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Alareeki A, Awad SF, Al-Mawali A, Morsi M, Critchley JA, Al-Lawati JA, Abu-Raddad LJ. Impact of mitigating obesity, smoking, and physical inactivity on type 2 diabetes mellitus burden in Oman: insights from mathematical modeling. BMJ Open Diabetes Res Care 2024; 12:e004248. [PMID: 39097298 DOI: 10.1136/bmjdrc-2024-004248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/05/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION To estimate the impact of reducing obesity, smoking, and physical inactivity (PIA) prevalence, and of introducing physical activity (PA) as an explicit intervention, on the prevalence, incidence, and mortality of type 2 diabetes mellitus (T2DM) in Oman. RESEARCH DESIGN AND METHODS A deterministic population-level mathematical model was employed to investigate the impact of different scenarios for reducing T2DM risk factors on T2DM epidemiology. The model was stratified by sex, age group, risk factor status, T2DM status, and intervention status and parameterized with nationally representative data. Intervention scenarios were calculated and compared with a baseline (no-intervention) scenario for changes in T2DM prevalence, incidence, and mortality among adult Omanis between 2020 and 2050. RESULTS In the no-intervention scenario, T2DM prevalence increased from 15.2% in 2020 to 23.8% in 2050. Achieving the goals of halting the rise of obesity, reducing smoking by 30%, and reducing PIA by 10% as outlined in the WHO's Global Action Plan for Non-communicable Diseases (implemented between 2020 and 2030 and then maintained between 2031 and 2050) would reduce T2DM prevalence by 32.2%, cumulative incidence by 31.3%, and related deaths by 19.3% by 2050. Halting the rise of or reducing obesity prevalence by 10%-50% would reduce T2DM prevalence by 33.0%-51.3%, cumulative incidence by 31.9%-53.0%, and related deaths by 19.5%-35.6%. Reducing smoking or PIA prevalence by 10%-50% would lead to smaller reductions of less than 5% in T2DM prevalence, cumulative incidence, and related deaths. Introducing PA with varying intensities at a 25% coverage would reduce T2DM prevalence by 4.9%-14.1%, cumulative incidence by 4.8%-13.8%, and related deaths by 3.4%-9.6% by 2050. CONCLUSIONS Intervention-for-prevention efforts targeting obesity reduction and introducing PA could result in major reductions in the T2DM burden. Prioritizing such interventions could alleviate the burden of T2DM in Oman and other countries with similarly high T2DM and obesity burdens.
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Affiliation(s)
- Asalah Alareeki
- Infectious Disease Epidemiology Group, World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Susanne F Awad
- Infectious Disease Epidemiology Group, World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Adhra Al-Mawali
- Quality Assurance and Planning, German University of Technology in Oman, Athaibah, Muscat, Oman
- Oman Educational Services LLC, Muscat, Oman
| | - Magdi Morsi
- Centre of Studies & Research, Government of Oman Ministry of Health, Muscat, Masqat, Oman
| | - Julia A Critchley
- Population Health Research Institute, Saint George's University, Saint George, UK
| | - Jawad A Al-Lawati
- Directorate General of Primary Health Care, Government of Oman Ministry of Health, Muscat, Masqat, Oman
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
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Shahabi N, Javdan G, Hosseini Z, Aghamolaei T, Ghanbarnejad A, Behzad A. A health promotion model-based intervention to enhance treatment adherence in patients with type 2 diabetes. BMC Public Health 2024; 24:1943. [PMID: 39030532 PMCID: PMC11264937 DOI: 10.1186/s12889-024-19452-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 07/11/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND The present study aimed to determine the effect of an intervention based on Pender's health promotion model (HPM) on treatment adherence in patients with type 2 diabetes (T2D). METHODS The present quasi-experimental study with a 3-month follow-up was conducted in Bandar Abbas, a city in the south of Iran in 2023. The intervention group (IG) with a total number of 95 T2D patients was selected from Hormuz diabetes clinic and the control group (CG) with 95 T2D patients was selected from comprehensive health centers through a clustering sampling method. The educational intervention was implemented in 10 sessions to improve patients' treatment adherence. The teaching methods in training sessions were lectures, joint discussions, Q&A, role-play and peer training. The participants were evaluated using a researcher-made questionnaire including the constructs of Pender's HPM about T2D treatment adherence, hemoglobin A1C (HbA1C), and BMI. Independent-samples t-test, paired-samples t-test, covariance analysis and stepwise regression analysis were used. Data analysis was done in SPSS 26. FINDINGS Three months after the intervention, in comparison to the CG, the mean and standard deviation of treatment adherence benefits (p = 0.002), treatment adherence self-efficacy (p = 0.010), treatment adherence related affect (p = 0.001), interpersonal influences (p = 0.012), commitment to plan of action (p < 0.001), treatment adherence behavior (p = 0.022), treatment adherence experiences (p = 0.001) was higher in the IG. The mean and standard deviation of situational influences (p < 0.001), immediate competing demands and preferences (p = 0.018) were lower than the CG. The results obtained from the analysis of covariance