Physically active vs. sedentary academic lessons: A dose response study for elementary student time on task

BackgroundPhysically active academic lessons are an effective intervention to reduce sedentary time and increase student physical activity. They have also been shown to enhance task engagement, as indicated by observations of attention and behavior control, time on task (TOT). However, it is not clear if the improved TOT stems from the physical activity or if it is the result of an enjoyable break from traditional instruction. If it is due to physical activity, what dose of intensity is required for the effect? This study was designed to test these questions.MethodsParticipants were 320 children (7–9 years) recruited from school districts in Central Texas in 2012. They were assigned by classroom (n = 20) to one of four conditions: 1) sedentary, standard lesson (n = 72); 2) sedentary academic game (n = 87); 3) low to moderate intensity PA (LMPA), academic game (n = 81); and 4) moderate to vigorous intensity PA (MVPA), academic game (n = 76). Measures included PA via accelerometer and TOT.ResultsMixed-method RMANOVA indicated TOT decreased following the standard lesson (p < 0.001), showed no change following the sedentary academic game (p = 0.68), and increased following the LMPA (p < 0.01) and MVPA (p < 0.001) academic games.ConclusionsWhile the sedentary, academic game prevented the reduction in TOT observed in the standard lesson, PA resulted in increased TOT. Future research should be designed to examine the potential academic benefits of the change in TOT.     

Proxy reports of physical activity were valid in older people with and without cognitive impairment

ObjectiveTo determine the validity of proxy reports of physical activity in people with symptoms of cognitive impairment.Study Design and SettingIn the Canadian Study of Health and Aging, a multicenter prospective cohort study, someone close to the participant (proxy) reported exercise levels for people who screened positive for cognitive impairment or were institutionalized (n = 2421), some of whom were subsequently diagnosed with cognitive impairment (n = 1612) and some of whom were diagnosed as having no cognitive impairment (n = 809). The reliability and validity of proxy reports of physical activity were examined by agreement with self-reports of physical activity (intraclass correlation coefficient) and by association with adverse health markers (Mantel–Haenzel χ²) and survival time (Cox proportional hazards).ResultsProxy reports of physical activity had moderate interrater reliability (0.55, 95% confidence interval: 0.49–0.61, P < 0.001). People in higher physical activity group had fewer adverse health outcomes than those in lower physical activity groups. Predictive validity was confirmed as people who had higher proxy-reported physical activity survived longer that those with lower physical activity.ConclusionProxy-reported physical activity appears to be a valid estimate of physical activity in people with symptoms or a diagnosis of cognitive impairment.     

The association between physical activity and liver fat after five years of follow-up in a primary prevention multi-ethnic cohort

Objective: Excess liver fat (LF) is associated with dyslipidemia, insulin resistance and cardiovascular disease. Evidence suggests that there is an independent relationship between physical activity (PA) and LF although little is known of the role of PA intensity in reducing LF. The purpose was to evaluate whether meeting PA guidelines, the amount of PA and the intensity of PA at baseline were associated with LF after five-years.Methods: Men and women (n = 478) living in Vancouver, Canada of Aboriginal, Chinese, European or South Asian background completed baseline measurements in 2004–2005. Liver fat was assessed using CT scans at 5-year follow-up, and PA using a PA questionnaire at baseline as well as demographics and anthropometry.Results: In separate unadjusted models, meeting moderate–vigorous PA (MVPA) guidelines (p = 0.009), vigorous PA (p = 0.002) and MVPA (p = 0.017) but not moderate PA (p = 0.068) was predictive of LF at five years (p = 0.009). In multiple linear regression models, when adjusted for covariates, meeting MVPA guidelines and MVPA with LF at five years was no longer significant (p > 0.05) while vigorous PA remained significant (p = 0.021).Conclusion: Meeting PA guidelines through MVPA may not be adequate to prevent the accumulation of LF and PA guidelines may require revision. Vigorous PA should be encouraged to prevent LF accumulation.     

