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More than 40 years after the 1978 Bethesda Conference on the Declining Mortality from Coronary Heart Disease provided the scientific community with a blueprint for systematic analysis to understand declining rates of coronary heart disease, there are indications the decline has ended or even reversed despite advances in our knowledge about the condition and treatment. Recent data show a more complex situation, with mortality rates for overall cardiovascular disease, including coronary heart disease and stroke, decelerating, whereas those for heart failure are increasing. To mark the 40th anniversary of the Bethesda Conference, the National Heart, Lung, and Blood Institute and the American Heart Association cosponsored the "Bending the Curve in Cardiovascular Disease Mortality: Bethesda + 40" symposium. The objective was to examine the immediate and long-term outcomes of the 1978 conference and understand the current environment. Symposium themes included trends and future projections in cardiovascular disease (in the United States and internationally), the evolving obesity and diabetes epidemics, and harnessing emerging and innovative opportunities to preserve and promote cardiovascular health and prevent cardiovascular disease. In addition, participant-led discussion explored the challenges and barriers in promoting cardiovascular health across the lifespan and established a potential framework for observational research and interventions that would begin in early childhood (or ideally in utero). This report summarizes the relevant research, policy, and practice opportunities discussed at the symposium.

Background Taxes on sugar-sweetened beverages (SSBs) have been implemented globally to reduce the burden of cardiometabolic diseases by disincentivizing consumption through increased prices (e.g., 1 peso/litre tax in Mexico) or incentivizing industry reformulation to reduce SSB sugar content (e.g., tiered structure of the United Kingdom [UK] Soft Drinks Industry Levy [SDIL]). In Germany, where no tax on SSBs is enacted, the health and economic impact of SSB taxation using the experience from internationally implemented tax designs has not been evaluated. The objective of this study was to estimate the health and economic impact of national SSBs taxation scenarios in Germany. Methods and findings In this modelling study, we evaluated a 20% ad valorem SSB tax with/without taxation of fruit juice (based on implemented SSB taxes and recommendations) and a tiered tax (based on the UK SDIL) in the German adult population aged 30 to 90 years from 2023 to 2043. We developed a microsimulation model (IMPACT.sub.NCD Germany) that captures the demographics, risk factor profile and epidemiology of type 2 diabetes, coronary heart disease (CHD) and stroke in the German population using the best available evidence and national data. For each scenario, we estimated changes in sugar consumption and associated weight change. Resulting cases of cardiometabolic disease prevented/postponed and related quality-adjusted life years (QALYs) and economic impacts from healthcare (medical costs) and societal (medical, patient time, and productivity costs) perspectives were estimated using national cost and health utility data. Additionally, we assessed structural uncertainty regarding direct, body mass index (BMI)-independent cardiometabolic effects of SSBs and cross-validated results with an independently developed cohort model (PRIMEtime). We found that SSB taxation could reduce sugar intake in the German adult population by 1 g/day (95%-uncertainty interval [0.05, 1.65]) for a 20% ad valorem tax on SSBs leading to reduced consumption through increased prices (pass-through of 82%) and 2.34 g/day (95%-UI [2.32, 2.36]) for a tiered tax on SSBs leading to 30% reduction in SSB sugar content via reformulation. Through reductions in obesity, type 2 diabetes, and cardiovascular disease (CVD), 106,000 (95%-UI [57,200, 153,200]) QALYs could be gained with a 20% ad valorem tax and 192,300 (95%-UI [130,100, 254,200]) QALYs with a tiered tax. Respectively, [euro]9.6 billion (95%-UI [4.7, 15.3]) and [euro]16.0 billion (95%-UI [8.1, 25.5]) costs could be saved from a societal perspective over 20 years. Impacts of the 20% ad valorem tax were larger when additionally taxing fruit juice (252,400 QALYs gained, 95%-UI [176,700, 325,800]; [euro]11.8 billion costs saved, 95%-UI [[euro]6.7, [euro]17.9]), but impacts of all scenarios were reduced when excluding direct health effects of SSBs. Cross-validation with PRIMEtime showed similar results. Limitations include remaining uncertainties in the economic and epidemiological evidence and a lack of product-level data. Conclusions In this study, we found that SSB taxation in Germany could help to reduce the national burden of noncommunicable diseases and save a substantial amount of societal costs. A tiered tax designed to incentivize reformulation of SSBs towards less sugar might have a larger population-level health and economic impact than an ad valorem tax that incentivizes consumer behaviour change only through increased prices., Author(s): Karl M. F. Emmert-Fees 1,2,3,*, Ben Amies-Cull 4,5, Nina Wawro 3, Jakob Linseisen 6, Matthias Staudigel 7, Annette Peters 3, Linda J. Cobiac 8, Martin O'Flaherty 9, Peter Scarborough [...]