proved the effectiveness of the intervention in the constructs of Pender's HPM and HbA1C in participants of the IG (p < 0.001). The regression analysis showed, after the intervention, for every 1 unit of change in commitment to behavior planning, action related affect and perceived self-efficacy, compared to before the intervention, there were 0.22 units, 0.16 units and 0.26 units of change in the behavior score in the IG. CONCLUSION The findings proved the effectiveness of the educational intervention in improving the constructs in Pender's HPM and the blood sugar level of T2D patients. As the results of the educational intervention showed, the use of a suitable educational approach as well as the development of appropriate educational content for the target population can significantly improve the treatment adherence behavior. TRIAL REGISTRATION This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1: https://www.irct.ir/trial/61741 ) and first release date of 17th March 2022.
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Affiliation(s)
- Nahid Shahabi
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Gholamali Javdan
- Food Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Zahra Hosseini
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Teamur Aghamolaei
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Ghanbarnejad
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ahmad Behzad
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Natarajan J, Joseph MA, Alawi RA, Bulushi TA, Alawi IA, Junaibi SMA, Thanka AN, Balushi LDA, Ismaili ISA, Shumma M, Nabhani SSTA. Wellbeing, quality of life and satisfaction of patients with hard-to-heal wounds: a descriptive study. J Wound Care 2024; 33:526-532. [PMID: 38967342 DOI: 10.12968/jowc.2022.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
OBJECTIVE A hard-to-heal wound is defined as a wound that failed to proceed through the normal phases of wound healing in an orderly and timely manner. The purpose of this article is to describe the impact of hard-to-heal wounds on the wellbeing, quality of life (QoL) and satisfaction with QoL of patients in Oman with hard-to-heal wounds. METHOD A descriptive cross-sectional study of patients with hard-to-heal wounds attending three tertiary care hospitals using a self-reported questionnaire was conducted. RESULTS A total of 275 patients took part in the study. Patients reported a low wellbeing score (67.06±19.72), moderate QoL score (52.18±25.07) and moderate satisfaction scores (68.91±23.88). Significant mean differences were reported with age, sex, educational level, monthly income and type of wound all at p<0.05. CONCLUSION The findings of this study demonstrated that hard-to-heal wounds could influence the wellbeing, QoL and overall satisfaction with QoL of patients. DECLARATION OF INTEREST Funding was received through an internal grant of the Sultan Qaboos University to conduct the research conducting the research (IG/CON/FACN/20/01). The authors have no conflicts of interest to declare.
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Affiliation(s)
- Jansirani Natarajan
- Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Mickael Antoine Joseph
- Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Rashid Al Alawi
- Surgery Department, Royal Hospital, Muscat, Sultanate of Oman
| | - Taimoor Al Bulushi
- Department of Plastic and Reconstructive Surgery, Khoula Hospital, Muscat, Sultanate of Oman
| | | | - Suad Moosa Al Junaibi
- Adult Health Nursing Department, Oman College of Health Sciences, Muscat, Sultanate of Oman
| | - Anitha Nesa Thanka
- Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | | | | | - Moath Shumma
- Department of Plastic and Reconstructive Surgery, Khoula Hospital, Muscat, Sultanate of Oman
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Mingrone G, Rajagopalan H. Bariatrics and endoscopic therapies for the treatment of metabolic disease: Past, present, and future. Diabetes Res Clin Pract 2024; 211:111651. [PMID: 38580037 DOI: 10.1016/j.diabres.2024.111651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
The burden of chronic metabolic diseases such as obesity, type 2 diabetes mellitus (T2DM), and metabolic dysfunction-associated steatotic liver disease (MASLD) and the urgency of the epidemiological situation necessitate the development of therapies that enhance metabolic health and alter the trajectory of metabolic disease in society. Certain bariatric-metabolic surgeries have proven to be effective approaches for treating metabolic dysfunction, showing remission or significant improvements in obesity, T2DM, and MASLD-related outcomes, suggesting that these interventions might be able to "reset" a pathologically calibrated metabolic setpoint. However, considering the challenges and invasiveness of surgery, endoscopic bariatric metabolic therapies (EBMTs) have emerged with a primary focus to reconstruct or mimic anatomical and/or functional changes observed with bariatric surgery in a more broadly accessible manner. These innovative approaches offer a potentially promising solution to address significant unmet medical need in the large segment of society, which remains at risk for the consequences of metabolic diseases. In this review, we discuss therapeutic options within the EBMT space in the context of the metabolic setpoint intellectual model and provide a brief overview of current knowledge surrounding their mechanisms of action and impact on metabolic health. Finally, we explore future perspectives and directions in this exciting field.
