The World Hypertension League: where now and where to in salt reduction

High dietary salt is a leading risk for death and disability largely by causing increased blood pressure. Other associated health risks include gastric and renal cell cancers, osteoporosis, renal stones, and increased disease activity in multiple sclerosis, headache, increased body fat and Meniere's disease. The World Hypertension League (WHL) has prioritized advocacy for salt reduction. WHL resources and actions include a non-governmental organization policy statement, dietary salt fact sheet, development of standardized nomenclature, call for quality research, collaboration in a weekly salt science update, development of a process to set recommended dietary salt research standards and regular literature reviews, development of adoptable power point slide sets to support WHL positions and resources, and critic of weak research studies on dietary salt. The WHL plans to continue to work with multiple governmental and non-governmental organizations to promote dietary salt reduction towards the World Health Organization (WHO) recommendations.

Using the Global Burden of Disease study to assist development of nation-specific fact sheets to promote prevention and control of hypertension and reduction in dietary salt: a resource from the World Hypertension League

Increased blood pressure and high dietary salt are leading risks for death and disability globally. Reducing the burden of both health risks are United Nations' targets for reducing noncommunicable disease. Nongovernmental organizations and individuals can assist by ensuring widespread dissemination of the best available facts and recommended interventions for both health risks. Simple but impactful fact sheets can be useful for informing the public, healthcare professionals, and policy makers. The World Hypertension League has developed fact sheets on dietary salt and hypertension but in many circumstances the greatest impact would be obtained from national-level fact sheets. This manuscript provides instructions and a template for developing fact sheets based on the Global Burden of Disease study and national survey data.

Healthy food subsidies and unhealthy food taxation: A systematic review of the evidence

The Global Burden of Disease Study and related studies report unhealthy diet is the leading risk for death and disability globally. Given the evidence associating diet and non-communicable diseases (NCDs), international and national health bodies including the World Health Organization and United Nations have called for population health interventions to improve diet as a means to target NCDs. One of the proposed interventions is to ensure healthy foods/beverages are more accessible to purchasers and unhealthy ones less accessible via fiscal policy, namely taxation and subsidies. The objective of this systematic review was to evaluate the evidence base to assess the effect of healthy food/beverage subsidies and unhealthy food/beverage taxation. A comprehensive review was conducted by searching PubMed, Medline, and Google Scholar for peer-reviewed publications and seventy-eight studies were identified for inclusion in this review. This review was performed in keeping with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Although moderate in quality, there was consistent evidence that taxation and subsidy intervention influenced dietary behaviors. The quality, level and strength of evidence along with identified gaps in research support the need for further policies and ongoing evaluation of population-wide food/beverage subsidies and taxation. To maximize success and effect, this review suggests that food taxes and subsidies should be a minimum of 10 to 15% and preferably used in tandem. Implementation of population-wide polices for taxation and subsides with ongoing evaluation of intended and unintended effects are supported by this review.

Healthy food procurement policies and their impact

Unhealthy eating is the leading risk for death and disability globally. As a result, the World Health Organization (WHO) has called for population health interventions. One of the proposed interventions is to ensure healthy foods are available by implementing healthy food procurement policies. The objective of this systematic review was to evaluate the evidence base assessing the impact of such policies. A comprehensive review was conducted by searching PubMed and Medline for policies that had been implemented and evaluated the impact of food purchases, food consumption, and behaviors towards healthy foods. Thirty-four studies were identified and found to be effective at increasing the availability and purchases of healthy food and decreasing purchases of unhealthy food. Most policies also had other components such as education, price reductions, and health interventions. The multiple gaps in research identified by this review suggest that additional research and ongoing evaluation of food procurement programs is required. Implementation of healthy food procurement policies in schools, worksites, hospitals, care homes, correctional facilities, government institutions, and remote communities increase markers of healthy eating. Prior or simultaneous implementation of ancillary education about healthy eating, and rationale for the policy may be critical success factors and additional research is needed.

Implementation of diabetes prevention programs in rural areas: Montana and south-eastern Australia compared

OBJECTIVE

To identify the key elements that enabled the Greater Green Triangle Diabetes Prevention Project (GGT DPP) and the Montana Cardiovascular Disease and Diabetes Prevention (CDDP) programs successful establishment and implementation in rural areas, as well as identifying specific challenges or barriers for implementation in rural communities.

