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How is goal setting used in interventions for chronic disease prevention and management in sub-Saharan Africa? A systematic review and narrative synthesis.

Non-communicable diseases are increasingly prevalent in sub-Saharan Africa, and goal setting is often used to promote healthy self-management behaviours. In this review, we aimed to synthesise literature around how goal setting is used, for application in future interventions in the region. A systematic search was conducted in six databases and results screened for eligibility. Study characteristics, intervention details, goal setting components, feedback from participants and facilitators were extracted. Data were analysed using narrative synthesis and thematic analysis. The Mixed Methods Appraisal Tool was used to assess study quality. We included 24 publications describing 18 unique interventions. Included studies were of high to moderate methodological quality. Goal setting intervention components were informed by a variety of frameworks and involved a range of tasks. Interventions were often facilitator-led; many were conducted in group settings. Participants reported goal setting as useful for putting self-management into practice but encountered challenges related to language and literacy levels. Adequate detail on goal setting intervention components was not always present. Through this review, we provide a comprehensive picture of the variability of goal setting approaches in chronic disease prevention and management in sub-Saharan Africa and recommend more standardised use and reporting of goal setting intervention components.

Humans

Simulating the effects of an alcohol minimum unit price policy on distilled spirits sales in 28 states of the USA.

BACKGROUND AND AIMS: Excessive alcohol use is a leading preventable chronic disease risk factor. Alcohol minimum unit pricing (MUP) policies are not used in the United States despite evidence of associations with reduced drinking and alcohol-related harms. To inform potential population-level chronic disease prevention strategies, we estimated effects of various hypothetical MUPs on alcohol sales. METHOD: Simulation based on observational time-series data. We used weekly off-premises product-specific alcohol retail sales and prices in 28 states of the United States for November 2022-November 2023 from NielsenIQ to estimate the own-price elasticity of spirits and cross-price elasticities of wine, beer and ready-to-drinks with respect to spirits. Using estimated elasticities, we simulated changes in total alcohol sales associated with hypothetical spirits MUPs ranging from $0.10 to $1.10 per standard drink (0.6 fluid ounces of alcohol). RESULTS: A hypothetical MUP of $0.80 per standard drink on spirits yielded the largest estimated decrease in alcohol sales (-1.7%) and would affect 5374 of 26 249 spirits products. To reach the $0.80 MUP, the sales-weighted average price increase among affected products was $0.24 per drink. CONCLUSIONS: Minimum unit pricing policies on distilled spirits in the United States could shift purchasing behavior and help reduce alcohol-related harms.

alcohol policy

Preventable mortality in Mexico: bridging gaps in chronic disease and ageing care.

Preventable mortality remains a critical public health challenge in Mexico, with 819 672 deaths recorded in 2024. Of these, 37.21% in the general population were attributed to ischaemic heart disease (IHD) and diabetes mellitus. We analyse Instituto Nacional de Estadística y Geografía mortality data to assess disparities in cardiovascular mortality across age groups, sex and geographical regions, and to identify key gaps in Mexico's preventive care strategies. Age-standardised mortality rates (ASMRs) reveal persistently elevated cardiovascular mortality in northern states, including Chihuahua, Coahuila, Durango and Nuevo León, and in southeastern states, including Veracruz, Tabasco, Campeche and Yucatán. The burden is highly concentrated among older adults and geographically clustered in specific high-risk regions. These patterns reflect structural gaps in prevention, early detection and access to adequate care rather than unavoidable demographic change. Obesity, diabetes and hypertension form a pathophysiological triad that synergistically exacerbates cardiovascular disease through shared mechanisms and comorbidities. Despite substantial global declines in IHD mortality over the past two decades, Mexico continues to experience elevated and regionally extreme cardiovascular mortality, highlighting a failure to translate established global evidence into national practice. Drawing on evidence-based interventions implemented in comparable health systems, we propose seven scalable strategies: (1) expanding access to health services in underserved regions, (2) integrating preventive health programmes within primary care, (3) developing structured physical activity initiatives, (4) establishing a geriatric care framework, (5) promoting community-based nutrition and wellness programmes, (6) advancing gender-sensitive cardiovascular prevention across adulthood and ageing and (7) implementing school-based health education programmes. These interventions could substantially reduce cardiovascular mortality, lower healthcare costs and improve long-term population health outcomes in Mexico.

Humans

Nourishing collaboration: interdisciplinary nutrition education for health care professionals.

Nutrition education remains insufficient in many health care professional training programs despite the central role of diet in the prevention and management of chronic disease. Contemporary nutrition science increasingly recognizes that dietary behaviors and health outcomes are shaped by complex interactions among biological, behavioral, environmental, and food system factors. This perspective proposes an interdisciplinary framework for nutrition education that integrates the complementary expertise of physicians, dietitians, chefs, and farmers. By bridging clinical care, nutrition science, culinary practice, and agricultural systems, such an approach may strengthen the translation of evidence into practice, improve nutrition-related competencies among health care professionals, and ultimately enhance population health outcomes.

