WHO Global Action Plan Research Articles

Sodium in the New Zealand diet: proposed voluntary food reformulation targets will not meet the WHO goal of a 30% reduction in total sodium intake

PurposeTo simulate the potential impact of the HeartSAFE 2020 programme, a food reformulation initiative by the New Zealand (NZ) Heart Foundation, on sodium intake in the NZ adult population.MethodsA representative sample of NZ adults aged 15 years and older completed a 24-h diet recall survey, with 25% of participants completing a second diet recall, in the 2008/09 New Zealand Adult Nutrition Survey (n = 4721). These data were used to estimate sodium intakes of participants. The effect of altering the sodium content of 840 foods in 17 categories and 35 sub-categories included in the NZ HeartSAFE 2020 programme was simulated. The simulated sodium intake reductions in each food sub-category for the entire sample were calculated. Using sampling weights, simulated reductions in population sodium intake and by sociodemographic subgroups were also analysed.ResultsSodium intake from foods included in the HeartSAFE 2020 programme was 1307 mg/day (95% CI 1279, 1336) at baseline. After applying the HeartSAFE 2020 targets, potential sodium intake was 1048 mg/day (95% CI 1024, 1027). The absolute sodium reduction was 260 mg/day (95% CI 252, 268), corresponding to 20% sodium reduction for the foods included in the NZ HeartSAFE programme.ConclusionCurrent sodium targets featured in the NZ HeartSAFE programme will not meet the 30% sodium intake reduction set out by the WHO Global Action Plan. A more comprehensive strategy consistent with the WHO SHAKE Technical Package is needed to advance the goal of sodium intake reduction.

Extending political will into action in African LMICs: abating global antimicrobial resistance

Extending political will into action in African LMICs: abating global antimicrobial resistance

Global consumption of antimicrobials: impact of the WHO Global Action Plan on Antimicrobial Resistance and 2019 coronavirus pandemic (COVID-19).

Little is known about the effect of the COVID-19 pandemic on antimicrobial consumption worldwide. To describe the impact of the WHO Global Action Plan on Antimicrobial Resistance (GAP-AMR) on antimicrobial consumption pre-pandemic and to evaluate the impact of the COVID-19 pandemic on antimicrobial consumption worldwide. A cross-sectional time-series analysis using a dataset of monthly purchases of antimicrobials (antibiotics, antivirals and antifungals) from August 2014 to August 2020. Antimicrobial consumption per 1000 population was assessed pre-pandemic by economic development status using linear regression models. Interventional autoregressive integrated moving average (ARIMA) models tested for significant changes with pandemic declaration (March 2020) and during its first stage from April to August 2020, worldwide and by country development status. Prior to the pandemic, antimicrobial consumption decreased worldwide, with a greater apparent decrease in developed versus developing countries (-8.4%, P = 0.020 versus -1.2%, P = 0.660). Relative to 2019, antimicrobial consumption increased by 11.2%, P < 0.001 in March 2020. The greatest increase was for antivirals in both developed and developing countries (48.2%, P < 0.001; 110.0%, P < 0.001) followed by antibiotics (6.9%, P < 0.001; 5.9%, P = 0.003). From April to August 2020, antimicrobial consumption decreased worldwide by 18.7% (P < 0.001) compared with the previous year. Specifically, antibiotic consumption significantly decreased in both developed and developing countries (-28.0%, P < 0.001; -16.8%, P < 0.001). The global decrease in antimicrobial consumption pre-pandemic suggests a positive impact of the WHO GAP-AMR. During the pandemic, an initial increase in antimicrobial consumption was followed by a decrease worldwide. AMR plans should specify measures to ensure full implementation of AMR efforts during health crises such as the COVID-19 pandemic.