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Affiliation(s)
- Geltrude Mingrone
- Division of Obesity and Metabolic Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy; Division of Diabetes & Nutritional Sciences, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, United Kingdom.
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Wang X, Chen J, Cao Z, Yu X. Associations between human cytomegalovirus infection and type 2 diabetes mellitus: a systematic review and meta-analysis. BMJ Open 2023; 13:e071934. [PMID: 37620256 PMCID: PMC10450059 DOI: 10.1136/bmjopen-2023-071934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE Multiple studies have reported a potential contribution of human cytomegalovirus (HCMV) to the pathogenesis of type 1 diabetes and post-transplantation diabetes. However, the association between HCMV and type 2 diabetes mellitus (T2DM) remains unclear. In this paper, we employ the meta-analysis approach to investigate the potential correlation between HCMV infection and T2DM. METHOD The data of our study were collected from PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure and WAN FANG databases from inception to November 2022. Using the Review Manager V.5.4 software, the meta-analysis was performed. RESULTS A total of 18 139 patients from 22 studies were included in our analysis. In the Asian subgroup, the patients with T2DM group had a significantly higher frequency of HCMV infection and older age compared with the healthy group. In the European, the frequency of HCMV infection in the T2DM was lower than the healthy group, although this difference was not statistically significant. After adjusting for demographic factors, the adjusted OR of T2DM for risk of by HCMV status was not found to be significant (adjusted OR=1.19, 95% CI=0.88 to 1.62, p>0.05). Additionally, T2DM with vasculopathy had a significantly higher rate of HCMV infection compared with those without vasculopathy (OR=1.87, 95% CI=1.24 to 2.83, p<0.05). Among T2DM with HCMV infection, there were significant increases in fasting blood glucose levels and the proportion of CD8+ T lymphocytes. Conversely, fasting blood insulin levels, the proportion of CD4+ T lymphocyte and the CD4+/CD8+ ratio were significantly decreased compared with the healthy group. CONCLUSION At present, the available evidence does not provide a clear understanding of whether there is a significant association between T2DM and HCMV infection. Additionally, T2DM with HCMV infection exhibited significantly worse blood glucose regulation and immune markers, as well as a higher frequency of vasculopathy. PROSPERO REGISTRATION NUMBER CRD42022342066.