Humans

[Does the concept for the prevention of chronic ischemic heart disease correspond to current ideas on etiology and pathogenesis of arteriosclerosis?].

A summarizing description of the essential relations between the existence of risk factors and the course of the morphologic changes in the arteriosclerosis in the intima is given. In this process the low density lipoproteins play an important role which together with further etiologic factors contribute to an increased permeability of the endothelium and to the stimulation of the proliferation and modulation of the smooth muscle cells, which are of central importance in the vascular reaction. Certain effects on the progression of the arteriosclerosis as well as a regression of adequate morphologic changes are to be expected from an elimination of risk factors, provided the necessary measures begin in the early stages of the arteriosclerosis, i. e. in the preatheromatous stage.

Adult

[Medico-physiological basis of functional properties and classification of elastic products for prevention and treatment of chronic diseases of veins of the lower limbs].

Chronic diseases of the venous system of the lower extremities and concomitant disorders in haemodynamics and vessel architecture are discussed. Data are presented suggesting correlation between the disease frequency and sex, age or profession. There are also discussed the problems of prophylaxis and treatment of these diseases, with particular reference to elastic man-made fiber products. On the basis of the presented data a classification scheme was made; there are also given the work properties and indications concerning the use of various elastic textiles for prophylaxis and treatment of venous system diseases.

Adult

Selected chronic disease 'risk factors' in two elementary school populations. A pilot study.

Ninety-five first-grade elementary school students (aged 5 to 6 years) in two New York City area schools participated in a pilot test of a chronic disease primary prevention program stressing nutrition, antismoking, and physical activity. Program components included a health knowledge questionnaire; measurement of height, weight, skin-fold thickness, total serum cholesterol level, and blood pressure; and a modified Harvard step test of pulse rate recovery after exercise and subsequent classroom health education. The proportion of students with test values higher than specified critical levels was much greater in school M compared with school S. These measures will be repeated after one year to determine the feasibility and potential effectiveness of certain classroom health education activities.

Blood Pressure

Prevention of inherited multifactorial diseases.

Among the inherited multifactorial diseases are included a number of the common chronic diseases of adults. Assignment of risks within high-risk families, based on both genetic and environmental factors, offers opportunity for prevention of a portion of the present chronic disease burden. The most realistic option for prevention must be assessed for each disease, since this varies from no options to a relatively simple decision to avoid a specific environmental risk factor. Attention to specific options for prevention is an aid to identifying areas of high priority research, such as (1) factors which influence compliance with preventive management, (2) the quality of the physician-patient relationship, (3) environmental monitoring and technics for assessing genetic susceptibility to environmental risks, and (4) education of physicians in the art of chronic disease prevention.

Breast Neoplasms

Development of chronic liver disease after acute non-A, non-B post-transfusion hepatitis. Role of gamma-globulin prophylaxis in its prevention.

Progression of acute type B hepatitis to chronic liver disease and cirrhosis is well recognized, whereas no progression of acute type A hepatitis has as yet been documented. The natural history of acute non-A, non-B hepatitis has not been previously characterized. Ten cases of chronic liver disease were identified in 44 cases of acute non-A, non-B post-transfusion hepatitis. Age, sex, severity of acute illness, and prevalence of preoperative antibodies to known hepatitis-producing agents did not differ between the group whose hepatitis progressed to chronicity and the group whose hepatitis resolved. Less progression of acute hepatitis to chronic liver disease was seen in those patients receiving immune serum globulin preoperatively than in those receiving an albumin placebo (P = 0.009). Only 3 patients had clinical symptoms of hepatitis at the time of liver biopsy, and elevations of liver enzymes and gamma-globulin were mild. However, liver biopsy specimens in 8 of 10 patients showed chronic active hepatitis and an additional biopsy specimen showed cirrhosis. Acute non-A, non-B post-transfusion hepatitis often progresses to chronic active hepatitis. Preoperative gamma-globulin prophylaxis significantly reduces this progression. Identification and characterization of this viral agent(s) will further aid in the prevention of this undesirable complication of blood transfusion.

Acute Disease

[Venous thrombosis during long-term corticoid therapy in chronic obstructive lung diseases].

Venous thrombosis is a serious disease. In the case of chronic obstructive lung diseases several causes of venous thrombosis coincide being polycythemia, thrombocythemia the patient's limitation of exercise and the low flow rate of the venous blood. The therapeutic administration of corticoids leads to polycythemia and thrombocythemia. The high risk of venous thrombosis must be always regarded in corticosteroid therapy of chronic obstructive lung disease. Preventive measures should be provided.

Adult