METHODS

Focus groups were held with the facilitators who delivered the GGT DPP in Australia and the Montana CDDP programs in the USA. Interview questions covered the facilitators' experiences with recruitment, establishing the program, the components and influence of rurality on the program, barriers and challenges to delivering the program, attributes of successful participants, and the influence of community resources and partnerships on the programs.

RESULTS

Four main themes emerged from the focus groups: establishing and implementing the diabetes prevention program in the community; strategies for recruitment and retention of participants; what works in lifestyle intervention programs; and rural-centred issues.

CONCLUSIONS

The results from this study have assisted in determining the factors that contribute to developing, establishing and implementing successful diabetes prevention programs in two rural areas. Recommendations to increase the likelihood of success of programs in rural communities include: securing funding early for the program; establishing support from community leaders and developing positive relationships with health care providers; creating a professional team with passion for the program; encouraging participants to celebrate their small and big successes; and developing procedures for providing post-intervention support to help participants maintain their success.

Lethal effect of Rickettsia rickettsii on its tick vector (Dermacentor andersoni)

Rickettsia rickettsii, the causative agent of Rocky Mountain spotted fever, was lethal for the majority of experimentally and transovarially infected Rocky Mountain wood ticks (Dermacentor andersoni). Overall, 94.1% of nymphs infected as larvae by feeding on rickettsemic guinea pigs died during the molt into adults and 88. 3% of adult female ticks infected as nymphs died prior to feeding. In contrast, only 2.8% of uninfected larvae failed to develop into adults over two generations. Infected female ticks incubated at 4 degreesC had a lower mortality (80.9%) than did those held at 21 degreesC (96.8%). Rickettsiae were vertically transmitted to 39.0% of offspring, and significantly fewer larvae developed from infected ticks. The lethal effect of R. rickettsii may explain the low prevalence of infected ticks in nature and affect its enzootic maintenance.

Characterization of an endosymbiont infecting wood ticks, Dermacentor andersoni, as a member of the genus Francisella

A microorganism (Dermacantor andersoni symbiont [DAS]) infecting Rocky Mountain wood ticks (D. andersoni) collected in the Bitterroot Mountains of western Montana was characterized as an endosymbiont belonging to the genus Francisella. Previously described as Wolbachia like, the organism's DNA was amplified from both naturally infected tick ovarial tissues and Vero cell cultures by PCR assay with primer sets derived from eubacterial 16S ribosomal DNA (rDNA) and Francisella membrane protein genes. The 16S rDNA gene sequence of the DAS was most similar (95.4%) to that of Francisella tularensis subsp. tularensis. Through a combination of Giménez staining, PCR assay, and restriction fragment length polymorphism analysis, 102 of 108 female ticks collected from 1992 to 1996 were infected. Transovarial transmission to female progeny was 95.6%, but we found no evidence of horizontal transmission.

Rickettsia peacockii sp. nov., a new species infecting wood ticks, Dermacentor andersoni, in western Montana

Rickettsia peacockii, a new species of spotted fever group rickettsiae, was identified from Rocky Mountain wood ticks (Dermacentor andersoni) collected in the Sapphire Mountain Range on the eastern side of Bitterroot Valley, Montana. DNA from R. peacockii SkalkahoT (T = type strain) in naturally infected tick tissue was amplified by a PCR assay with primer sets derived from eubacterial 16S ribosomal DNA (rDNA), rickettsial citrate synthase, and 190-kDa surface antigen (rOmpA) genes. Partial 16S rDNA and rOmpA gene sequences exhibited levels of similarity of 99.7 and 93.2%, respectively, with the sequences of the spotted fever agent Rickettsia rickettsii R. By using Gimenez staining, fluorescent antibody tests, a PCR assay, and a restriction fragment length polymorphism analysis, 76 of 115 female ticks (minimal field infection rate, 66.1%) collected between 1992 and 1995 were found to be infected. The organism is passed transstadially and transovarially (minimal vertical transmission rate, 73.3%), and infections are localized in ovarial tissues. Attempts to cultivate R. peacockii were unsuccessful.

