over time. However, throughout the period there remained discussions focussing on concerns around the implications for the economy and the privatization agenda, national agriculture and the welfare of farmers. Effective control appears to require certain political ingredients to be implemented: politicians who are well informed on tobacco control measures and understand the range of issues surrounding the policies (not only those directly health-related); and supportive public health information in the community. Evidence-based public health policy should be introduced to the politicians.

Promoting health-enhancing physical activity in Europe: Current state of surveillance, policy development and implementation.

This study aims to present information on the surveillance, policy developments, and implementation of physical activity policies in the 28 European Union (EU) countries. Data was collected on the implementation of the EU Recommendation on health-enhancing physical activity (HEPA) across sectors. In line with the monitoring framework proposed in the Recommendation, a questionnaire was designed to capture information on 23 physical activity indicators. Of the 27 EU countries that responded to the survey, 22 have implemented actions on more than 10 indicators, four countries have implemented more than 20 indicators, and one country has fully addressed and implemented all of the 23 indicators of the monitoring framework. The data collected under this HEPA monitoring framework provided, for the first time, an overview of the implementation of HEPA-related policies and actions at the national level throughout the EU. Areas that need more investment are the "Senior Citizens" sector followed by the "Work Environment", and the "Environment, Urban Planning, and Public Safety" sectors. This information also enabled comparison of the state of play of HEPA policy implementation between EU Member States and facilitated the exchange of good practices.

Biomechanical coupling facilitates spinal neural tube closure in mouse embryos.

Neural tube (NT) formation in the spinal region of the mammalian embryo involves a wave of "zippering" that passes down the elongating spinal axis, uniting the neural fold tips in the dorsal midline. Failure of this closure process leads to open spina bifida, a common cause of severe neurologic disability in humans. Here, we combined a tissue-level strain-mapping workflow with laser ablation of live-imaged mouse embryos to investigate the biomechanics of mammalian spinal closure. Ablation of the zippering point at the embryonic dorsal midline causes far-reaching, rapid separation of the elevating neural folds. Strain analysis revealed tissue expansion around the zippering point after ablation, but predominant tissue constriction in the caudal and ventral neural plate zone. This zone is biomechanically coupled to the zippering point by a supracellular F-actin network, which includes an actin cable running along the neural fold tips. Pharmacologic inhibition of F-actin or laser ablation of the cable causes neural fold separation. At the most advanced somite stages, when completion of spinal closure is imminent, the cable forms a continuous ring around the neuropore, and simultaneously, a new caudal-to-rostral zippering point arises. Laser ablation of this new closure initiation point causes neural fold separation, demonstrating its biomechanical activity. Failure of spinal closure in pre-spina bifida Zic2Ku mutant embryos is associated with altered tissue biomechanics, as indicated by greater neuropore widening after ablation. Thus, this study identifies biomechanical coupling of the entire region of active spinal neurulation in the mouse embryo as a prerequisite for successful NT closure.