People with disabilities experience persistent, multifaceted disadvantage across the life course. The origins of life course disadvantage among people with disabilities may stem, in part, from exclusion during developmentally sensitive periods in childhood. Time use among adolescents represents a potentially important mechanism implicated in the emergence of disability-related disadvantage, but previous research has largely neglected the time use of school age adolescents with disabilities. Utilizing nationally representative time diary data, this study investigated disability-related differences in adolescents' time use, and how these gaps vary by sex and age. Results indicated that disability-related differences in time use are widespread and substantial in magnitude. Adolescents with disabilities spend more time in screen-based leisure, alone, and with mothers, and less time in educational activities than non-disabled adolescents. Boys with disabilities additionally spend less time in structured leisure and with peers than non-disabled boys. Differences in time alone, with peers, and in screen-based leisure increase in magnitude at older ages. We conclude that differential time use in adolescence may contribute to multiple persistent disadvantages experienced by people with disabilities over the life course. [ABSTRACT FROM AUTHOR]

Objective To systematically review published studies of interventions to reduce people's intake of dietary trans-fatty acids (TFAs). Methods We searched online databases (CIN AHL, the CRD Wider Public Health database, Cochrane Database of Systematic Reviews, Ovid[R], MEDLINE[R], Science Citation Index and Scopus) for studies evaluating TFA interventions between 1986 and 2017. Absolute decrease in TFA consumption (g/day) was the main outcome measure. We excluded studies reporting only on the TFA content in food products without a link to intake. We included trials, observational studies, meta-analyses and modelling studies. We conducted a narrative synthesis to interpret the data, grouping studies on a continuum ranging from interventions targeting individuals to population-wide, structural changes. Results After screening 1084 candidate papers, we included 23 papers: 12 empirical and 11 modelling studies. Multiple interventions in Denmark achieved a reduction in TFA consumption from 4.5 g/day in 1976 to 1.5 g/day in 1995 and then virtual elimination after legislation banning TFAs in manufactured food in 2004. Elsewhere, regulations mandating reformulation of food reduced TFA content by about 2.4 g/ day. Worksite interventions achieved reductions averaging 1.2 g/day. Food labelling and individual dietary counselling both showed reductions of around 0.8 g/day. Conclusion Multicomponent interventions including legislation to eliminate TFAs from food products were the most effective strategy. Reformulation of food products and other multicomponent interventions also achieved useful reductions in TFA intake. By contrast, interventions targeted at individuals consistently achieved smaller reductions. Future prevention strategies should consider this effectiveness hierarchy to achieve the largest reductions in TFA consumption. Objectif Effectuer une revue systematique des etudes publiees portant sur des interventions qui visent a reduire la consommation par les individus d'acides gras trans alimentaires. Methodes Nous avons recherche dans des bases de donnees en ligne-(CINAHL, The CRD Wider Public Health database, The Cochrane Database of Systematic Reviews, Ovid[R], MEDLINE[R], Science Citation Index et Scopus) des etudes evaluant les interventions relatives aux acides gras trans entre 1986 et 2017. Le principal critere d'evaluation etait la baisse absolue de la consommation d'acides gras trans (g/ jour). Nous avons exclu les etudes mentionnant uniquement la teneur en acides gras trans dans les produits alimentaires sans etablir de lien avec leur consommation. Nous avons inclus des essais, des etudes observationnelles, des meta-analyses et des etudes de modelisation. Nous avons realise une synthese descriptive afin d'interpreter les donnees en