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Buckley L, Morphett K, Rychetnik L, Land MA, Cullerton K. Spokespeople in public health: Important characteristics from the perspective of Australian public health professionals. Health Promot J Austr 2023. [PMID: 37579756 DOI: 10.1002/hpja.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Spokespeople play a significant role in communicating public health information yet there is little research understanding the characteristics of those who provide such messaging. METHODS One hundred and four health professionals (70% female) recruited through professional association mailing lists in Australia completed a brief online quantitative and qualitative survey. RESULTS Participants reported characteristics they believed to be important for spokespeople, those that they believed their organisation considered important, and those they thought engendered public trust. Knowledge of public health issues, public speaking skills, and willingness to speak on behalf of the organisation were identified as important characteristics (by at least 70%). Qualitative results showed some participants distinguished between perceived, as well as actual, expertise, and described the potential for public health university programs to include public speaking and communication skills. Participants also identified an individual's role in the organisation was considered important in their organisation's selection of a spokesperson, particularly in relation to seniority and leadership. CONCLUSIONS The study provides an initial description and priority considerations from health professionals about key characteristics of effective spokespeople. Findings suggest possible avenues for training and support for spokespeople and the need for further research regarding the characteristics of who are effective spokespeople. SO WHAT?: Findings suggest possible avenues for training and support for spokespeople and the need for further research regarding the characteristics of who are effective spokespeople.
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Affiliation(s)
- Lisa Buckley
- School of Public Health, the University of Queensland, Herston, Queensland, Australia
| | - Kylie Morphett
- School of Public Health, the University of Queensland, Herston, Queensland, Australia
| | - Lucie Rychetnik
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Mary-Anne Land
- Public Health Association of Australia, Curtin, Australia
| | - Katherine Cullerton
- School of Public Health, the University of Queensland, Herston, Queensland, Australia
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Land MA, Neal BC, Johnson C, Nowson CA, Margerison C, Petersen KS. Salt consumption by Australian adults: a systematic review and meta-analysis. Med J Aust 2019; 208:75-81. [PMID: 29385968 DOI: 10.5694/mja17.00394] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/24/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Salt reduction is a public health priority because it is a leading contributor to the global burden of disease. As in Australia there is uncertainty about the current level of salt intake, we sought to estimate current levels. STUDY DESIGN Random effects meta-analysis of data from 31 published studies and one unpublished dataset that reported salt or sodium consumption by Australian adults on the basis of 24-hour urine collections or dietary questionnaires. DATA SOURCES MEDLINE (via Ovid) and EMBASE (to August 2016). DATA SYNTHESIS Thirty-one published studies and one unpublished dataset (1989-2015; 16 836 individuals) were identified. The mean weighted salt consumption estimated from 24-hour urine collections was 8.70 g/day (95% CI, 8.39-9.02 g/day); after adjusting for non-urinary salt excretion, the best estimate of salt intake in Australia is 9.6 g/day. The mean weighted intake was 10.1 g/day (95% CI, 9.68-10.5 g/day) for men and 7.34 g/day (95% CI, 6.98-7.70 g/day) for women. Mean weighted consumption was 6.49 g/day (95% CI, 5.94-7.03 g/day) when measured with diet diaries, 6.76 g/day (95% CI, 5.48-8.05 g/day) when assessed with food frequency questionnaires, and 6.73 g/day (95% CI, 6.34-7.11) when assessed by dietary recall. Salt intake had not decreased between 1989 and 2015 (R<sup>2</sup> = -0.02; P = 0.36). CONCLUSION Salt intake in Australian adults exceeds the WHO-recommended maximum of 5 g/day and does not appear to be declining. Measuring salt intake with methods based on self-reporting can substantially underestimate consumption. The data highlight the need for ongoing action to reduce salt consumption in Australia and robust monitoring of population salt intake.