P04 An evaluation of antimicrobial stewardship education in the School of Pharmacy of an Irish university—a mixed methods study

BackgroundAntimicrobial stewardship (AMS) is essential to control the emergence of antimicrobial resistance (AMR) which has become an international health priority. Education of undergraduate students on AMS and AMR is a strategic objective in the WHO Global Action Plan on AMR and Ireland's National Action Plan.1,2 Research on AMS/AMR education has focused primarily on medical students with less emphasis on those from other healthcare profession including pharmacy students.ObjectivesTo investigate AMS and AMR education in the Pharmacy undergraduate programme in the School of Pharmacy of an Irish University.MethodsA mixed methods study was conducted. Ten semi-structured interviews were conducted in October 2019 with academic staff to capture their views on AMS education. Participants included staff members from different disciplines, those identified as involved in teaching elements of infectious disease, antibiotics, AMS and related topics, and those involved in curriculum design and approval within the School of Pharmacy. Interview transcripts were analysed by thematic analysis. An electronic survey of 17 questions was emailed to all second to fifth year UCC Pharmacy students in October 2019 to gather students’ views and experiences of AMS education. The survey contained four sections which addressed demographics, AMS, resources and education using open-ended, closed-ended or Likert-scale questions. Ethical approval was obtained.ResultsSix key themes were identified from the ten interviews: (i) curriculum priorities and capacity; (ii) housing of the subject, fragmentation and cohesion; (iii) integration; (iv) communication; (v) teaching methods; and (vi) assessment methods. 113 students participated in the survey (32.3% response rate). 96% agree that a strong knowledge of antimicrobials for their future careers is important, and over 89% of students desire more education on AMR and AMS. Only 43% of students found their AMS education provided sufficient preparation for practice. Students felt most prepared to recognize clinical signs of infection and least prepared for IV to oral switching, interpreting biological marker and de-escalation of antimicrobials. Over 50% of students never used or were not familiar with the national primary care antimicrobial guidelines: www.antibioticprescribing.ie.ConclusionsPharmacy students and staff agree that AMS and AMR are important and need enhanced educational focus. Students feel there are gaps in their AMS education and expressed a desire for more education in this area. Improved communication and identification of curriculum priorities by staff could help to establish a more cohesive and comprehensive educational approach to this area.

The European Food Regulatory Environment Index: a tool to monitor progress in implementing food environment policies.

BackgroundEvidence based health policy, such as that put forward in the European Food and Nutrition Action Plan 2015–2020 and the WHO Global Action Plan on the Prevention and Control of Noncommunicable Diseases, has a role in curbing the consumption of unhealthful foods and drink. We ask how countries are performing in the adoption of these policies and how the comprehensiveness of their food environment policies explains variations in consumption of unhealthful products across Europe.MethodsIn order to assess the state of policy adoption, we developed a composite indicator—the Food Regulatory Environment Index (FREI) for which we calculated unweighted and weighted formulations according to the strength of the evidence base. We used linear regression models to explain variations in the consumption of unhealthful products as well as variations in a composite indicator of obesogenic diets.ResultsOverall, wealthier countries in the Region perform better. The weighting of the constituent policies does not affect the rankings. We find negative associations between unweighted and weighted formulations of the Index and household consumption of sugary and carbonate drinks as well as with the composite indicator for obesogenic diets.ConclusionsThe main strength of this study is the comprehensiveness and comparability of the policy data across the relatively large number of countries covered. There is a negative association that is statistically significant, between all formulations of the FREI and the household consumption of sugary and carbonated drinks. There is also a negative association between some FREI formulations and obesogenic diets.

