Setting sodium targets for pre-packaged foods in China — an exploratory study

IntroductionSetting sodium targets for pre-packaged food has been a priority strategy for reducing population sodium intake. This study aims to explore the attitudes and considerations of researchers and key stakeholders toward implementing such policy in China.MethodsAn exploratory study comprising a survey and a focus group discussion was conducted among 27 purposively selected participants including 12 researchers, 5 consumers, 4 administrators, 3 industry association representatives and 3 food producers. The survey/discussion covered the key questions considered when developing/promoting sodium targets. Free-text responses were manually classified and summarized using thematic analysis.ResultsTwo-thirds of the participants supported target-setting policy. Researchers and administrators were most supportive, and food producers and associations were least supportive. Adapted WHO food categorization framework was well accepted to underpin target-setting to ensure international comparability and applicability for Chinese products. Maximum values were the most agreed target type. The WHO benchmarks were thought to be too ambitious to be feasible given the current food supply in China but can be regarded as long-term goals. Initially, a reduction of sodium content by 20% was mostly accepted to guide the development of maximum targets. Other recommendations included implementing a comprehensive strategy, strengthening research, engaging social resources, establishing a systematic monitoring/incentive system, maintaining a fair competitive environment, and developing a supportive information system. Target-setting policy was acceptable by most stakeholders and should be implemented alongside strategies to reduce discretionary salt use.DiscussionOur findings provide detailed guidance for the Chinese government when developing a target-setting strategy. The methods and results of this study also provide meaningful references for other countries to set sodium targets for pre-packaged foods and implement other salt reduction strategies simultaneously

Nutritional Quality of Pre-Packaged Foods in China under Various Nutrient Profile Models

This study used various nutrient profile models (NPMs) to evaluate the nutritional quality of pre-packaged foods in China to inform future food policy development. Nutrition data for pre-packaged foods were collected through FoodSwitch China in 2017–2020. The analyses included 73,885 pre-packaged foods, including 8236 beverages and 65,649 foods. Processed foods (PFs) and ultra-processed foods (UPFs) accounted for 8222 (11.4%) and 47,003 (63.6%) of all products, respectively. Among the 55,425 PFs and UPFs, the overall proportion of products with an excessive quantity of at least one negative nutrient was 86.0% according to the Chilean NPM (2019), 83.3% for the Pan American Health Organization NPM (PAHO NPM), and 90.6% for the Western Pacific Region NPM for protecting children from food marketing (WPHO NPM), respectively. In all NPMs, 70.4% of PFs and UPFs were identified as containing an excessive quantity of at least one negative nutrient, with higher proportions of UPFs compared to PFs. Food groups exceeding nutrient thresholds in most NPMs included snack foods, meat and meat products, bread and bakery products, non-alcoholic beverages, confectionery, and convenience foods. In conclusion, PFs and UPFs accounted for three-fourths of pre-packaged foods in China, and the majority of PFs and UPFs exceeded the threshold for at least one negative nutrient under all three NPMs. Given the need to prevent obesity and other diet-related chronic diseases, efforts are warranted to improve the healthiness of foods in China through evidence-based food policy

An mHealth-based school health education system designed to scale up salt reduction in China (EduSaltS): A development and preliminary implementation study

BackgroundHigh-salt diet is an important risk factor for several non-communicable diseases. School-based health education has been found effective in reducing salt intake among children and their families in China. However, no such interventions have been scaled up in the real world. For this purpose, a study was launched to support the development and scale-up of an mHealth-based system (EduSaltS) that integrated routine health education and salt reduction and was delivered through primary schools. This study aims to elaborate the framework, development process, features, and preliminary scaling-up of the EduSaltS system.MethodsThe EduSaltS system evolved from previously successfully tested interventions to reduce family salt intake by empowering schoolchildren through school health education. EduSaltS was designed by following the WHO’s conceptual framework for developing a scaling-up strategy which accounted for the nature of the innovation, the capacity of the implementing organizations, the characteristics of the environment, the resources available, and type of scaling up. The system was then developed step by step from determination of online platform architecture, definition of component interventions and activities, development of specific educational materials and tools, to the development of the online/offline hybridized system. The system was tested and refined by a pilot in two schools and a preliminary scale-up in two cities in China.ResultsEduSaltS was developed as an innovative health education system, including an online WeChat-based education platform, a set of offline activities, and an actual administrative website showing the progress and setting the system. The WeChat platform could be installed on users’ smartphones to automatically deliver 20 sessions of five-minute well-structured cartoon video classes, followed by other online interactive activities. It also helps support project implementation and real-time performance evaluation. As a first-stage roll-out, a one-year course has been successfully implemented among 54,538 children and their families from 209 schools in two cities, and the average course completion rate was 89.1%.ConclusionAs an innovative mHealth-based health education system, EduSaltS was developed based on successfully tested interventions and an appropriate framework for scaling up. The early-stage roll-out has shown its preliminary scalability, and further evaluation is ongoing

Quality of stroke guidelines in low- and middle-income countries: a systematic review.