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Affiliation(s)
| | - Bruce C Neal
- The George Institute for Global Health, Sydney, NSW
| | | | - Caryl A Nowson
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC
| | - Claire Margerison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC
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Huang L, Crino M, Wu JH, Woodward M, Land MA, McLean R, Webster J, Enkhtungalag B, Nowson CA, Elliott P, Cogswell M, Toft U, Mill JG, Furlanetto TW, Ilich JZ, Hong YH, Cohall D, Luzardo L, Noboa O, Holm E, Gerbes AL, Senousy B, Pinar Kara S, Brewster LM, Ueshima H, Subramanian S, Teo BW, Allen N, Choudhury SR, Polonia J, Yasuda Y, Campbell NR, Neal B, Petersen KS. Reliable Quantification of the Potential for Equations Based on Spot Urine Samples to Estimate Population Salt Intake: Protocol for a Systematic Review and Meta-Analysis. JMIR Res Protoc 2016; 5:e190. [PMID: 27655265 PMCID: PMC5052460 DOI: 10.2196/resprot.6282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/21/2016] [Indexed: 11/13/2022] Open
Abstract
Background Methods based on spot urine samples (a single sample at one time-point) have been identified as a possible alternative approach to 24-hour urine samples for determining mean population salt intake. Objective The aim of this study is to identify a reliable method for estimating mean population salt intake from spot urine samples. This will be done by comparing the performance of existing equations against one other and against estimates derived from 24-hour urine samples. The effects of factors such as ethnicity, sex, age, body mass index, antihypertensive drug use, health status, and timing of spot urine collection will be explored. The capacity of spot urine samples to measure change in salt intake over time will also be determined. Finally, we aim to develop a novel equation (or equations) that performs better than existing equations to estimate mean population salt intake. Methods A systematic review and meta-analysis of individual participant data will be conducted. A search has been conducted to identify human studies that report salt (or sodium) excretion based upon 24-hour urine samples and spot urine samples. There were no restrictions on language, study sample size, or characteristics of the study population. MEDLINE via OvidSP (1946-present), Premedline via OvidSP, EMBASE, Global Health via OvidSP (1910-present), and the Cochrane Library were searched, and two reviewers identified eligible studies. The authors of these studies will be invited to contribute data according to a standard format. Individual participant records will be compiled and a series of analyses will be completed to: (1) compare existing equations for estimating 24-hour salt intake from spot urine samples with 24-hour urine samples, and assess the degree of bias according to key demographic and clinical characteristics; (2) assess the reliability of using spot urine samples to measure population changes in salt intake overtime; and (3) develop a novel equation that performs better than existing equations to estimate mean population salt intake. Results The search strategy identified 538 records; 100 records were obtained for review in full text and 73 have been confirmed as eligible. In addition, 68 abstracts were identified, some of which may contain data eligible for inclusion. Individual participant data will be requested from the authors of eligible studies. Conclusions Many equations for estimating salt intake from spot urine samples have been developed and validated, although most have been studied in very specific settings. This meta-analysis of individual participant data will enable a much broader understanding of the capacity for spot urine samples to estimate population salt intake.
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Affiliation(s)
- Liping Huang
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China
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Christoforou A, Trieu K, Land MA, Bolam B, Webster J. State-level and community-level salt reduction initiatives: a systematic review of global programmes and their impact. J Epidemiol Community Health 2016. [DOI: 10.1136/jech-2015-206997\] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Christoforou A, Trieu K, Land MA, Bolam B, Webster J. State-level and community-level salt reduction initiatives: a systematic review of global programmes and their impact. J Epidemiol Community Health 2016; 70:1140-1150. [PMID: 27222501 DOI: 10.1136/jech-2015-206997] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/05/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND High-salt diets are linked to elevated blood pressure, a major risk factor for cardiovascular diseases, particularly stroke. State and community salt reduction strategies may complement nationally led initiatives and contribute to achieving global salt reduction targets. We aim to systematically review such interventions and document reported impact where programmes have been evaluated. METHODS Electronic databases were searched up to June 2015 using terms 'salt' or 'sodium' and 'state' and 'community' in combination with 'campaign', 'initiative', 'project', 'strategy', 'intervention' or 'programme'. Data from evaluated and unevaluated interventions were included. Studies were analysed in relation to intervention components and outcome measures and appraised for quality using a Cochrane Risk-of-Bias Tool. RESULTS 39 state and community programmes were identified. Settings varied from whole communities (n=23), state-owned buildings (n=5), schools (n=7), workplaces (n=3) and correctional facilities (n=1). Strategies included nutrition education programmes, public education campaigns, changes to the food environment, other 'novel' approaches and multifaceted approaches. Of the 28 studies that evaluated intervention effectiveness, significant reductions were observed in terms of salt intake from dietary assessment (n=7), urinary sodium excretion (n=8), blood pressure (n=11) and sodium in foods (n=9). Six studies reported positive changes in consumer knowledge, attitudes and behaviours. All but two studies had some methodological limitations. CONCLUSIONS State and community salt reduction programmes may be effective in a range of settings but more robust evaluation methods are needed. Scaling up these efforts in coordination with national initiatives could provide the most effective and sustainable approach to reducing population salt intake.