From Plan to Impact IV, progress towards the WHO global action plan on dementia

AbstractBackgroundAt the World Health Assembly 2017, the World Health Organization launched the Global action plan on the public health response to dementia 2017‐2025. Alzheimer's Disease International (ADI) monitors progress towards the action areas and targets of the Global plan and in May 20201 will publish "From plan to impact IV", which is especially poignant in the context of Covid‐19.MethodADI continuously gathers information and updates relating to the 7 action areas of the Global action plan through our network of over 100 member associations and federations globally, as well as our contacts and partners in research, science, health and care, people living with dementia and carers. A specific analysis of progress towards the key goal of developing national dementia plans or strategies is a focal point of the research. In addition there will be a focus on the impact and implications of Covid‐19, including disruption to services, diagnosis and research.ResultThere was some encouraging policy developments in 2020 despite the challenges of Covid‐19, with the governments of China, Dominican Republic, Germany and Iceland developing national dementia plans. However, there are still only 35 national plans in existence, increasing urgency, and a need for a new focus and mobilisation to reach the central goal of the Global action plan, of 146 Member States developing a plan by 2025. This equates to the need for over 25 new plans every year.ConclusionProgress is being made across all 7 action areas of the Global action plan on dementia, with hope in the form of potential breakthroughs in disease modifying treatments and diagnostics, but this too is reflected in the need for much better healthcare preparedness. ADI, working with WHO and our partners, will continue to focus attention on governments across the world to take action, to develop robust and well‐funded national plans and to monitor their progress and to fulfil their commitments in adopting the Global action plan on dementia.

Diagnosing foreign patients in Europe: An EADC‐ISTAART study

AbstractBackgroundThe detection rate of people with neurocognitive disorder is low (20‐50%) even in highly developed countries. Early detection is a global priority (Aim 4 of WHO Global Action Plan on Dementia). Among the barriers to timely diagnosis in Europe is the migration status, which is currently increasing in prevalence, limiting access to specific assessments and care due to language barriers.MethodsWithin a wider European Alzheimer’s Disease Consortium (EADC) – ISTAART survey aimed at exploring the implementability of standard neuropsychological assessment in memory clinics, we examined the frequency and modality of assessments of foreign patients across tertiary memory clinics in Europe.ResultsPreliminary data show that in over 50% of EADC memory clinics, for which we have survey returns, foreign patients are assessed frequently (3 of 49 responding sites report daily, and 24/49 report monthly foreign assessments). Countries with more frequent requests are Belgium (4/4 Belgium responders report assessing foreign patients often, i.e. daily or monthly), Croatia (1/1), Czech Republic (1/1), Denmark (1/1), France (3/5), Germany (7/8), Sweden (2/2), Switzerland (4/4), and the United Kingdom (1/2). Only 9/49 centers reported using an interpreter often (&gt;60% of assessed foreign cases). The majority (33/49) translate local tests; however, as many as 19 centers do use culture‐ and language‐specific tests for foreign patients. Discussion: In tertiary European memory clinics, requests for assessments in a foreign language are very frequent, but the testing practices used for this purpose vary across sites. Our survey was conducted in centers of excellence and may not be fully representative: non‐academic centers are expected to be even more heterogeneous in their practices. This survey allows us to define more specific investigations, and to devise interventions to improve detection of neurocognitive disorders among foreign patients.ConclusionActions specifically dedicated to proper assessment of foreign people may contribute to improve early detection of neurocognitive disorders.