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Affiliation(s)
- Xiaona Wang
- Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jun Chen
- Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhichao Cao
- Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xuhui Yu
- Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Qiu HL, Fan S, Zhou K, He Z, Browning MH, Knibbs LD, Zhao T, Luo YN, Liu XX, Hu LX, Li JX, Zhang YD, Xie YT, Heinrich J, Dong GH, Yang BY. Global burden and drivers of hyperglycemia: Estimates and predictions from 1990 to 2050. Innovation (N Y) 2023; 4:100450. [PMID: 37485083 PMCID: PMC10362522 DOI: 10.1016/j.xinn.2023.100450] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 05/23/2023] [Indexed: 07/25/2023] Open
Abstract
Hyperglycemia is a key risk factor for death and disability worldwide. To better inform prevention strategies, we aimed to delineate and predict the temporal, spatial, and demographic patterns in mean fasting plasma glucose (FPG) levels and their related disease burden globally. Based on the Global Burden of Disease Study 2019, we estimated the distributions of mean FPG levels and high FPG-related disease burden by age, sex, year, socioeconomic status (SES), and geographical region from 1990 to 2050. We also investigated the possible associations of demographic, behavioral, dietary, metabolic, and environmental factors with FPG levels and high FPG-related disease burden. In 2019, the global mean FPG level was 5.40 mmol/L (95% uncertainty interval [UI]: 4.86-6.00), and high FPG contributed to 83.0 deaths (95% UI, 64.5-107.1) and 2,104.3 DALYs (95% UI: 1,740.7-2,520.7) per 100,000 people. For both historical (1990-2019) and future (2020-2050) periods, the mean FPG levels and the high FPG-related disease burden increased globally, with greater increases among the middle-aged and elderly, and people in low-to-middle SES countries, relative to their counterparts. Aging, unhealthy lifestyles, elevated body mass index, and lower air temperatures were potential risk factors for high FPG levels and the high FPG-related disease burden. This study demonstrates that high FPG continues to contribute to the global disease burden and is expected to do so for at least the next 30 years. Older people and those living in low-to-middle SES countries should receive more attention in glycemic management health interventions. In addition, effective interventions that target identified risk factors should be adopted to handle the increasingly large disease burden of high FPG.
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Affiliation(s)
- Hui-Ling Qiu
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Shujun Fan
- Guangzhou Joint Research Center for Disease Surveillance and Risk Assessment, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 511436, China
| | - Kaixin Zhou
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 101408, China
| | - Zhini He
- Food Safety and Health Research Center, Guangdong Provincial Key Laboratory of Tropical Disease Research, Guangzhou, Guangdong, China
- School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Matthew H.E.M. Browning
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC 29634, USA
| | - Luke D. Knibbs
- School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Tianyu Zhao
- Institute of Epidemiology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Ya-Na Luo
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiao-Xuan Liu
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Li-Xin Hu
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jia-Xin Li
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yi-Dan Zhang
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yu-Ting Xie
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Joachim Heinrich
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Centre for Environmental Health, 85764 Neuherberg, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Guang-Hui Dong
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Bo-Yi Yang
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
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Alareeki A, Awad SF, Critchley JA, El-Nahas KG, Al-Hamaq AO, Alyafei SA, Al-Thani MHJ, Abu-Raddad LJ. Epidemiological impact of public health interventions against diabetes in Qatar: mathematical modeling analyses. Front Public Health 2023; 11:1167807. [PMID: 37404285 PMCID: PMC10315912 DOI: 10.3389/fpubh.2023.1167807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
Aims To predict the epidemiological impact of specific, and primarily structural public health interventions that address lifestyle, dietary, and commuting behaviors of Qataris as well as subsidies and legislation to reduce type 2 diabetes mellitus (T2DM) burden among Qataris. Methods A deterministic population-based mathematical model was used to investigate the impact of public health interventions on the epidemiology of T2DM among Qataris aged 20-79 years, which is the age range typically used by the International Diabetes Federation for adults. The study evaluated the impact of interventions up to 2050, a three-decade time horizon, to allow for the long-term effects of different types of interventions to materialize. The impact of each intervention was evaluated by comparing the predicted T2DM incidence and prevalence with the intervention to a counterfactual scenario without intervention. The model was parameterized using representative data and stratified by sex, age, T2DM risk factors, T2DM status, and intervention status. Results All intervention scenarios had an appreciable impact on reducing T2DM incidence and prevalence. A lifestyle management intervention approach, specifically applied to those who are categorized as obese and ≥35 years old, averted 9.5% of new T2DM cases by 2050. An active commuting intervention approach, specifically increasing cycling and walking, averted 8.5% of new T2DM cases by 2050. Enhancing consumption of healthy diets including fruits and vegetables, specifically a workplace intervention involving dietary modifications and an educational intervention, averted 23.2% of new T2DM cases by 2050. A subsidy and legislative intervention approach, implementing subsidies on fruits and vegetables and taxation on sugar-sweetened beverages, averted 7.4% of new T2DM cases by 2050. A least to most optimistic combination of interventions averted 22.8-46.9% of new T2DM cases by 2050, respectively. Conclusions Implementing a combination of individual-level and structural public health interventions is critical to prevent T2DM onset and to slow the growing T2DM epidemic in Qatar.