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Affiliation(s)
- Anthea Christoforou
- Food Policy Division, The George Institute for Global Health (affiliated with the University of Sydney), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kathy Trieu
- Food Policy Division, The George Institute for Global Health (affiliated with the University of Sydney), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Mary-Anne Land
- Food Policy Division, The George Institute for Global Health (affiliated with the University of Sydney), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Bruce Bolam
- The Victorian Health Promotion Foundation (VicHealth), Carlton, Victoria, Australia
| | - Jacqui Webster
- Food Policy Division, The George Institute for Global Health (affiliated with the University of Sydney), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Land MA, Webster JL, Ma G, Li M, Su'a SAF, Ieremia M, Viali S, Faeamani G, Bell AC, Quested C, Neal BC, Eastman CJ. Salt intake and iodine status of women in Samoa. Asia Pac J Clin Nutr 2016; 25:142-9. [PMID: 26965773 DOI: 10.6133/apjcn.2016.25.1.09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this study was to determine iodine nutrition status and whether iodine status differs across salt intake levels among a sample of women aged 18-45 years living in Samoa. A cross-sectional survey was completed and 24-hr urine samples were collected and assessed for iodine (n=152) and salt excretion (n=119). The median urinary iodine concentration (UIC) among the women was 88 μg/L (Interquartile range (IQR)=54-121 μg/L). 62% of the women had a UIC <100 μg/L. The crude estimated mean 24-hr urinary salt excretion was 6.6 (standard deviation 3.2) g/day. More than two-thirds (66%) of the women exceeded the World Health Organization recommended maximum level of 5 g/day. No association was found between median UIC and salt excretion (81 μg/L iodine where urinary salt excretion >=5 g/day versus 76 μg/L where urinary salt excretion <5 g/day; p=0.4). Iodine nutrition appears to be insufficient in this population and may be indicative of iodine deficiency disorders in Samoan women. A collaborative approach in monitoring iodine status and salt intake will strengthen both programs and greatly inform the level of iodine fortification required to ensure optimal iodine intake as population salt reduction programs take effect.
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Affiliation(s)
- Mary-Anne Land
- The George Institute for Global Health, Sydney Medical School, Sydney, Australia. ; .,School of Medicine, the University of Sydney, Sydney, Australia
| | - Jacqui L Webster
- The George Institute for Global Health, Sydney Medical School, Sydney, Australia.,School of Medicine, the University of Sydney, Sydney, Australia
| | - Gary Ma
- School of Medicine, University of Western Sydney, Campbell town, Australia
| | - Mu Li
- The School of Public Health, the University of Sydney, Sydney, Australia
| | | | | | - Satu Viali
- Medical Specialist Clinic and Ministry of Health, Apia, Samoa National Health Service Samoa, Apia, Samoa
| | | | - A Colin Bell
- School of Medicine, Deakin University, Melbourne, Australia
| | - Christine Quested
- The School of Public Health, the University of Sydney, Sydney, Australia
| | - Bruce C Neal
- The George Institute for Global Health, Sydney Medical School, Sydney, Australia.,School of Medicine, the University of Sydney, Sydney, Australia
| | - Creswell J Eastman
- International Council for the Control of Iodine Deficiency Disorders-Global Network, Sydney, Australia
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Land MA, Neal B, Hosein E. Implementing the Communication for Behavioral Impact Framework to Reduce Population Salt Consumption. J Nutr Educ Behav 2016; 48:350-353.e1. [PMID: 27169643 DOI: 10.1016/j.jneb.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Mary-Anne Land
- Food Policy, George Institute for Global Health, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia.