Nourishing our future: the Lancet Series on adolescent nutrition

Adolescence is a time of phenomenal growth. During adolescence height velocity is second only to the first 2 years of life 1 Patton G Sawyer S Santelli J et al. Our future: a Lancet Commission on adolescent health and wellbeing. Lancet. 2016; 387: 2423-2478 Summary Full Text Full Text PDF PubMed Google Scholar , 2 Depauw E Oxley D Toddlers, teenagers, and terminal heights: the importance of puberty for male adult stature, Flanders, 1800–76. Econ Hist Rev. 2019; 72: 925-952 Crossref Scopus (10) Google Scholar and every physiological system is transformed. 3 Prentice AM Ward KA Goldberg GR et al. Critical windows for nutritional interventions against stunting. Am Clin Nutr. 2013; 97: 911-918 Crossref PubMed Scopus (276) Google Scholar Yet adolescent growth and nutrition have been overlooked in the UN Decade of Action on Nutrition (2016–25). The Sustainable Development Goals for nutrition include no adolescent-specific targets. 4 WHOGlobal targets 2025 to improve maternal, infant and young children nutrition. World Health Organization, Geneva2017 Google Scholar WHO's global action plan for the prevention and control of non-communicable diseases similarly had no clearly specified targets for overweight and obesity in older children or adolescents. 5 WHOGlobal action plan for the prevention and control of noncommunicable diseases 2013–2020. World Health Organization, Geneva2013 Google Scholar Donor investments in adolescent nutrition remain woefully inadequate. 6 Li ZH Li MQ Patton GC Lu CL Global development assistance for adolescent health from 2003 to 2015. JAMA Netw Open. 2018; 1e181072 Crossref PubMed Google Scholar Adolescent underweight and micronutrient deficiencies persist in many places as the world faces increases in adolescent overweight and obesity. From 1990 to 2016, the number of adolescents affected by overweight and obesity globally more than doubled to almost one in five while the absolute number of adolescents with anaemia increased by 20% to almost one in four. 7 Azzopardi PS Hearps SJ Francis KL et al. Progress in adolescent health and wellbeing: tracking 12 headline indicators for 195 countries and territories, 1990–2016. Lancet. 2019; 393: 101-118 Summary Full Text Full Text PDF Scopus (89) Google Scholar Nutrition in adolescent growth and developmentDuring adolescence, growth and development are transformative and have profound consequences on an individual's health in later life, as well as the health of any potential children. The current generation of adolescents is growing up at a time of unprecedented change in food environments, whereby nutritional problems of micronutrient deficiency and food insecurity persist, and overweight and obesity are burgeoning. In a context of pervasive policy neglect, research on nutrition during adolescence specifically has been underinvested, compared with such research in other age groups, which has inhibited the development of adolescent-responsive nutritional policies. Full-Text PDF Food choice in transition: adolescent autonomy, agency, and the food environmentDietary intake during adolescence sets the foundation for a healthy life, but adolescents are diverse in their dietary patterns and in factors that influence food choice. More evidence to understand the key diet-related issues and the meaning and context of food choices for adolescents is needed to increase the potential for impactful actions. The aim of this second Series paper is to elevate the importance given to adolescent dietary intake and food choice, bringing a developmental perspective to inform policy and programmatic actions to improve diets. Full-Text PDF Strategies and interventions for healthy adolescent growth, nutrition, and developmentAdolescence is a pivotal point in the life course, characterised by transformative physical, cognitive, and emotional growth, an openness to change, and a drive to reshape the social environment. It offers unique opportunities to adopt changes in diet and physical activity that can persist into later life. Yet pre-existing nutritional problems, including micronutrient deficiencies, food insecurity, and poor-quality diets, persist at the same time as adolescents face the rapid emergence of an obesity epidemic. Full-Text PDF

A new global policy framework for adolescent nutrition?