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Affiliation(s)
- Asalah Alareeki
- Infectious Diseases Epidemiology Group, Weill Cornell Medical College–Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Doha, Qatar
| | - Susanne F. Awad
- Infectious Diseases Epidemiology Group, Weill Cornell Medical College–Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Julia A. Critchley
- Population Health Research Institute, St George's, University of London, London, United Kingdom
| | | | | | - Salah A. Alyafei
- Public Health Department, Ministry of Public Health, Doha, Qatar
| | | | - Laith J. Abu-Raddad
- Infectious Diseases Epidemiology Group, Weill Cornell Medical College–Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, United States
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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Zhang Z, Ji C, Wang D, Wang M, Song D, Xu X, Zhang D. The burden of diabetes on the soft tissue seal surrounding the dental implants. Front Physiol 2023; 14:1136973. [PMID: 36875028 PMCID: PMC9978121 DOI: 10.3389/fphys.2023.1136973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
Soft tissue seal around implant prostheses is considered the primary barrier against adverse external stimuli and is a critical factor in maintaining dental implants' stability. Soft tissue seal is formed mainly by the adhesion of epithelial tissue and fibrous connective tissue to the transmembrane portion of the implant. Type 2 diabetes mellitus (T2DM) is one of the risk factors for peri-implant inflammation, and peri-implant disease may be triggered by dysfunction of the soft tissue barrier around dental implants. This is increasingly considered a promising target for disease treatment and management. However, many studies have demonstrated that pathogenic bacterial infestation, gingival immune inflammation, overactive matrix metalloproteinases (MMPs), impaired wound healing processes and excessive oxidative stress may trigger poor peri-implant soft tissue sealing, which may be more severe in the T2DM state. This article reviews the structure of peri-implant soft tissue seal, peri-implant disease and treatment, and moderating mechanisms of impaired soft tissue seal around implants due to T2DM to inform the development of treatment strategies for dental implants in patients with dental defects.
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Affiliation(s)
- Zhanwei Zhang
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral, Shandong University , Jinan, China
| | - Chonghao Ji
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral, Shandong University , Jinan, China
| | | | - Maoshan Wang
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral, Shandong University , Jinan, China
| | - Dawei Song
- School of Stomatology, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
| | - Xin Xu
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral, Shandong University , Jinan, China
| | - Dongjiao Zhang
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral, Shandong University , Jinan, China
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Huang YY, Qin XK, Dai YY, Huang L, Huang GR, Qin YC, Wei X, Huang YQ. Preparation and hypoglycemic effects of chromium- and zinc-rich Acetobacter aceti. World J Diabetes 2022; 13:442-453. [PMID: 35800410 PMCID: PMC9210545 DOI: 10.4239/wjd.v13.i6.442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/25/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND At present, there is no ideal method to cure diabetes, and there are few reports on the treatment of diabetes with probiotics.
AIM To propose a method for preparing a new type of chromium- and zinc-rich Acetobacter aceti (A. aceti) and explore its ability to enhance the hypoglycemic effects of probiotics in the treatment of diabetes.
METHODS A. aceti was cultured in a liquid medium that contained chromium trichloride and zinc chloride, both at a concentration of 64 mg/mL, with the initial concentration of the bacterial solution 1 × 104 CFU/mL. After the bacterial solution had been inducted for 48 h, the culture media was changed and the induction was repeated once. The levels of chromium and zinc in the bacteria were detected by inductively coupled plasma mass spectrometry, and the contents of NADH and glucose dehydrogenase were determined using an NAD/NADH kit and glucose dehydrogenase kit, respectively. Streptozotocin was used to establish a mouse model to evaluate the hypoglycemic effects of the proposed chromium- and zinc-rich A. aceti. Ten-times the therapeutic dose was administered to evaluate its biological safety. The effect on MIN6 islet cells was also assessed in vitro.
RESULTS The levels of chromium metal, metallic zinc, NADH coenzyme, and glucose dehydrogenase in A. aceti prepared by this method were 28.58-34.34 mg/kg, 5.35-7.52 mg/kg, 5.13-7.26 μM, and 446.812-567.138 U/g, respectively. The use of these bacteria resulted in a better hypoglycemic effect than metformin, promoting the repair of tissues and cells of pancreatic islets in vivo and facilitating the growth of MIN6 pancreatic islet cells and increasing insulin secretion in vitro. Ten-times the therapeutic dose of treatment was non-toxic to mice.