| | - Bruce Neal
- Food Policy, George Institute for Global Health, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia
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Webster J, Su'a SAF, Ieremia M, Bompoint S, Johnson C, Faeamani G, Vaiaso M, Snowdon W, Land MA, Trieu K, Viali S, Moodie M, Bell C, Neal B, Woodward M. Salt Intakes, Knowledge, and Behavior in Samoa: Monitoring Salt-Consumption Patterns Through the World Health Organization's Surveillance of Noncommunicable Disease Risk Factors (STEPS). J Clin Hypertens (Greenwich) 2016; 18:884-91. [PMID: 26843490 PMCID: PMC5067650 DOI: 10.1111/jch.12778] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 11/26/2022]
Abstract
This project measured population salt intake in Samoa by integrating urinary sodium analysis into the World Health Organization's (WHO's) STEPwise approach to surveillance of noncommunicable disease risk factors (STEPS). A subsample of the Samoan Ministry of Health's 2013 STEPS Survey collected 24‐hour and spot urine samples and completed questions on salt‐related behaviors. Complete urine samples were available for 293 participants. Overall, weighted mean population 24‐hour urine excretion of salt was 7.09 g (standard error 0.19) to 7.63 g (standard error 0.27) for men and 6.39 g (standard error 0.14) for women (P=.0014). Salt intake increased with body mass index (P=.0004), and people who added salt at the table had 1.5 g higher salt intakes than those who did not add salt (P=.0422). A total of 70% of the population had urinary excretion values above the 5 g/d cutoff recommended by the WHO. A reduction of 30% (2 g) would reduce average population salt intake to 5 g/d, in line with WHO recommendations. While challenging, integration of salt monitoring into STEPS provides clear logistical and cost benefits and the lessons communicated here can help inform future programs.
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Affiliation(s)
- Jacqui Webster
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.
| | | | | | - Severine Bompoint
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - Claire Johnson
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Wendy Snowdon
- WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Mary-Anne Land
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - Satu Viali
- Medical Specialist Clinic and Ministry of Health, Apia, Samoa
| | - Marj Moodie
- Deakin Health Economics, Faculty of Health, Deakin University, VIC, Australia
| | - Colin Bell
- School of Medicine, Deakin University, Melbourne, VIC, Australia
| | - Bruce Neal
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - Mark Woodward
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.,The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD
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Huang L, Crino M, Wu JHY, Woodward M, Barzi F, Land MA, McLean R, Webster J, Enkhtungalag B, Neal B. Mean population salt intake estimated from 24-h urine samples and spot urine samples: a systematic review and meta-analysis. Int J Epidemiol 2016; 45:239-50. [DOI: 10.1093/ije/dyv313] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Land MA, Jeffery P, Webster J, Crino M, Chalmers J, Woodward M, Nowson C, Smith W, Flood V, Neal B. Protocol for the implementation and evaluation of a community-based intervention seeking to reduce dietary salt intake in Lithgow, Australia. BMC Public Health 2014; 14:357. [PMID: 24731226 PMCID: PMC3989835 DOI: 10.1186/1471-2458-14-357] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 04/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Excess dietary salt is a leading risk for health. Multiple health, government, industry and community organisations have identified the need to reduce consumption of dietary salt. This project seeks to implement and evaluate a community-based salt reduction intervention. METHODS The study comprises a baseline assessment followed by a targeted intervention and then an evaluation of efficacy. The study location is Lithgow, a regional town in New South Wales, Australia. The salt reduction intervention is based upon the Communication for Behavioural Impact framework which utilises an integrated communication model to enact community advocacy and impact by providing tools that enable the translation of knowledge into behavioural change. The duration of the intervention will be between 6 and 12 months. The primary evaluation will be through measurement of 24-hr urinary sodium excretion in independent population samples aged>20 years, drawn before and after the intervention period. The study is designed to detect a difference in mean sodium excretion of 0.7 grams per day or greater with 80% power and p=0.05. DISCUSSION This study will provide a robust evaluation of the effectiveness of a community-based intervention seeking to reduce dietary salt intake using the Communication for Behavioural Impact framework. The results will provide important new evidence to inform the design and implementation of current and future salt reduction policies in Australia. The results will also have important international implications because, following the recent World Health Organization recommendations for the control of non-communicable diseases, many countries are now seeking to achieve a reduction in average population salt consumption. TRIAL REGISTRATION ClinicalTrials.gov, NCT02105727.