This new Lancet series on adolescent nutrition 1 Norris SA Frongillo EA Black MM et al. Nutrition in adolescent growth and development. Lancet. 2021; (published online Nov 29.)https://doi.org/10.1016/S0140-6736(21)01590-7 Summary Full Text Full Text PDF Google Scholar , 2 Neufeld LM Andrade EB Suleiman AB et al. Food choice in transition: adolescent autonomy, agency, and the food environment. Lancet. 2021; (published online Nov 29.)https://doi.org/10.1016/S0140-6736(21)01687-1 Summary Full Text Full Text PDF PubMed Google Scholar , 3 Hargreaves D Mates E Menon P et al. Strategies and interventions for healthy adolescent growth, nutrition, and development. Lancet. 2021; (published online Nov 29.)https://doi.org/10.1016/S0140-6736(21)01593-2 Summary Full Text Full Text PDF PubMed Google Scholar sets out the challenges and opportunities for addressing healthy adolescent nutrition and development. Adolescence is a time when the multiple faces of malnutrition clearly materialise, as exemplified by overweight adolescents who were stunted children, or obese children with micronutrient deficiencies. This is also a time of extreme plasticity of the body and of changing lifestyles and norms when unhealthy behaviours can be adopted or instead virtuous circles of healthy behaviours can be established. Nourishing our future: the Lancet Series on adolescent nutritionAdolescence is a time of phenomenal growth. During adolescence height velocity is second only to the first 2 years of life1,2 and every physiological system is transformed.3 Yet adolescent growth and nutrition have been overlooked in the UN Decade of Action on Nutrition (2016–25). The Sustainable Development Goals for nutrition include no adolescent-specific targets.4 WHO's global action plan for the prevention and control of non-communicable diseases similarly had no clearly specified targets for overweight and obesity in older children or adolescents. Full-Text PDF Nutrition in adolescent growth and developmentDuring adolescence, growth and development are transformative and have profound consequences on an individual's health in later life, as well as the health of any potential children. The current generation of adolescents is growing up at a time of unprecedented change in food environments, whereby nutritional problems of micronutrient deficiency and food insecurity persist, and overweight and obesity are burgeoning. In a context of pervasive policy neglect, research on nutrition during adolescence specifically has been underinvested, compared with such research in other age groups, which has inhibited the development of adolescent-responsive nutritional policies. Full-Text PDF Food choice in transition: adolescent autonomy, agency, and the food environmentDietary intake during adolescence sets the foundation for a healthy life, but adolescents are diverse in their dietary patterns and in factors that influence food choice. More evidence to understand the key diet-related issues and the meaning and context of food choices for adolescents is needed to increase the potential for impactful actions. The aim of this second Series paper is to elevate the importance given to adolescent dietary intake and food choice, bringing a developmental perspective to inform policy and programmatic actions to improve diets. Full-Text PDF Strategies and interventions for healthy adolescent growth, nutrition, and developmentAdolescence is a pivotal point in the life course, characterised by transformative physical, cognitive, and emotional growth, an openness to change, and a drive to reshape the social environment. It offers unique opportunities to adopt changes in diet and physical activity that can persist into later life. Yet pre-existing nutritional problems, including micronutrient deficiencies, food insecurity, and poor-quality diets, persist at the same time as adolescents face the rapid emergence of an obesity epidemic. Full-Text PDF

Legal strategies to improve physical activity in populations.

The World Health Assembly has adopted the World Health Organization’s (WHO) recommended target of achieving a 15% reduction in physical inactivity by 2030. The WHO Global Action Plan on Physical Activity provides a framework for countries to achieve this, using a systems-based approach to address the social and environmental determinants of physical inactivity. Lack of progress in many countries indicates a need to identify new ways of addressing this public health priority. WHO continues to highlight the importance of legislative and regulatory measures within the multicomponent and multisectoral action needed to reduce physical inactivity. Yet research into the role of law for addressing physical inactivity has been limited, in contrast to the legal approaches to other major noncommunicable disease risk factors such as smoking and alcohol use. Conceptual frameworks for public health law offer a method for mapping and understanding the determinants, mechanisms and outcomes of law-making for the promotion of physical activity within populations. We describe the development and application of a framework that aligns legal strategies with the WHO Global Plan policy objectives. This new framework – the Regulatory Approaches to Movement, Physical Activity, Recreation, Transport and Sport – can help policy-makers to use the untapped potential of legal interventions to support or strengthen a whole-system response for promoting physical activity. The framework illustrates the role of legal interventions to improve physical activity and identifies opportunities for research to advance understanding, implementation and evaluation of legal responses to this issue.

The World Cancer Declaration: time to consolidate wins and work towards 2025.

In 2011, a Comment published in The Lancet Oncology outlined the indicators required to monitor the impact of the World Cancer Declaration, a call to action to address the growing burden of cancer globally. 1 Adams C Torode J Henshall S Cazap E Ryel AL Grey N The World Cancer Declaration: from resolution to action. Lancet Oncol. 2011; 12: 1091-1092 Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar The World Cancer Declaration targets were subsequently aligned to those of the WHO Global Action Plan on non-communicable diseases, which laid out actions to be implemented by 2025. 10 years later and just 4 years away from 2025, has there been progress? Concerns over the World Cancer Declaration outcome analysisIn their Comment in The Lancet Oncology, Sonali Johnson and colleagues1 discussed the progress of the World Cancer Declaration targets, which were aligned to the WHO Global Action Plan on non-communicable diseases. We agree that the vision remains relevant and, to succeed in achieving these targets, we must do more. However, we take this opportunity to discuss the intricacies of various targets and progress. Full-Text PDF