CONCLUSION Chromium trichloride and zinc chloride can be employed to induce the preparation of chromium- and zinc-rich A. aceti, which can then promote the hypoglycemic effect found in normal A. aceti. The bacteria biotransforms the chromium and zinc in a way that could increase their safety as a treatment for diabetes.
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Affiliation(s)
- Yong-Yi Huang
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infection, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Xiang-Kun Qin
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infection, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Yuan-Yuan Dai
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infection, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Liang Huang
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infection, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Gan-Rong Huang
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infection, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Yan-Chun Qin
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infection, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Xian Wei
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infection, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Yan-Qiang Huang
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infection, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
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10
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Anakök GA, Awad SF, Çağlayan Ç, Huangfu P, Abu-Raddad LJ, Unal B, Critchley JA. Impact of trends and gender disparity in obesity on future type 2 diabetes in Turkey: a mathematical modelling analysis. BMJ Open 2022; 12:e053541. [PMID: 35545390 PMCID: PMC9096547 DOI: 10.1136/bmjopen-2021-053541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Using a previously developed and validated mathematical model, we predicted future prevalence of type 2 diabetes mellitus (T2DM) and major modifiable risk factors (obesity, physical inactivity and smoking) stratified by age and sex in Turkey up to the year 2050. METHODS Our deterministic compartmental model fitted nationally representative demographic and risk factor data simultaneously for Turkish adults (aged 20-79) between 1997 and 2017, then estimated future trends. Our novel approach explored the impact of future obesity trends on these projections, specifically modelling (1) a gradual fall in obesity in women after the year 2020 until it equalled the age-specific levels seen in men and (2) cessation of the rise in obesity after 2020. RESULTS T2DM prevalence is projected to rise from an estimated 14.0% (95% uncertainty interval (UI) 12.8% to 16.0%) in 2020 to 18.4% (95% UI 16.9% to 20.9%) by 2050; 19.7% in women and 17.2% in men by 2050; reflecting high levels of obesity (39.7% for women and 22.0% for men in 2050). Overall, T2DM prevalence could be reduced by about 4% if obesity stopped rising after 2020 or by 12% (22% in women) if obesity prevalence among women could be lowered to equal that of men. The higher age-specific obesity prevalence among women resulted in 2 076 040 additional women developing T2DM by the year 2050. CONCLUSION T2DM is common in Turkey and will remain so. Interventions and policies targeting the high burden of obesity (and low physical activity levels), particularly in women, could significantly impact future disease burdens.
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Affiliation(s)
- Gül Anil Anakök
- Department of Public Health, Kocaeli University School of Medicine, Kocaeli, Turkey
- Kartepe District Health Directorate, Kocaeli, Turkey
| | | | - Çiğdem Çağlayan
- Department of Public Health, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Peijue Huangfu
- Population Health Research Institute, St George's University of London, London, UK
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Belgin Unal
- Department of Public Health, Faculty of Medicine, Dokuz Eylul Universitesi, Izmir, Turkey
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11
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Kumar L, Mohammadnezhad M. Health Care Workers' Perceptions on Factors Affecting Diabetes Self-Management Among Type 2 Diabetes Mellitus Patients in Fiji: A Qualitative Study. Front Public Health 2022; 10:779266. [PMID: 35444994 PMCID: PMC9013814 DOI: 10.3389/fpubh.2022.779266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
BackgroundType 2 Diabetes Mellitus (T2DM) is known as a major cause of mortality globally. Diabetes self-management refers to daily activities undertaken to control or reduce the impact of diabetes on health and well-being to avoid further illness. Health Care Workers' (HCWs) can assist patients to be aware of self-care and solve the challenges diabetes presents. The management of diabetes can improve once HCWs promote measures that facilitate self-care activities by providing necessary information and supporting patients' initiatives to make lifestyle changes. This study aimed to explore HCWs perceptions on factors affecting diabetes self-management among T2DM patients of Fiji.MethodsA qualitative study design was conducted to explore HCWs perceptions on factors affecting diabetes self-management using two Focus Group Discussions (FGDs) in Labasa, Fiji in 2021. The study settings were the Diabetic Hub Center, special outpatient department Labasa hospital and Nasea health Center Labasa. The study settings are located in an urban area. These health facilities provide special outpatient clinics to T2DM patients including clinics for other medical conditions. Nasea Health Center had 1,300 patients, the special outpatient's department Labasa hospital had 560 patients and the diabetic hub center Labasa had 295 patients at the time of the study. These patients either had T2DM or T2DM with other medical conditions. Purposive sampling was employed to recruit HCWs. The data were collected using an interview guide in semi-structured interviews and the interviews were audio recorded. The recorded data was transcribed verbatim and analyzed using thematic analysis process.ResultsThe participants were 9 HCWs with age range of 25-49 years. A counselor, a medical officer, physiotherapist, nurses and dieticians were among the HCWs. Three major themes and seven sub themes were identified. These included Theme 1- “availability of services” with the sub themes of clinical services for T2DM and other support services available for T2DM patients. Theme 2- “barriers and challenges to diabetes self-management” with the sub themes of health system factors, socioeconomic factors and health system factors. Theme 3- “Needs for diabetes management” with the sub themes resources and skilled personnel.ConclusionThe findings of this study demonstrate health system challenges such as lack of material resources and human resources compounded the factors affecting diabetes self-management. HCWs training as diabetes educators and developing policy on diabetes self-management are highly recommended to facilitate diabetes self-management.