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Affiliation(s)
- Mary-Anne Land
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Missenden Road, Po Box M201, Camperdown, NSW 2050, Australia.
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Land MA, Webster J, Christoforou A, Johnson C, Trevena H, Hodgins F, Chalmers J, Woodward M, Barzi F, Smith W, Flood V, Jeffery P, Nowson C, Neal B. The association of knowledge, attitudes and behaviours related to salt with 24-hour urinary sodium excretion. Int J Behav Nutr Phys Act 2014; 11:47. [PMID: 24708561 PMCID: PMC4234277 DOI: 10.1186/1479-5868-11-47] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 04/01/2014] [Indexed: 12/25/2022] Open
Abstract
AIM Salt reduction efforts usually have a strong focus on consumer education. Understanding the association between salt consumption levels and knowledge, attitudes and behaviours towards salt should provide insight into the likely effectiveness of education-based programs. METHODS A single 24-hour urine sample and a questionnaire describing knowledge, attitudes and behaviours was obtained from 306 randomly selected participants and 113 volunteers from a regional town in Australia. RESULTS Mean age of all participants was 55 years (range 20-88), 55% were women and mean 24-hour urinary salt excretion was 8.8(3.6) g/d. There was no difference in salt excretion between the randomly selected and volunteer sample. Virtually all participants (95%) identified that a diet high in salt can cause serious health problems with the majority of participants (81%) linking a high salt diet to raised blood pressure. There was no difference in salt excretion between those who did 8.7(2.1) g/d and did not 7.5(3.3) g/d identify that a diet high in salt causes high blood pressure (p=0.1). Nor was there a difference between individuals who believed they consumed "too much" 8.9(3.3) g/d "just the right amount" 8.4(2.6) g/d or "too little salt" 9.1(3.7) g/d (p=0.2). Likewise, individuals who indicated that lowering their salt intake was important 8.5(2.9) g/d vs. not important 8.8(2.4) g/d did not have different consumption levels (p=0.4). CONCLUSION The absence of a clear association between knowledge, attitudes and behaviours towards salt and actual salt consumption suggests that interventions focused on knowledge, attitudes and behaviours alone may be of limited efficacy.