Dispersal and survival of Aedes albopictus at a scrap tire yard in Missouri

Field-reared Aedes albopictus were marked with fluorescent pigment upon release and recaptured with a vacuum aspirator at a scrap tire yard and in surrounding vegetation in Potosi, MO, during 1989-90. In 8 dispersal trials, 8.1% (1,100/13,513) of the Ae. albopictus were recaptured with 84.4% (928/1,100) collected in the forest edge ecotone between 10 and 600 m from the release point. The maximum dispersal distance recorded was 525 m and 11.1% (122/1,100) dispersed further than 100 m. In 3 survival trials, 4.8% (2,660/55,284) of the mosquitoes were recaptured. Adult Ae. albopictus females survived an average of 8.2 days (probability of daily survival [PDS] = 0.89, range = 0-24) and males an average of 3.9 days (PDS = 0.77, range = 0-12). The dispersal and survival capacity of Ae. albopictus adults may contribute to the spread and potential health threat of this mosquito in the USA.

Blood hosts of Aedes albopictus in the United States

Bloodfed Aedes albopictus were collected during 1989-91 by vacuum aspirator from rural and urban study sites in Missouri, Florida, Indiana, Illinois, and Louisiana. Blood hosts identified by ELISA and precipitin tests were rabbit (n = 91), Rattus sp. (n = 69), dog (n = 14), unidentified mammal (n = 14), cow (n = 13), human (n = 10), deer (n = 10), sciurid (n = 7), turtle (n = 5), murid other than Rattus sp. (n = 4), raccoon (n = 3), passeriform bird (n = 3), and cat (n = 2). As an opportunistic bloodfeeder, Ae. albopictus may be a potential vector of domestic arboviruses and a nuisance pest where infestations occur.

Host-feeding patterns of Aedes albopictus (Diptera: Culicidae) at a temperate North American site

Precipitin tests and ELISA were used to investigate host-feeding patterns of 172 blood-fed Aedes albopictus (Skuse) collected at Potosi, MO, during the summers of 1989 and 1990. One hundred ten (64.0%) mosquitoes had fed on mammals, 29 (16.9%) on birds, and none on turtles or snakes. Thirty-three (19.2%) mosquitoes failed to react in all tests. Eighty-six (78.2%) of the 110 mammalian feeds were positive for lower taxa as follows: rabbit, 24.5%; deer, 14.5%; dog, 13.6%; human, 8.2%; squirrel, 7.3%; opossum, 4.5%; myomorph rodents other than Rattus, 3.6%; raccoon, 0.9%; and bovine, 0.9%. Positive feeds were not detected for the following mammals: cat (n = 99); horse (n = 95); Rattus (n = 84); and swine (n = 84). Fourteen (48.3%) of the 29 avian feeds were positive for lower taxa as follows: Passeriformes, 24.1%; Columbiformes, 17.2%; Ciconiiformes, 3.4%; and quail, 3.4%. These data, the first on host-feeding patterns for Ae. albopictus populations in the New World, indicate that Ae. albopictus is an opportunistic feeder that utilizes a wide variety of hosts and, therefore, has the potential to become involved in the transmission cycles of indigenous arboviruses.

Isolation of eastern equine encephalitis virus from Aedes albopictus in Florida

Fourteen strains of eastern equine encephalitis (EEE) virus were isolated from Aedes albopictus mosquitoes collected in Polk County, Florida. These are the first isolations of an arbovirus of proven public health and veterinary importance from naturally infected Ae. albopictus in the United States since established populations of this introduced mosquito were first discovered in 1985. The widespread distribution of Ae. albopictus in Florida and in other areas of the United States where EEE is endemic raises concern that this species may become an epizootic and epidemic vector of EEE virus.

A new arbovirus from Aedes albopictus, an Asian mosquito established in the United States

Ten strains of a new arbovirus belonging to the Bunyamwera group (Bunyaviridae) were recovered from field-collected Aedes albopictus mosquitoes in Potosi, Missouri. This evidence indicates that this species may serve as an arbovirus vector in the United States. The urban-suburban distribution, aggressive biting behavior, and broad viral susceptibility of Ae. albopictus may lead to the transmission of viruses of known public health importance and perhaps of viruses hitherto not transmitted to humans because of the feeding pattern of their usual vectors.