Physical activity outcomes in afterschool programs: A group randomized controlled trial

IntroductionAfterschool programs (ASPs) across the US are working towards achieving the standard of all children accumulating 30 min of moderate-to-vigorous physical activity (MVPA) during program time. This study describes the two-year impact of an intervention designed to assist ASPs meeting the 30 min/day MVPA standard.MethodsUsing a two-year delayed treatment, group randomized controlled trial, 20 ASPs serving ~ 1700 children/year (6–12 yrs) were randomized to either an immediate (n = 10, baseline-2013 and 2 yrs intervention fall-2013-to-spring-2015) or delayed group (n = 10, baseline 2013–2014 and 1 yr intervention fall-2014-to-spring-2015). The intervention, Strategies-To-Enhance-Practice (STEPs), focused on programming MVPA in the daily schedule, training of staff and leaders, and ongoing technical support/assistance. Accelerometry-derived proportion of children meeting the 30 min/day MVPA standard was measured in the spring of each year. Mixed model logistic regressions were used to examine the change in the odds of achieving the MVPA standard. Analyses were conducted in 2015. Data were collected in one southeastern US state.ResultsImmediate boys (n = 677) and delayed girls (n = 658) increased the percent achieving 30 min MVPA/day from 35.9% to 47.0% (odds ratio [OR] = 1.88, 95% CI 1.18–3.00) and 13.1% to 19.1% (OR = 1.42, 95% CI 1.03–1.96). Immediate girls (n = 613) and delayed boys (n = 687) exhibited a nonsignificant increase from 19.1% to 21.6% (OR = 1.20, 95% CI 0.84–1.72) and 29.0% to 31.3% (OR = 1.13, 95%CI 0.80–1.58).ConclusionsSTEPs can have an impact on children's MVPA and time spent sedentary, yet was unable to fully achieve the goal of all children accumulating 30 min MVPA/day. Additional efforts are need to identify strategies ASPs can use to meet this important public health standard.     

Symptoms of specific anxiety disorders may relate differentially to different physical activity modalities in young adults

BackgroundAnxiety symptoms may be a barrier to physical activity (PA) such that persons who experience anxiety engage in less PA. The purpose of this study was to assess if symptoms of panic disorder, social phobia, generalized anxiety disorder (GAD) or agoraphobia are associated with frequency, intensity or type of PA in young adults.MethodsData on lifetime anxiety symptoms and current PA levels were collected in self-report questionnaires in 2007–2008 from 880 persons aged 18–24 years participating in the Nicotine Dependence in Teens (NDIT) study. The associations between anxiety symptom subtypes and different PA modalities were investigated in five multivariable logistic regression models, one for each of five PA indicators (i.e., meeting moderate-to vigorous PA (MVPA) guidelines, meeting strength training guidelines, meeting both MVPA and strength training guidelines, participating in team sports, frequent walking) as outcomes.Results37%, 47%, 40% and 21% of participants reported lifetime symptoms of panic disorder, social phobia, GAD, and agoraphobia, respectively. In multivariable logistic regression, participants who endorsed lifetime GAD symptoms were statistically significantly less likely to meet MVPA guidelines (OR 0.5, 95% CI 0.4–0.8, p < 0.05), and MVPA and strength training guidelines (OR 0.7, 95% CI 0.5–1.0, p < 0.05). Those with agoraphobia symptoms were more likely to walk frequently [OR (95% CI) = 1.6 (1.1, 2.3)].ConclusionPA interventions may need to be tailored to people who have experienced specific anxiety symptoms to maximize adherence to PA recommendations, and increase the potential for health benefits from PA participation.     