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Affiliation(s)
- Mary-Anne Land
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, PO BOX M201, Missenden Road, Camperdown, Sydney, NSW, Australia
| | - Jacqui Webster
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, PO BOX M201, Missenden Road, Camperdown, Sydney, NSW, Australia
| | - Anthea Christoforou
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, PO BOX M201, Missenden Road, Camperdown, Sydney, NSW, Australia
| | - Claire Johnson
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, PO BOX M201, Missenden Road, Camperdown, Sydney, NSW, Australia
| | - Helen Trevena
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, PO BOX M201, Missenden Road, Camperdown, Sydney, NSW, Australia
| | - Frances Hodgins
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, PO BOX M201, Missenden Road, Camperdown, Sydney, NSW, Australia
| | - John Chalmers
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, PO BOX M201, Missenden Road, Camperdown, Sydney, NSW, Australia
| | - Mark Woodward
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, PO BOX M201, Missenden Road, Camperdown, Sydney, NSW, Australia
| | - Federica Barzi
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, PO BOX M201, Missenden Road, Camperdown, Sydney, NSW, Australia
| | | | - Victoria Flood
- The Sydney University of Sydney and St Vincent’s Hospital, Sydney, Australia
| | | | | | - Bruce Neal
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, PO BOX M201, Missenden Road, Camperdown, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Webster J, Snowdon W, Moodie M, Viali S, Schultz J, Bell C, Land MA, Downs S, Christoforou A, Dunford E, Barzi F, Woodward M, Neal B. Cost-effectiveness of reducing salt intake in the Pacific Islands: protocol for a before and after intervention study. BMC Public Health 2014; 14:107. [PMID: 24495646 PMCID: PMC3933378 DOI: 10.1186/1471-2458-14-107] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is broad consensus that diets high in salt are bad for health and that reducing salt intake is a cost-effective strategy for preventing chronic diseases. The World Health Organization has been supporting the development of salt reduction strategies in the Pacific Islands where salt intakes are thought to be high. However, there are no accurate measures of salt intake in these countries. The aims of this project are to establish baseline levels of salt intake in two Pacific Island countries, implement multi-pronged, cross-sectoral salt reduction programs in both, and determine the effects and cost-effectiveness of the intervention strategies. METHODS/DESIGN Intervention effectiveness will be assessed from cross-sectional surveys before and after population-based salt reduction interventions in Fiji and Samoa. Baseline surveys began in July 2012 and follow-up surveys will be completed by July 2015 after a 2-year intervention period.A three-stage stratified cluster random sampling strategy will be used for the population surveys, building on existing government surveys in each country. Data on salt intake, salt levels in foods and sources of dietary salt measured at baseline will be combined with an in-depth qualitative analysis of stakeholder views to develop and implement targeted interventions to reduce salt intake. DISCUSSION Salt reduction is a global priority and all Member States of the World Health Organization have agreed on a target to reduce salt intake by 30% by 2025, as part of the global action plan to reduce the burden of non-communicable diseases. The study described by this protocol will be the first to provide a robust assessment of salt intake and the impact of salt reduction interventions in the Pacific Islands. As such, it will inform the development of strategies for other Pacific Island countries and comparable low and middle-income settings around the world.
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Affiliation(s)
- Jacqui Webster
- George Institute for Global Health, (affiliated with the University of Sydney), Level 10, King George V Building, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales 2050, Australia.
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Land MA, Webster J, Christoforou A, Praveen D, Jeffery P, Chalmers J, Smith W, Woodward M, Barzi F, Nowson C, Flood V, Neal B. Salt intake assessed by 24 h urinary sodium excretion in a random and opportunistic sample in Australia. BMJ Open 2014; 4:e003720. [PMID: 24440795 PMCID: PMC3902305 DOI: 10.1136/bmjopen-2013-003720] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The gold standard method for measuring population sodium intake is based on a 24 h urine collection carried out in a random population sample. However, because participant burden is high, response rates are typically low with less than one in four agreeing to provide specimens. At this low level of response it is possible that simply asking for volunteers would produce the same results. SETTING Lithgow, New South Wales, Australia. PARTICIPANTS We randomly selected 2152 adults and obtained usable 24 h urine samples from 306 (response rate 16%). Specimens were also collected from a further 113 volunteers. Estimated salt consumption and the costs for each strategy were compared. RESULTS The characteristics of the 'random' and 'volunteer' samples were moderately different in mean age 58 (SD 14.6 vs 49(17.7) years, respectively; p<0.001) as well as self-reported alcohol use, tobacco use, history of hypertension and prescription drug use (all p<0.04). Overall crude mean 24 h urinary salt excretion was 8.9(3.6) g/day in the random sample vs 8.5(3.3) g/day for the volunteers (p=0.42). Corresponding age-adjusted and sex-adjusted estimates were 9.2(3.3) and 8.8(3.4) g/day (p=0.29). Estimates for men 10.3(3.8) vs 9.6(3.3) g/day; (p=0.26) and women 7.6(3) vs 7.9(3.2) g/day; (p=0.43) were also similar for the two samples, as was salt excretion across age groups (p=0.72). The cost of obtaining each 24 h urine sample was two times greater for the random compared to volunteer samples ($A62 vs $A31). CONCLUSIONS The estimated salt consumption derived from the two samples was comparable and was not substantively different to estimates obtained from other surveys. In countries where salt is pervasive and cannot easily be avoided, estimates of consumption obtained from volunteer samples may be valid and less costly.