World Alzheimer Report 2019: Attitudes to dementia, a global survey

AbstractBackgroundIn 2019 Alzheimer’s Disease International (ADI) undertook the biggest global survey on attitudes to dementia, with 70,000 people across 54 countries participating. Alongside expert essays, case studies and programmes to tackle stigma, the survey results formed the core of the 2019 World Alzheimer ReportMethodADI commissioned London School of Economics &amp; Political Science to create and design a global survey engaging 4 distinct audiences: people living with dementia, carers, healthcare professionals and the general public. The survey was distributed online, through the ADI network, with an offline/supported option for assisted completion.ResultHeadlines. 95% of respondents think they will develop dementia in their lifetimes. 78% are concerned. 2 in 3 people think dementia is a normal part of ageing. 62% of healthcare practitioners that resounded believe dementia is a normal part of ageing. 1 in 4 believes there is nothing you can do about it. 82% would take a genetic test. 54% believe lifestyle factors play a part in developing dementia.ConclusionThree years after the introduction of the WHO Global action plan on dementia, with a clear objective of raising awareness, it is evident that stigma is still one of the major barriers to people seeking out information, advice, support and even a diagnosis. Increasing awareness and tackling stigma is vital, not only to help improve the lives of those living with a diagnosis but to ensure that risk reduction messages have impact. There is evidently also still a need to improve understanding of dementia as a medical condition, and not just a normal part of ageing, for both the general public but also healthcare practitioners.

Disclosure of individual‐specific results to participants of a dementia prevalence study: A qualitative study

AbstractBackgroundDementia research and innovation is action area 7 of the WHO Global action plan on the public health response to dementia. Effective progress in this area depends on the promotion of participation in research both for people with and for those without dementia. However, evidence suggests that current research ethics policies and norms take participants’ preferences in little account, and may hinder equitable opportunities to take part in epidemiological research. Before conducting an epidemiological study into dementia and its impact, whose primary outcome is prevalence of dementia based on a probabilistic dementia diagnosis, we conducted a qualitative study to explore participants’ understanding of the meaning of individual‐specific results and on their preferences regarding their return.MethodBetween July 2019 and January 2020, we conducted interviews with individuals who participated in the validation phase of an epidemiological study (N = 22). Participants were 65 years old or older and resident in the Italian‐speaking part of Switzerland. We elicited information on their participation experience in the validation study, their reasons for participation (including expectations and potential barriers), their opinion on the return of research results, their understanding of these results. We also explored the communication preferences and the personal justification in favor or against the and the anticipated feelings with respect to the return of results. Finally, we discussed their preferences regarding the provision of informed consent for the return of study results. All interviews were recorded, transcribed and analyzed using thematic analysis techniques.ResultMost participants reported that researchers have a duty to share individual‐specific results with participants if requested to, and that these results must meet certain validity and reliability criteria. The main reasons in support for the return include the desire to know/ exclude oneself dementia diagnosis, and the need to establish a relationship of mutual trust between researchers and participants.ConclusionIn the context of an epidemiological study on dementia, researchers should demonstrate the validity of individual results (including dementia diagnosis) and offer in advance to participants the opportunity to receive this information accounting for their preferences and values.

Benchmarking national action plans on antimicrobial resistance in eight selected LMICs: Focus on the veterinary sector strategies.