Accelerometer determined sedentary behavior and dietary quality among US adults

ObjectiveScant evidence exists pertaining to objectively measured sedentary time and dietary quality among adults. Therefore, we examined the relationships between sedentary time, physical activity, and dietary quality.MethodsCross-sectional analyses of a 4,910 US adults from two cycles (2003–2006) of the National Health and Nutrition Examination Survey. The primary independent variables were sedentary time and physical activity (continuous and categorical), while the outcomes were overall dietary quality (Healthy Eating Index (HEI) 2010), fruit and vegetable scores, and empty caloric intake (kcal).ResultsMultivariable analyses revealed that a 1 min increase in daily sedentary behavior was associated with a 0.2 kcal decrease in empty calories (− 0.18, 95% CI = − 0.34, − 0.03); however, sedentary time was not significantly related to overall dietary quality (HEI) and fruit and vegetable intake. In comparison, a 1 min increase in daily moderate-to-vigorous intensity physical activity was related to a 0.1 higher HEI score (0.08, 95% CI = 0.04, 0.11), a 0.01 higher fruit score (0.01, 95% CI = 0.01, 0.02), and conversely a 1.3 kcal decrease in empty calories (− 1.35, 95% CI = − 2.01, − 0.69). In addition, meeting physical activity guidelines was associated with a 2.8 point higher HEI score (2.82, 95% CI = 1.40, 4.25), a 0.5 point higher fruit score (0.51, 95% CI = 0.31–0.71), and 37.4 fewer empty calories (− 37.43, 95% CI = − 64.86, − 9.10).ConclusionsPhysical activity is significantly related to better overall dietary quality, while sedentary behavior is not. Findings suggest the need to promote physical activity and encourage adherence to dietary guidelines jointly, whereas sedentary behavior and overall dietary quality might need to be targeted independently.     

Hábitos saludables y prevención de la osteoporosis en mujeres perimenopáusicas de un ámbito rural

ObjectiveThe probability of developing osteoporosis decreases with an adequate supply of vitamin D, a balanced diet, and increased physical activity. In this study, we evaluated whether an educational intervention improves osteoporosis-related behavior in perimenopausal women from rural areas.MethodsA randomized experimental evaluation was performed of an educational intervention. The variables were physical activity, calcium intake and sun exposure in women from rural areas aged 45-54 years (n = 216) at time 0 and 12 months after the educational intervention. In the control group (n = 106), the information was sent by surface mail (month 0). In the intervention group (n = 110), two interactive workshops were given (month 0). The topic of the workshops and the information sent by surface mail was healthy habits for osteoporosis prevention.ResultsAfter 12 months, the intervention group, but not the control group, had increased their physical activity (p = 0.006), sun exposure (p = 0.029), and calcium intake (53% to 64%).ConclusionA simple educational intervention in perimenopausal women from rural areas improved healthy habits for osteoporosis prevention.     

Self-determined motivation and physical activity in children and adolescents: A systematic review and meta-analysis

ObjectiveSelf-determination theory is used as a framework for examining the relation between motivation and physical activity. The purpose of this review was to systematically review studies that assessed the association between self-determined motivation and physical activity levels in children and adolescents.MethodWe searched electronic databases in April 2013. Included studies assessed the relation between motivation (as outlined in self-determination theory) and physical activity in children and adolescents.ResultsForty-six studies (n = 15,984 participants) met the inclusion criteria. Meta-analysis indicated that overall levels of self-determined motivation had a weak to moderate, positive associations with physical activity (ρ = .21 to .31). Autonomous forms of motivation (i.e., intrinsic motivation and identified regulation) had moderate, positive associations with physical activity (ρ = .27 to .38), whereas controlled forms of motivation (i.e., introjection and external regulation) had weak, negative associations with physical activity (ρ = − .03 to −.17). Amotivation had a weak, negative association with physical activity (ρ = − .11 to − .21).ConclusionsEvidence provides some support for self-determination theory tenets. However, there was substantial heterogeneity in most associations and many studies had methodological shortcomings.     