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12
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Awad SF, A Toumi A, A Al-Mutawaa K, A Alyafei S, A Ijaz M, A H Khalifa S, B Kokku S, C M Mishra A, V Poovelil B, B Soussi M, G El-Nahas K, O Al-Hamaq A, A Critchley J, H Al-Thani M, Abu-Raddad LJ. Type 2 diabetes epidemic and key risk factors in Qatar: a mathematical modeling analysis. BMJ Open Diabetes Res Care 2022; 10:10/2/e002704. [PMID: 35443971 PMCID: PMC9021773 DOI: 10.1136/bmjdrc-2021-002704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/27/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION We aimed to characterize and forecast type 2 diabetes mellitus (T2DM) disease burden between 2021 and 2050 in Qatar where 89% of the population comprises expatriates from over 150 countries. RESEARCH DESIGN AND METHODS An age-structured mathematical model was used to forecast T2DM burden and the impact of key risk factors (obesity, smoking, and physical inactivity). The model was parametrized using data from T2DM natural history studies, Qatar's 2012 STEPwise survey, the Global Health Observatory, and the International Diabetes Federation Diabetes Atlas, among other data sources. RESULTS Between 2021 and 2050, T2DM prevalence increased from 7.0% to 14.0%, the number of people living with T2DM increased from 170 057 to 596 862, and the annual number of new T2DM cases increased from 25 007 to 45 155 among those 20-79 years of age living in Qatar. Obesity prevalence increased from 8.2% to 12.5%, smoking declined from 28.3% to 26.9%, and physical inactivity increased from 23.1% to 26.8%. The proportion of incident T2DM cases attributed to obesity increased from 21.9% to 29.9%, while the contribution of smoking and physical inactivity decreased from 7.1% to 6.0% and from 7.3% to 7.2%, respectively. The results showed substantial variability across various nationality groups residing in Qatar-for example, in Qataris and Egyptians, the T2DM burden was mainly due to obesity, while in other nationality groups, it appeared to be multifactorial. CONCLUSIONS T2DM prevalence and incidence in Qatar were forecasted to increase sharply by 2050, highlighting the rapidly growing need of healthcare resources to address the disease burden. T2DM epidemiology varied between nationality groups, stressing the need for prevention and treatment intervention strategies tailored to each nationality.