OBJECTIVE: To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries. METHODS: We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences. FINDINGS: We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations. CONCLUSION: Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions

Applying systems thinking to identify enablers and challenges to scale-up interventions for hypertension and diabetes in low-income and middle-income countries: protocol for a longitudinal mixed-methods study.

INTRODUCTION: There is an urgent need to reduce the burden of non-communicable diseases (NCDs), particularly in low-and middle-income countries, where the greatest burden lies. Yet, there is little research concerning the specific issues involved in scaling up NCD interventions targeting low-resource settings. We propose to examine this gap in up to 27 collaborative projects, which were funded by the Global Alliance for Chronic Diseases (GACD) 2019 Scale Up Call, reflecting a total funding investment of approximately US$50 million. These projects represent diverse countries, contexts and adopt varied approaches and study designs to scale-up complex, evidence-based interventions to improve hypertension and diabetes outcomes. A systematic inquiry of these projects will provide necessary scientific insights into the enablers and challenges in the scale up of complex NCD interventions. METHODS AND ANALYSIS: We will apply systems thinking (a holistic approach to analyse the inter-relationship between constituent parts of scaleup interventions and the context in which the interventions are implemented) and adopt a longitudinal mixed-methods study design to explore the planning and early implementation phases of scale up projects. Data will be gathered at three time periods, namely, at planning (TP), initiation of implementation (T0) and 1-year postinitiation (T1). We will extract project-related data from secondary documents at TP and conduct multistakeholder qualitative interviews to gather data at T0 and T1. We will undertake descriptive statistical analysis of TP data and analyse T0 and T1 data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks. ETHICS AND DISSEMINATION: The current protocol was approved by the Monash University Human Research Ethics Committee (HREC number 23482). Informed consent will be obtained from all participants. The study findings will be disseminated through peer-reviewed publications and more broadly through the GACD network

Mixed Noise Removal for Hyperspectral Image With <inline-formula><tex-math notation="LaTeX">l0{l_{0}}</tex-math></inline-formula>-<inline-formula><tex-math notation="LaTeX">l1−2{l_{1 - 2}}</tex-math></inline-formula>SSTV Regularization

Hyperspectral images (HSIs) are usually corrupted by various types of mixed noises, which degrades the qualities of acquired images and limits the subsequent applications. In this article, we propose a novel denoised method based on a hybrid spatial&#x2013;spectral total variation (SSTV) regularization, which we refer to as ${l_{0}}$-${l_{1 - 2}}$SSTV. Specifically, ${l_{0}}$-${l_{1 - 2}}$SSTV can be treated as an integrated regularization embedding spatial&#x2013;spectral ${l_{0}}$ gradient model into ${l_{1 - 2}}$SSTV. ${l_{1 - 2}}$SSTV regularization exploits the sparse structures in both spatial and spectral domains. Hence, the correlations within HSIs are fully considered. Due to the good performance of ${l_{1 - 2}}$-norm in image restoration, ${l_{1 - 2}}$SSTV gives a tighter approximation for the gradient domains of HSIs. It can effectively avoid artifacts and oversmoothing caused by the limitation of the SSTV regularization based on ${l_{1}}$-norm (${l_{1}}$SSTV). Meanwhile, the ${l_{0}}$ gradient regularization controls the number of nonzero gradients to promote the local piecewise smoothness, making denoised images preserve clear edges. With the effective combination of ${l_{1 - 2}}$SSTV and ${l_{0}}$ gradient regularization, ${l_{0}}$-${l_{1 - 2}}$SSTV produces high-quality restoration results in the denoising process: better detail preservation and sharper edges. The augmented Lagrangian method and the difference of convex algorithm are exploited to optimize the proposed model. The results for simulated and real experiments demonstrate the effectiveness and superiority of the proposed method compared with state-of-the-art methods

The characteristics of dyslipidemia patients with different durations in Beijing: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Prevalence of dyslipidemia is high and increases even in younger people. The key aim of this study was to explore the group characteristics of patients in different durations of dyslipidemia and provide clues for the management of dyslipidemia in Beijing.</p> <p>Results</p> <p>Patients with short duration of dyslipidemia were mainly characterized by relatively young age, occupational groups, not eating or irregular eating breakfast, less physical activities, having the habit of smoking, and 53.8% is with abnormal LDL-c, 10.4% is with abnormal HDL-c, and 51.5% is with abnormal TG. 54.6% of patients with longer duration is with abnormal LDL-c, 12.8% of them is with abnormal HDL-c, and 57.1% is with abnormal TG. They paid much more attentions to their health, tried to eat breakfast regularly and do more physical activities, gave up smoking, and had regular breakfast, but increasing physiological disorders such as elevated blood pressure and glucose appeared. Severe sequelaes (stroke, myocardial infarction) were mainly observed in patients with the duration of more than 10 years. And in this group the proportions of patients with LDL-c ≥ 4.15 mmol/L and TG ≥ 4.53 mmol/L are the highest among the three groups.</p> <p>Conclusions</p> <p>we should strengthen the tertiary prevention and improve the control rate of dyslipidemia in Beijing. Health promotion programs such as tobacco control and physical exercise should be carried out for younger patients.</p