Acute kidney injury in infective endocarditis: A retrospective analysis

BackgroundAcute kidney injury (AKI) is associated with high case fatality in infective endocarditis (IE), but epidemiological data on the frequency of AKI during IE is scarce. We aimed to describe the frequency and risk factors for AKI during the course of IE using Kidney Disease: Improving Global Outcomes consensual criteria.MethodsUsing the French hospital discharge database (French acronym PMSI), we retrospectively reviewed the charts of 112 patients presenting with a first episode of probable or definite IE between January 2010 and May 2015.ResultsSeventy-seven patients (68.8%) developed AKI. In univariate analysis, risk factors for AKI were cardiac surgery for IE (n = 29, 37.7% vs. n = 4, 1.4%, P < 0.0005), cardiac failure (n = 29, 36.7% vs. n = 1, 2.9%, P < 0.0005), diabetes mellitus (n = 14, 18.2% vs. n = 1, 0.9%, P = 0.034), and prosthetic valve IEs (n = 24, 31.2% vs. n = 4, 11.4%). No differences were observed for gentamicin exposure (n = 57, 64% vs. n = 32, 86.5%, P = 0.286). Prosthetic valve IE, cardiac failure, and vancomycin exposure were independently associated with AKI with respective odds ratio of 5.49 (95% CI 1.92–17.9), 4.37 (95% CI 4.37–465.7), and 1.084 (1.084–16.2). Mean length of hospital stay was significantly longer in patients presenting with AKI than in controls (respectively 52.4 ± 22.1 days vs. 39.6 ± 12.6, P < 0.005).ConclusionAKI is very frequent during IE, particularly in patients with prosthetic valve IE, cardiac failure, and those receiving vancomycin.     

The ‘Healthy Dads,Healthy Kids’ community randomized controlled trial: A community-based healthy lifestyle program for fathers and their children

ObjectiveTo evaluate the effectiveness of the ‘Healthy Dads, Healthy Kids (HDHK)’ program when delivered by trained facilitators in community settings.MethodA two-arm randomized controlled trial of 93 overweight/obese fathers (mean [SD] age = 40.3 [5.3] years; BMI = 32.5 [3.8] kg/m²) and their primary school-aged children (n = 132) from the Hunter Region, Australia. In 2010–2011, families were randomized to either: (i) HDHK intervention (n = 48 fathers, n = 72 children) or (ii) wait-list control group. The 7-week intervention included seven sessions and resources (booklets, pedometers). Assessments were held at baseline and 14-weeks with fathers' weight (kg) as the primary outcome. Secondary outcomes for fathers and children included waist, BMI, blood pressure, resting heart rate, physical activity (pedometry), and self-reported dietary intake and sedentary behaviors.ResultsLinear mixed models (intention-to-treat) revealed significant between-group differences for fathers' weight (P < .001, d = 0.24), with HDHK fathers losing more weight (− 3.3 kg; 95%CI, − 4.3, − 2.4) than control fathers (0.1 kg; 95%CI, − 0.9,1.0). Significant treatment effects (P < .05) were also found for fathers' waist (d = 0.41), BMI (d = 0.26), resting heart rate (d = 0.59), energy intake (d = 0.49) and physical activity (d = 0.46) and for children's physical activity (d = 0.50) and adiposity (d = 0.07).DiscussionHDHK significantly improved health outcomes and behaviors in fathers and children, providing evidence for program effectiveness when delivered in a community setting.     

Implementing classroom physical activity breaks: Associations with student physical activity and classroom behavior

ObjectiveTo investigate the relation of classroom physical activity breaks to students' physical activity and classroom behavior.MethodsSix elementary-school districts in California implemented classroom physical activity interventions in 2013–2014. Students' (N = 1322) accelerometer-measured moderate-to-vigorous physical activity (MVPA) during school and teachers' (N = 397) reports of implementation and classroom behavior were assessed in 24 schools at two time points (both post-intervention). Mixed-effects models accounted for nested data.ResultsMinutes/day of activity breaks was positively associated with students' MVPA (βs = .07–.14; ps = .012–.016). Students in classrooms with activity breaks were more likely to obtain 30 min/day of MVPA during school (OR = 1.75; p = .002). Implementation was negatively associated with students having a lack of effort in class (β = − .17; p = .042), and student MVPA was negatively associated with students being off task or inattentive in the classroom (β = − .17; p = .042). Students provided with 3–4 physical activity opportunities (classroom breaks, recess, PE, dedicated PE teacher) had ≈ 5 more min/day of school MVPA than students with no opportunities (B = 1.53 min/opportunity; p = .002).ConclusionsImplementing classroom physical activity breaks can improve student physical activity during school and behavior in the classroom. Comprehensive school physical activity programs that include classroom-based activity are likely needed to meet the 30 min/day school physical activity guideline.     