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Affiliation(s)
- Mary-Anne Land
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jacqui Webster
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anthea Christoforou
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - D Praveen
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul Jeffery
- Deakin University, Melbourne, Victoria, Australia
| | - John Chalmers
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Wayne Smith
- New South Wales Health, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Federica Barzi
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Caryl Nowson
- Deakin University, Melbourne, Victoria, Australia
| | - Victoria Flood
- The University of Wollongong, Wollongong, New South Wales, Australia
| | - Bruce Neal
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Land MA, Christoforou A, Downs S, Webster J, Billot L, Li M, Peña-Rosas JP, Neal B. Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders. Cochrane Database of Systematic Reviews 2013. [DOI: 10.1002/14651858.cd010734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mary-Anne Land
- The George Institute for Global Health - Australia; Food Policy; Level 10, King George V Building RPA. 83-117 Missenden Road Camperdown NSW Australia 2050
| | - Anthea Christoforou
- The George Institute for Global Health - Australia; Food Policy; Level 10, King George V Building RPA. 83-117 Missenden Road Camperdown NSW Australia 2050
| | - Shauna Downs
- The George Institute for Global Health - Australia; Food Policy; Level 10, King George V Building RPA. 83-117 Missenden Road Camperdown NSW Australia 2050
| | - Jacqui Webster
- The George Institute for Global Health - Australia; Food Policy; Level 10, King George V Building RPA. 83-117 Missenden Road Camperdown NSW Australia 2050
| | - Laurent Billot
- The George Institute for Global Health; Statistics and Data Management; Level 10, King George V Building RPA. 83-117 Missenden Road Camperdown NSW Australia 2050
| | - Mu Li
- The University of Sydney; Sydney School of Public Health; Level 10, King George V Building RPA. 83-117 Missenden Road Camperdown NSW Australia 2050
| | - Juan Pablo Peña-Rosas
- World Health Organization; Evidence and Programme Guidance, Department of Nutrition for Health and Development; 20 Avenue Appia Geneva Switzerland 1211
| | - Bruce Neal
- The George Institute for Global Health; Level 10, King George V Building RPA. 83-117 Missenden Road Camperdown New South Wales Australia 2050
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Morrison RE, Wan JY, Dorko CS, Sargent SJ, Land MA, Bronze CB. Use of telephone medicine for the care of patients with human immunodeficiency virus infection or AIDS: comparison of a private infectious disease practice with a university clinic practice. Clin Infect Dis 1997; 24:269-70. [PMID: 9114162 DOI: 10.1093/clinids/24.2.269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- R E Morrison
- Department of Medicine, University of Tennessee College of Medicine, Memphis 38103, USA
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Abstract
AIM To detect the prevalence of herpes virus-like DNA sequences in AIDS associated Kaposi sarcoma (KSHV) lesions and normal tissue. METHODS KSHV detection was performed by polymerase chain reaction (PCR) using four different sets of primers. PCR products were cloned, sequenced, and analysed. RESULTS All of four biopsies of Kaposi sarcoma lesions and all of three paraffin embedded Kaposi sarcoma tissues were positive for KSHV, while normal tissue from the same patients was negative. Sequence analysis of amplification products revealed polymorphisms that result in amino acid changes of the predicted sequence. CONCLUSIONS KSHV is prevalent in tissues from Kaposi sarcoma, suggesting a role in the development of the tumour. On this basis, anti-herpes virus agents should be considered to control Kaposi sarcoma.