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Affiliation(s)
- Susanne F Awad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Doha, Dawha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York City, New York, USA
| | - Amine A Toumi
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Kholood A Al-Mutawaa
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Salah A Alyafei
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Muhammad A Ijaz
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | | | - Suresh B Kokku
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Amit C M Mishra
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Benjamin V Poovelil
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Mounir B Soussi
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | | | | | - Julia A Critchley
- Population Health Research Institute, St. George's, University of London, London, UK
| | - Mohammed H Al-Thani
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Doha, Dawha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York City, New York, USA
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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Bezrodny SL, Mardanly SG, Zatevalov AM, Pomazanov VV, Mekhtiyev ER. Estimation of the state of the microbiome in the elderly with impairments of carbohydrate and lipid exchange by the method of microbiome-associated exposomics. MICROBIOLOGY INDEPENDENT RESEARCH JOURNAL 2022. [DOI: 10.18527/2500-2236-2022-9-1-9-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A biochemical analysis of blood and a study of the chemical composition of the blood samples of 163 people 45–90 years old with type 2 diabetes mellitus and dyslipidemia was conducted. The concentrations of the following compounds in the blood were determined: fatty acids, aldehydes, and styrenes of microbial origin as well as the levels of glucose triglycerides, cholesterol, and lipids of low and high density. The chemical composition of blood was determined by gas chromatography-mass spectrometry. The concentrations of fatty acids, aldehydes, and styrenes were used to calculate the total molar concentration of chemical compounds, the concentration of octadecene aldehyde (18a), the total concentration of hydroxy acids of derivatives of the hydroxyl residue of lipid A of bacterial endotoxin (3OH-FA), and the grouped total concentrations of chemical compounds of microbial origin, which determine the representation of the main four phylotypes of the human microbiome: Actinobacteria, Bacteroidetes, Proteobacteria, and Firmicutes.As a result of the study, data were obtained on an increase in the total concentration of chemical compounds, the concentration of octadecene aldehyde, and the concentration of 3OH-FA in violation of carbohydrate metabolism by the type of diabetes mellitus type 2. There was a decrease in the representation of Bacteroidetes in violation of carbohydrate metabolism and a decrease in the representation of Proteobacteria, Firmicutes in violation of carbohydrate and lipid metabolism, and an increase in the representation of Actinobacteria in violation of lipid metabolism, including those combined with a violation of carbohydrate metabolism.In patients with type 2 diabetes mellitus and in the control group, there was an inverse correlation between the presence of Firmicutes and blood glucose levels. In the type 2 diabetes mellitus group, there was a direct correlation between the representation of Bacteroidetes and the level of triglycerides in the blood.In patients with lipid metabolism disorders, we did not reveal statistically significant changes in the concentrations of microbial markers in the blood of patients nor statistically significant correlations between the biochemical blood parameters and the representation of microbiome phylotypes.
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Affiliation(s)
- S. L. Bezrodny
- Ecolab ZAO;
G. N. Gabrichevsky Research Institute for Epidemiology and Microbiology
| | | | - A. M. Zatevalov
- G. N. Gabrichevsky Research Institute for Epidemiology and Microbiology
| | | | - E. R. Mekhtiyev
- G. N. Gabrichevsky Research Institute for Epidemiology and Microbiology
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14
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A systematic review of interventions to promote physical activity in six Gulf countries. PLoS One 2021; 16:e0259058. [PMID: 34710147 PMCID: PMC8553078 DOI: 10.1371/journal.pone.0259058] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022] Open
Abstract
Physical activity (PA) levels are low in Gulf Cooperation Council countries (GCC; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates). We carried out a systematic review (PROSPERO registration number 131817) to assess the effect of interventions to increase PA levels in this region. We also assessed their effects on anthropometry and cardiovascular risk. A systematic search of six databases (Medline, EMBASE, SPORTDiscus, CINAHL, Cochrane, Web of Science) was performed to identify randomized and non-randomized intervention studies performed in adults and children published between January 1985 and November 2020. We included studies published in English or Arabic, and included PA interventions regardless of setting, delivery, and duration. The primary outcomes were changes in PA duration and intensity. Secondary outcomes included anthropometric measures (e.g., weight, body mass index) and cardiovascular risk profiles (e.g., lipid measures, blood glucose). Two independent reviewers screened studies in accordance with pre-determined criteria, extracted data, assessed risk of bias (Cochrane Risk of Bias 2 and Newcastle Ottawa Scale) and undertook a narrative synthesis. From 13,026 records identified, 14 studies were included. Nine studies focussed exclusively on changing PA behaviour, resulting in statistically significant increases in step count ranging from an additional 757 steps/day (95% confidence interval [CI] 0-1,513) to 3,853 steps/day (95% CI 3,703-4,002). Five identified studies were multi-component lifestyle interventions, targeting people at higher risk (due to obesity or type 2 diabetes). Evidence for increases in PA from multi-component studies was limited, although improvements were seen in outcomes e.g. body weight and blood lipid levels. In conclusion, relatively few studies have focussed on changing PA behaviour, despite the urgent need in the GCC. Limited evidence suggested that pedometer-based programmes encouraging step counting and walking were effective in promoting PA, at least in the short term. Policies to roll out such interventions should be implemented and evaluated.
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