regroupant les etudes selon un continuum allant des interventions ciblant des individus a des changements structurels au niveau de la population. Resultats Apres avoir examine 1084 etudes, nous en avons selectionne 23:12 etudes empiriques et 11 etudes de modelisation. Au Danemark, de multiples interventions ont permis de faire passer la consommation d'acides gras trans de 4,5 g/jour en 1976 a 1,5 g/jour en 1995, jusqu'a une elimination virtuelle suite a l'adoption d'une loi en 2004 interdisant les acides gras trans dans les produits alimentaires industriels. Dans d'autres pays, des reglementations imposant une reformulation des aliments ont reduit la teneur en acides gras trans d'environ 2,4 g/jour. Des interventions sur les lieux de travail ont induit des baisses de 1,2 g/jour en moyenne. L'etiquetage des produits alimentaires et la fourniture de conseils dietetiques individualises ont quant a eux entraine des diminutions d'environ 0,8 g/jour. Conclusion La strategie la plus efficace consistait en des interventions a plusieurs composantes incluant une loi destinee a eliminer les acides gras trans des produits alimentaires. La reformulation des produits alimentaires et d'autres interventions a plusieurs composantes ont egalement permis de reduire efficacement la consommation d'acides gras trans. En revanche, les baisses induites par les interventions ciblant des individus etaient systematiquement moins importantes. Cette hierarchie de l'efficacite doit etre prise en compte dans les futures strategies de prevention afin de reduire au maximum la consommation d'acides gras trans. Objetivo Revisar de forma sistematica los estudios publicados sobre intervenciones para reducir la ingesta de acidos grasos trans (TFA, por sus siglas en ingles) en la dieta. Metodologia En bases de datos en linea (CINAHL, la base de datos de salud publica mas amplia del CRD, la base de datos Cochrane sobre revisiones sistematicas, Ovid[R], MEDLINE[R], Science Citation Index y Scopus), se buscaron estudios que evaluasen las intervenciones deTFA entre 1986 y 2017. El descenso absoluto del consumo deTFA (g/dia) fue la principal medida como resultado. Se excluyeron los estudios que informan solo sobre el contenido deTFA en los productos alimenticios sin relacionarlos con la ingesta. Se incluyeron ensayos, estudios observacionales, metanalisis y estudios de modelacion. Se llevo a cabo una sintesis narrativa para interpretar los datos, agrupando los estudios en un continuo que va desde las intervenciones dirigidas a personas hasta los cambios estructurales en toda la poblacion. Resultados Despues de examinar 1084 documentos candidatos, se incluyeron 23 articulos: 12 estudios empiricos y 11 de modelacion. Las multiples intervenciones en Dinamarca lograron una reduccion en el consumo de TFA de 4,5 g/dia en 1976 a 1,5 g/dia en 1995 y posteriormente la eliminacion virtual tras la legislacion de 2004 que prohibio los TFA en los alimentos manufacturados. En otros lugares, las regulaciones que obligan a la reformulacion de los alimentos redujeron el contenido deTFA en unos 2,4 g/dia. Las intervenciones en el lugar de trabajo consiguieron reducciones con un promedio de 1,2 g/dia. El etiquetado de los alimentos y el asesoramiento alimenticio individual mostraron reducciones de alrededor de 0,8 g/dia. Conclusion Las intervenciones de componentes multiples, incluida la legislacion para eliminar los TFA de los productos alimenticios, fueron la estrategia mas efectiva. La reformulacion de los productos alimenticios y otras intervenciones de componentes multiples tambien lograron reducciones utiles en la ingesta deTFA. Por el contrario, las intervenciones dirigidas a personas lograron sistematicamente reducciones mas pequenas. Las futuras estrategias de prevencion deberian tener en cuenta esta jerarquia de efectividad para conseguir la mayor reduccion posible en el consumo de TFA., Introduction Over two-thirds of the global burden of disability and death is attributable to noncommunicable diseases. Diseases such as cardiovascular diseases, common cancers, dementia, diabetes and respiratory disorders kill over [...]