The predominance of Ethiopian specific Mycobacterium tuberculosis families and minimal contribution of Mycobacterium bovis in tuberculous lymphadenitis patients in Southwest Ethiopia

BackgroundEthiopia has an extremely high rate of extrapulmonary tuberculosis, dominated by tuberculous lymphadenitis (TBLN). However, little is known about Mycobacterium tuberculosis complex (MTBc) lineages responsible for TBLN in Southwest Ethiopia.MethodsA total of 304 MTBc isolates from TBLN patients in Southwest Ethiopia were genotyped primarily by spoligotyping. Isolates of selected spoligotypes were further analyzed by 15-loci mycobacterial interspersed repetitive unit–variable number tandem repeat (MIRU-VNTR) (n = 167) and qPCR-based single nucleotide polymorphism (n = 38). Isolates were classified into main phylogenetic lineages and families by using the reference strain collections and identification tools available at MIRU-VNTRplus data base. Resistance to rifampicin was determined by Xpert MTB/RIF.ResultsThe majority of isolates (248; 81.6%) belonged to the Euro-American lineage (Lineage 4), with the ill-defined T and Haarlem as largest families comprising 116 (38.2%) and 43 (14.1%) isolates respectively. Of the T family, 108 isolates were classified as being part of the newly described Ethiopian families, namely Ethiopia_2 (n = 44), Ethiopia_3 (n = 34) and Ethiopia_H₃₇Rv-like (n = 30). Other sub-lineages included URAL (n = 18), S (n = 17), Uganda I (n = 16), LAM (n = 13), X (n = 5), TUR (n = 5), Uganda II (n = 4) and unknown (n = 19). Lineage 3 (Delhi/CAS) was the second most common lineage comprising 44 (14.5%) isolates. Interestingly, six isolates (2%) were belonged to Lineage 7, unique to Ethiopia. Lineage 1 (East-African Indian) and Lineage 2 (Beijing) were represented by 3 and 1 isolates respectively. M. bovis was identified in only two (0.7%) TBLN cases. The cluster rate was highest for Ethiopia_3 isolates showing clonal similarity with isolates from North Ethiopia. Lineage 3 was significantly associated with rifampicin resistance.ConclusionsIn TBLN in Southwest Ethiopia, the recently described Ethiopia specific Lineage 4 families were predominant, followed by Lineage 3 and Lineage 4-Haarlem. The contribution of M. bovis in TBLN infection is minimal.     

An exploratory investigation of purging disorder

ObjectivePurging Disorder (PD) is an understudied pattern of behaviors within the Eating Disorder Not Otherwise Specified (EDNOS) category. Such categorization may suggest that PD is not clinically significant as other eating disorders. However, evidence has suggested that PD is associated with significant impairments in psychosocial functioning and well-being. Despite the apparent clinical significance of PD, it remains to be determined if PD is distinct from other clinically significant eating disorders. The present study sought to assess the phenomenology, clinical significance, and distinctiveness of PD.MethodGroup scores on measures of eating pathology, body image disturbance, and psychological correlates were compared using MANOVA among a female undergraduate sample (N = 94) meeting diagnostic criteria for PD (n = 20), Bulimia Nervosa (BN; n = 35), restrained eating (n = 18), and healthy controls (n = 21).ResultsOverall, results indicated the PD group reported less severe symptoms than BN but more severe symptoms than controls. The PD and restraint groups were similar on most variables (including subjective binge behavior), with the exception of perfectionism and hunger.DiscussionFindings support the conceptualization of PD as existing along a spectrum of bulimic spectrum disorders rather than as a distinct diagnostic category.     