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Affiliation(s)
- E O'Neill
- Department of Virology/Molecular Biology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
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Carbone LD, Land MA, Stentz FB, Palmieri GM. Elevated cytokine levels in a patient with AIDS and hypercalcemia: effects of therapy with pamidronate. Clin Infect Dis 1995; 21:699. [PMID: 8527580 DOI: 10.1093/clinids/21.3.699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Little JP, Gardner G, Acker JD, Land MA. Otosyphilis in a Patient with Human Immunodeficiency Virus: Internal Auditory Canal Gumma. Otolaryngol Head Neck Surg 1995; 112:488-92. [PMID: 7870458 DOI: 10.1016/s0194-59989570292-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J P Little
- Department of Otolaryngology, Bowman Gray School of Medicine/North Carolina Baptist Hospital, Winston-Salem, NC 27157
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19
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Affiliation(s)
- J P Little
- Department of Otolaryngology, Bowman Gray School of Medicine/North Carolina Baptist Hospital, Winston-Salem, NC 27157
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Affiliation(s)
- R E Morrison
- Regional Medical Center, University of Tennessee, Memphis 38103
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21
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Hughes WT, Kennedy W, Dugdale M, Land MA, Stein DS, Weems JJ, Palte S, Lancaster D, Gidan-Kovnar S, Morrison RE. Prevention of Pneumocystis carinii pneumonitis in AIDS patients with weekly dapsone. Lancet 1990; 336:1066. [PMID: 1977035 DOI: 10.1016/0140-6736(90)92533-n] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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22
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Baddour LM, Land MA, Barrett FF, Rivara FP, Bruce WM, Bisno AL. Hepatobiliary abnormalities associated with postanginal sepsis. Common manifestations of an uncommon disease. Diagn Microbiol Infect Dis 1986; 4:19-28. [PMID: 3943289 DOI: 10.1016/0732-8893(86)90052-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We describe eight patients with postanginal sepsis, a rare, potentially life-threatening complication of oropharyngeal infection. Six of the patients manifested jaundice, hepatomegaly, and liver function abnormalities, and in several this led to an erroneous suspicion of primary hepatobiliary disease. All eight patients survived the infection, although many suffered local or disseminated septic complications and required prolonged hospitalization. The pathophysiologic mechanisms responsible for hepatotoxicity in patients with postanginal sepsis are not understood. Physicians must be cognizant, however, of the frequent occurrence of jaundice in septicemic anaerobic processes, and this finding should not obscure the existence of postanginal parapharyngeal and jugular venous infection.
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Abstract
We reviewed the clinical features, methods of diagnosis, and outcome of 31 patients with pyogenic liver abscess seen at a private community hospital between 1973 and 1980. Two patient groups emerged. Group 1 consisted of 25 patients who had classical signs and symptoms of primary liver abscess. Group 2 consisted of six patients, most with underlying malignancy, in whom liver abscess(es) occurred as part of a septicemic process involving multiple other sites. The mortality was 0% in group 1 and 100% in group 2. Further analysis of the patients in group 1 revealed that (1) in contrast to findings of older studies, pyogenic liver abscess in now largely a disease of older adults who often have no identifiable predisposing process; (2) newer noninvasive imaging techniques greatly facilitate a firm diagnosis; and (3) the prognosis for such patients has become remarkably good, perhaps because of earlier diagnosis.
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Land MA, Bisno AL. Acute rheumatic fever. A vanishing disease in suburbia. JAMA 1983; 249:895-8. [PMID: 6823041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We undertook a retrospective analysis of the incidence of acute rheumatic fever (ARF) in Memphis-Shelby County during the five-year period from 1977 through 1981. Cases were identified by review of local hospital records and by mail and telephone communication with 327 primary care physicians and neurologists. Forty-one patients met the modified Jones criteria, of whom 16 had conditions that were diagnosed in Memphis but who resided elsewhere. The overall ARF incidence among Memphis-Shelby County residents was 0.64 cases per 100,000 population each year. The highest rate, 3.74, was found among blacks aged 5 to 17 years residing in the inner city, while white children in the suburban and rural areas had a rate of only 0.49. Current strategies for prevention and diagnosis of ARF must take into account the extraordinarily low level to which the incidence of the disease has fallen in certain suburban US populations.
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