BackgroundThe WHO Global Action Plan on antimicrobial resistance (GAP) provides a global strategy for combating antimicrobial resistance. Context-specific national action plans (NAP) translate GAP to reflect local priorities. However, the process by which countries translate GAP into NAPs, and the resultant concordance, is not well-known. The aim of the paper is to evaluate the NAPs of eight selected low- and lower-middle income countries (LMICs) against GAP and each other to identify best practices with a focus on the veterinary sector.MethodsUsing the WHO GAP, and the WHO Manual for designing NAPs, we performed a policy content evaluation for: Afghanistan, Bangladesh, Ethiopia, Ghana, Nepal, Nigeria, Pakistan and Uganda. NAPs were assessed as concordant with GAP if they contained ≥80% of the recommendations. Operational and monitoring and evaluation (M&E) plans were assessed as: Specific, Measurable, Assignable, and Time-bound (or SMAT). Financing, targets and legislation for antimicrobial use reduction, and medicine quality assurance mechanisms were assessed using a constructed framework. Countries were then ranked using a scoring system to identify best practices.ResultsAll NAPs contained ≥80% of GAP’s recommendations. Whereas Nepal’s NAP was strategic, the rest were operational and uniformly SMAT; except Afghanistan’s. The M&E plans were not all SMAT. Detailed costing and funding sources were included for only Ghana and Uganda. Quantitative target for antimicrobial use reduction was found only in Nepal’s NAP and legislation only for Bangladesh. Ghana’s and Uganda’s medicine quality assurance mechanisms were the most robust.ConclusionsAll NAPs were concordant with GAP. However, gaps exist in relation to M&E, diminishing the countries’ capacity to be accountable and implement corrective action if necessary. Most lacked financing plans and targets for antimicrobial use reduction. The antimicrobial quality assurances strategies are limited in most of the NAPs assessed. A mechanism by which countries can benchmark their NAP would allow identification of specific limitations and areas of best practice.

Atividade física nas prioridades da OMS:

Pretende-se debater a indução internacional de políticas de promoção de atividade física no Brasil, tomando o plano de ação global da OMS, More Active People For a Healthier World, como documento norteador, o Sistema Único de Saúde como contexto, e a perspectiva da determinação social da saúde como fundamentação teórica. Advoga-se deslocar a inatividade física do combate às DCNT para integrar a atividade física às políticas de promoção de saúde na Atenção Primária, tomando as condições crônicas como processo de mediação. Reconhecemos que as orientações da OMS têm forte poder de indução, todavia, não garante resultados. Estudos futuros poderão mapear como os gestores cumpriram o plano de ação da OMS, tendo em vista o contexto de saúde brasileiro.

World Health Organization 2020 guidelines on physical activity and sedentary behaviour

ObjectivesTo describe new WHO 2020 guidelines on physical activity and sedentary behaviour.MethodsThe guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations...

Trend of salt intake measured by 24-h urine collection in the Italian adult population between the 2008 and 2018 CUORE project surveys

Background and aimsThe WHO Global Action Plan for the Prevention of non-communicable diseases (NCDs) recommends a 30% relative reduction in mean population salt/sodium intake. The study assessed the trend in the habitual salt intake of the Italian adult population from 2008 to 2012 to 2018–2019 based on 24-h urinary sodium excretion, in the framework of the CUORE Project/MINISAL-GIRCSI/MENO SALE PIU’ SALUTE national surveys. Methods and resultsData were from cross-sectional surveys of randomly selected age and sex–stratified samples of resident persons aged 35–74 years in 10 (out of 20) Italian Regions distributed in North, Centre and South of the Country. Urinary sodium and creatinine measurements were carried out in a central laboratory. The analyses included 942 men and 916 women examined in 2008–2012, and 967 men and 1010 women examined in 2018–2019. The age-standardized mean daily population salt (sodium chloride) intake was 10.8 g (95% CI 10.5–11.1) in men and 8.3 g (8.1–8.5) in women in 2008–2012 and respectively 9.5 g (9.3–9.8) and 7.2 g (7.0–7.4) in 2018–2019. A statistically significant (p<0.0001) salt intake reduction was thus observed over 10 years for both genders, and all age, body mass index (BMI) and educational classes. ConclusionsThe average daily salt intake of the Italian general adult population remains higher than the WHO recommended level, but a significant reduction of 12% in men and 13% in women has occurred in the past ten years. These results encourage the initiatives undertaken by the Italian Ministry of Health aimed at the reduction of salt intake at the population level.

Quantifying population levels of physical activity in Africa using wearable sensors: implications for global physical activity surveillance

We are all Africans. Local availability of food likely caused the first Homo sapiens to migrate out of Africa some 50 000–70 000 years ago and populate the rest of...