Prospective effects of pedometer use and class competitions on physical activity in youth: A cluster-randomized controlled trial

ObjectiveTo evaluate the immediate effects of a school-based multi-component program to foster a physically active lifestyle in adolescence.Design/participantsIn a cluster-randomized controlled trial with pre- and post-assessment in 2014, 29 schools with 1162 8th grade students (48% girls) from Germany were included. Age ranged from 12 to 17 years (M = 13.74; SD = 0.67).InterventionWhile the control group attended education as usual, students in the intervention group received pedometers and took part in a class competition over a time period of 12 weeks. Classes with the most steps and best creative ideas to promote physical activity in everyday life were awarded.Main outcome measuresPrimary outcomes included out-of-school sports activities (h/week), moderate to vigorous physical activity (days/week with a minimum of 60 min), active commuting (min/day), doing chores (min/day), and sedentary behavior (h/day) assessed through self-administered questionnaires as well as cardiorespiratory fitness measured using the 20-m shuttle-run test (completed laps).ResultsSignificant interaction terms between group and wave of assessment were found on out-of-school sports activities (b = − 1.09 [− 1.89; − 0.29], p = 0.008), moderate to vigorous physical activity (b = − 0.29 [− 0.47; − 0.10], p = 0.002), and active commuting (b = − 20.41 [− 32.32; − 8.49], p = 0.001): students in the intervention group showed a higher increase of physical activity levels than students in the control group. The intervention effect on cardiorespiratory fitness missed significance marginally (b = − 1.52 [− 3.14; 0.98], p = 0.065), There was no effect on students' sedentary behavior (b = 0.06 [− 0.72; 0.84], p = 0.881).ConclusionsAn easy to administer school-based physical activity program (12 weeks) may enhance students' leisure-time physical activity.Trial registration number: ISRCTN49482118     

Summary-of-findings tables in Cochrane reviews improved understanding and rapid retrieval of key information

ObjectiveTo measure the effects of a summary-of-findings (SoF) table on user satisfaction, understanding, and time spent finding key results in a Cochrane review.Study Design and SettingWe randomized participants in an evidence-based practice workshop (randomized controlled trial [RCT] I) and a Cochrane Collaboration entities meeting (RCT II) to receive a Cochrane review with or without an SoF table. In RCT I, we measured user satisfaction. In RCT II, we measured correct comprehension and time spent finding key results.ResultsRCT I: Participants with the SoF table (n = 47) were more likely to “agree” or “strongly agree” that it was easy to find results for important outcomes than (n = 25) participants without the SoF table—68% vs. 40% (P = 0.021). RCT II: Participants with the SoF table (n = 18) were more likely to correctly answer two questions regarding results than (n = 15) those without the SoF table: 93% vs. 44% (P = 0.003) and 87% vs. 11% (P < 0.001). Participants with the SoF table spent an average of 90 seconds to find key information compared with 4 minutes for participants without the SoF table (P = 0.002).ConclusionIn two small trials, we found that inclusion of an SoF table in a review improved understanding and rapid retrieval of key findings compared with reviews with no SoF table.     

Carriage prevalence and serotype distribution of Streptococcus pneumoniae prior to 10-valent pneumococcal vaccine introduction: A population-based cross-sectional study in South Western Uganda, 2014