Body mass index and obesity in Italy: results of CUORE Project-Health Examination Survey 2018-2019

Abstract Background The WHO Global Action Plan for the Prevention of Non-Communicable Disease (WHO-NCD) recommends to halt the rise of obesity by 2025. Obesity is largely preventable. This preliminary analysis aims to assess mean level of BMI and prevalence of obesity in the Italian general adult population using the data collected within the CUORE Project to investigate if Italy can meet the WHO-NCD target. Methods Within the health examination survey conducted in 2018-2019, mean level of BMI and prevalence of obesity (BMI &amp;gt; =30 kg/m2) and overweight (25 &amp;lt; =BMI&amp;lt;30 kg/m2) were assessed in representative random samples of resident population, aged 35-74 years, stratified by age and sex (822 men and 869 women), from 8 Italian Regions in Northern, Central and Southern Italy. Weight and height were measured using standardized methods. A standardized questionnaire was used to collect data on educational level that was used as a proxy of socio-economic status. The survey is funded by the Italian Ministry of Health-CCM. Results In this preliminary analysis, mean level of BMI was 26.8 kg/m2 (95% C.I. 26.5-27.1) in men and 25.9 kg/m2 (25.6-26.3) in women. Prevalence of obesity was 19% (16-22) in men and 22% (19-25) in women; prevalence of overweight was 45% (41-48) in men and 28% (25-31) in women. Obesity resulted significantly higher in persons with lower educational level (primary or middle school) vs those with higher education: 26% (20-31) vs 16% (13-19) in men and 33% (27-38) vs 17% (14-20) in women. Both in men and women prevalence of obesity was significantly higher in the Southern regions. Conclusions Preliminary data show that more than half of Italian adults are overweight/obese. However, in comparison to BMI measured in the CUORE Project 10 years earlier, the prevalence of people at normal weight is increasing, moving in the direction of the WHO-NCDs obesity target. Preventive actions at community level should be more incisive in the population at low socio-economic level. Key messages Mean BMI and prevalence of obesity in the Italian general adult population are still high. If confirmed, in the last ten years an increase of normal weight prevalence in the Italian general adult population seems to be occurred.

Sodium intake in Italy from 2008 to 2019: results of the CUORE Project-Health Examination Surveys

Abstract Background The WHO Global Action Plan for the Prevention of NCDs recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan 2014-2019, in collaboration with the Interdisciplinary Working group for Salt Reduction in Italy. To estimate the habitual salt intake and its trend in the general adult population, national surveys, funded by the MoH-CCM, are conducted within the CUORE Project. Methods Baseline salt intake by the use of 24h urine collections was assessed in 2008-2012 from representative random samples of residents in all Italian Regions. A new survey was conducted in 2018-2019 involving random samples of residents in 10 Regions. Urinary sodium excretion is assayed by a central lab at Federico II University of Naples, subjected to strict quality controls. Comparisons are made considering, for both periods, the first seven regions examined in the 2018-2019 survey and the age range of 35-74 years. Results Within the 2008-2012 survey, mean level of sodium chloride per day in 642 men and 627 women were 10.6 g (10.3-11.0 g) and 8.0 g (7.7-8.3 g) respectively, whereas in the 2018-2019 survey the corresponding mean levels in 673 men and 709 women were 9.3 g (95% C.I.: 9.1-9.6 g) and 7.1 g (6.9-7.3 g), respectively. A sodium chloride intake level lower than the WHO recommended target of 5g/day (or 85 mmol/day) was detected in 5% (3-6%) of men and 16% (13-19%) of women examined in 2008-2012 vs 9% (6-11%) of men and 24% (20-27%) of women examined in 2018-2019. Conclusions These preliminary data show that the average habitual sodium intake in Italy is still higher than recommended but a significant reduction seems to occur. These results fully justify and encourage the ongoing preventive initiatives of MoH, facilitating the meeting of the WHO-NCD target. Key messages Habitual salt intake in the Italian general adult population is still higher than the recommended by the WHO. If confirmed, in the last ten years a reduction of habitual salt intake in Italian general adult population seems to be occurred.