BackgroundInformation on Streptococcus pneumoniae nasopharyngeal (NP) carriage before the pneumococcal conjugate vaccine (PCV) introduction is essential to monitor impact. The 10-valent PCV (PCV10) was officially introduced throughout Ugandan national childhood immunization programs in 2013 and rolled-out countrywide during 2014. We aimed to measure the age-specific Streptococcus pneumoniae carriage and serotype distribution across all population age groups in the pre-PCV10 era in South Western Uganda.MethodsWe conducted a two-stage cluster, age-stratified, cross-sectional community-based study in Sheema North sub-district between January and March 2014. One NP swab was collected and analyzed for each participant in accordance with World Health Organization guidelines.ResultsNP carriage of any pneumococcal serotype was higher among children <2 years old (77%; n = 387) than among participants aged ≥15 years (8.5%; n = 325) (chi² p < 0.001).Of the 623 positive cultures, we identified 49 serotypes among 610 (97.9%) isolates; thirteen (2.1%) isolates were non-typeable. Among <2 years old, serotypes 6A, 6B, 14, 15B, 19F and 23F accounted for half of all carriers. Carriage prevalence with PCV10 serotypes was 29.4% among individuals aged <2 years (n = 387), 23.4% in children aged 2–4 years (n = 217), 11.4% in 5–14 years (n = 417), and 0.4% among individuals ≥15 years of age (n = 325). The proportion of carried pneumococci serotypes contained in PCV10 was 38.1% (n = 291), 32.8% (n = 154), 29.4% (n = 156), and 4.4% (n = 22) among carriers aged <2 years, 2–4 years, 5–14 years and ≥15 years, respectively.DiscussionIn Sheema district, the proportion of PCV10 serotypes was low (<40%), across all age groups, especially among individuals aged 15 years or older (<5%). PCV10 introduction is likely to impact transmission among children and to older individuals, but less likely to substantially modify pneumococcal NP ecology among individuals aged 15 years or older.     

Obesity prevention and obesogenic behavior interventions in child care: A systematic review

ObjectiveReview peer-reviewed interventions designed to reduce obesity and improve obesogenic behaviors, including physical activity, diet, and screen time, at child care centers. Interventions components and outcomes, study design, duration, use of behavioral theory, and level of social ecological influence are detailed.MethodsArticle searches were conducted from March 2014, October 2014, March 2015, January 2016 across three databases. Eligible interventions were conducted in child care settings, included 3-to-5-year-old children, included an outcome measure of obesity or obesogenic behavior, and published in English. Study design quality was assessed using Stetler's Level of Quantitative Evidence.ResultsAll unique records were screened (n = 4589): 237 articles were assessed for eligibility. Of these, 97 articles describing 71 interventions met inclusion criteria. Forty-four articles included multi-level interventions. Twenty-nine interventions included an outcome measure of obesity. Forty-one interventions included physical activity. Forty-five included diet. Eight included screen time. Fifty-five percent of interventions were Level II (randomized controlled trials), while 37% were Level III (quasi-experimental or pre-post only study design), and 8% were Level IV (non-experimental or natural experiments). Most interventions had the intended effect on the target: obesity 48% (n = 14), physical activity 73% (n = 30), diet 87% (n = 39), and screen time 63% (n = 5).ConclusionSummarizing intervention strategies and assessing their effectiveness contributes to the existing literature and may provide direction for practitioners and researchers working with young children in child care. Most interventions produced the targeted changes in obesity and obesity-associated behaviors, supporting current and future efforts to collaborate with early-care centers and professionals for obesity prevention.     

Immune response to pneumococcal conjugate vaccine in patients with systemic vasculitis receiving standard of care therapy

AimTo study the effect of standard of care therapy on antibody response and functionality following immunization with 13-valent pneumococcal conjugate vaccine (PCV13) in patients with primary systemic vasculitis compared to healthy controls.Methods49 patients with vasculitis and 49 controls received a single dose (0.5 ml) PCV13 intramuscularly. Ongoing treatments: azathioprine (AZA; n = 11), cyclophosphamide (CYC; n = 6), methotrexate (MTX; n = 9), rituximab (n = 3); anti-TNF (n = 2), mycophenolate mofetil (n = 2), prednisolone alone (n = 15) and no active treatment (n = 2). Specific antibody concentrations for serotypes 6B and 23F were determined using ELISA and opsonophagocytic activity (OPA) assay (23F) was performed, on serum samples taken immediately before and 4–6 weeks after vaccination. Proportion of individuals with putative protective antibody concentration (≥1.0 µg/mL) and positive antibody response (≥2-fold increase from prevaccination concentration) for both serotypes were calculated and groups were compared.ResultsAt baseline, 6 patients (12%) and 12 controls (24%) had protective antibody levels for both serotypes. After vaccination, antibodies increased for both serotypes in patients and controls (p < 0.001), 32 patients (65%) and 35 controls (71%) reached protective level for 6B, and 32 patients (65%) and 37 controls (76%) for 23 F. Compared to controls, patients had lower prevaccination geometric mean concentration (23F, p = 0.01) and a numerical trend towards lower prevaccination level (6B) and postvaccination levels (both serotypes). Patients with prednisolone alone had lower prevaccination OPA (p < 0.01) compared to controls. OPA increased after vaccination in both patients and controls (p < 0.001), but improvement was better in controls (p = 0.001). AZA, CYC or MTX, but not prednisolone alone, tended towards a lower proportion of patients reaching protective antibody levels (p = 0.06), compared to controls.ConclusionsPneumococcal conjugate vaccine was safe and immunogenic in patients with established vasculitis. Treatment with DMARDs, mostly AZA, CYC and MTX but not systemic prednisolone may impair antibody response.Trial registration. ClinicalTrials.gov Identifier: NCT02240888. Registered 4 September, 2014     

Pedometer-assessed physical activity of Singaporean youths

ObjectiveThe aim of the study was to investigate the pedometer-assessed physical activity of Singaporean youths using an objective measurement of physical activity.Methods and resultsPedometer step count was monitored over the entire week in 877 participants aged 9–18 years in three schooling cohorts [primary (age, 9–12 years; n = 150 males; 156 females), secondary (age, 13–16 years; n = 137 males; 138 females) and junior college (age, 17–18 years; n = 140 males; 156 females)] in Singapore during July to September 2009. Analyses identified significant main effects for step count taken outside of school compared to within school (mean (SD): 5568 (4796) vs. 3881 (3149), p < 0.05). However, no significant difference was found for steps accumulated within or outside school in boys and girls across the schooling levels (steps × sex × level interaction, p > 0.05). Step counts were not significantly different between weekdays or weekends (9719 (6063) vs. 9483 (8056), p > 0.05), across schooling levels and between male and female participants (sex × level and steps × level × sex interactions, all p > 0.05).ConclusionStep count decline is drastic for male adolescents after primary school but remains low across the schooling levels for female participants. Aggregated daily step count fell short by up to 35% of the 16,000 and 13,000 steps recommended respectively for male and female youths.     

Annual influenza vaccination reduces total hospitalization in patients with chronic hepatitis B virus infection: A population-based analysis

BackgroundThis study evaluated hospitalization and mortality in patients with chronic hepatitis B virus infection (HBV (+)) and matched comparison patients after stratifying the patients according to annual influenza vaccination (Vaccine (+)).MethodsData from Taiwan's National Health Insurance program from 2000 to 2009 were used to identify HBV(+)/vaccine(+) (n = 4434), HBV(+)/Vaccine(−) (n = 3646), HBV(−)/Vaccine(+) (n = 8868), and HBV(−)/Vaccine(−) (n = 8868) cohorts. The risk of pneumonia/influenza, respiratory failure, intensive care, hospitalization, and mortality in the four cohorts was evaluated.ResultsThe total hospitalization rate was significantly lower in patients with chronic HBV infection who received an annual influenza vaccination than in chronic HBV-infected patients who did not receive an influenza vaccination (16.29 vs. 24.02 per 100 person-years), contributing to an adjusted hazard ratio (HR) of 0.56 (95% confidence interval (CI) = 0.50–0.62). The HBV(+)/Vaccine(+) cohort also had lower risks than the HBV(+)/Vaccine(−) cohort for pneumonia and influenza (adjusted HR = 0.79, 95% CI = 0.67–0.92), intensive care unit admission (adjusted HR = 0.33, 95% CI = 0.25–0.43), and mortality (adjusted HR = 0.19, 95% CI = 0.15–0.24).ConclusionsOur results suggest that annual influenza vaccination can reduce the risk of hospitalization and mortality in patients with chronic HBV infection.