Home-made carbonated water and the consumption of water and other beverages in children and adolescents: results of the DONALD study

Aim: To determine differences in intake of water, drinking water and beverages between consumers (C) and non-consumers (NC) of carbonated water prepared at home. Methods: Matched pairs design; 3-d-weighed diet records; participants of the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study) aged 2-18 y (n = 550, mean: 8.2 y). Results: The most important beverage was either carbonated (C: females 265, males 299 g/d) or bottled water (NC: males 267, females 282 g/d) followed by juice (120-174 g/d), soft drinks (134-167 g/d) and milk (84-149 g/d). Water intake from beverages was higher in males (NC: 902 and C: 906 g/d) than in females (NC: 789 and C: 771 g/d). However, total water intake per energy was higher in females (NC: 0.88 and C: 0.91 g/kcal) than in males (NC: 0.80 and C: 0.83 g/kcal). C had a significantly higher mean drinking water intake (tap + bottled + carbonated water) in percentage of total water intake (%TW) than NC, and lower mean intakes of milk, bottled water and tap water, respectively. There was a significantly lower mean fat intake in C (females: 32 and males: 33% of energy) versus NC (females: 34 and males: 36% of energy). Irrespective of carbonated water consumption, females had better drinking habits than males, with significantly higher mean intakes of water from food (%TW), water from beverages + food (%TW), and total water per energy.

Conclusions: Drinking habits and total water intakes of consumers are quite similar to those of non-consumers of carbonated water. Females in general show more favourable drinking habits than males.     

School‐based prevention of depression: a randomised controlled study of the beyondblue schools research initiative

Background: Depressive disorders are experienced by 3–5% of the adolescent population at any point of time. They adversely affect adolescent development in a range of areas and greatly increase risk for suicide. The present study investigated the effectiveness of a universal intervention designed to reduce depressive symptoms among students commencing high school. Methods: Twenty‐five pairs of secondary schools matched on socio‐economic status were randomly assigned to either an intervention or a comparison group (n = 5,634 Year 8 students). The intervention extended over a 3‐year period and utilised a comprehensive classroom curriculum programme, enhancements to the school climate, improvements in care pathways, and community forums. A range of measures completed by students, average age at baseline = 13.1 years (SD = .5), and teachers was used to assess changes in depressive symptoms, risk and protective factors relevant to depression, and the quality of the school environment. Results: Changes in the level of depressive symptoms and in the levels of risk and protective factors experienced by students in the two groups did not differ significantly over the 3 years of the study. Furthermore, statistically significant differences in the ratings of school climate across this time period were found only for staff‐rated assessments. Conclusions: Despite using an extensive, structured programme, based on best evidence to increase protective factors and reduce risk factors at the individual and school levels, the intervention did not reduce levels of depressive symptoms among participating adolescents. The results draw attention to the difficulties faced when implementing large‐scale, school‐based, universal preventive interventions. These include the need to develop methods to effectively train teachers across large geographical regions to deliver new interventions with fidelity, the difficulty of engaging young adolescents with prevention programmes, and the long period of time required to implement policy and practice changes at ‘whole‐school’ levels.     

Cost‐effectiveness of cognitive therapy as an early intervention for post‐traumatic stress disorder in children and adolescents: a trial based evaluation and model

Background

Untreated post‐traumatic stress disorder (PTSD) in children and adolescents is associated with a considerable economic burden on the health system, families and society. Recent research has demonstrated the potential efficacy of cognitive therapy as an early intervention for PTSD in children and adolescents. Children who experienced a single traumatic event in the previous two to six months and were randomized to cognitive therapy for PTSD (CT‐PTSD) were significantly more likely to be PTSD‐free compared to those randomized to usual care represented by waitlist control. The current study evaluated the economic impact of improvements in the treatment of PTSD in children and adolescents.

Methods

A cost‐effectiveness analysis was conducted from the national health service/personal social services perspective with outcomes expressed as quality‐adjusted life years (QALYs). Patient level costs and outcomes were collected during the 11 week clinical trial and extrapolated to a three year time horizon using economic modelling methods. Uncertainty was estimated using probabilistic sensitivity analysis and assumptions were tested using one way sensitivity analysis.

Results

The incremental cost‐effectiveness ratio at 3 years was £2,205 per QALY with a 60%–69% probability of CT‐PTSD being cost‐effective compared to usual care at the UK £20,000 to £30,000 per QALY decision threshold.

Conclusions

This study provides preliminary evidence for the cost‐effectiveness of cognitive therapy in this treatment population. Larger pragmatic trials with longer follow‐up are indicated.     

A study of the association between exercise‐induced wheeze and exercise versus methacholine‐induced bronchoconstriction in adolescents

Among asthmatics, exercise‐induced wheeze (EIW) is a frequent symptom, and 40–77% of asthmatics demonstrate exercise‐induced bronchoconstriction (EIB). In the North‐Trøndelag population‐based survey of 8,571 adolescents (YOUNG‐HUNT), 26% reported wheeze during the previous 12 months (current wheeze). Of those subjects, 50% reported EIW. The aim of the present study was to investigate the association between EIW and EIB in randomly selected adolescents with EIW as the only or predominant asthma‐like symptom, and to relate our findings to results from methacholine bronchoprovocation tests (MT) and measurements of exhaled nitric oxide (ENO). Sixty‐three subjects with current wheeze induced by exercise, but not by allergen exposure, were investigated using a treadmill exercise test (ET) and measurements of ENO. Fifty‐eight subjects completed a MT on a separate study day. EIB was defined as a fall of ≥ 10% in the forced expiratory volume in 1 second (FEV₁) after exercise (ΔFEV₁%_ex). Twenty‐one subjects (33%) had EIB and 33 (57%) had a positive MT. The degree of reported dyspnea during the ET was not correlated to the ΔFEV₁%_ex. The correlation between EIB and methacholine‐induced bronchoconstriction (MIB) was poor, and the ΔFEV₁%_ex was more pronounced in smokers than in non‐smokers. Moreover, ENO was not increased in subjects with positive vs. negative ET. Hence, EIW, when reported as the only or predominant asthma‐like symptom, was linked to EIB in only one‐third of the patients. We conclude that EIW is a poor predictor of EIB in epidemiological studies. The poor correlation between EIB and MIB indicates that these two tests measure different mechanisms of bronchial hyper‐responsiveness.     

Molecular analysis of the CART gene in overweight and obese Italian children using family‐based association methods

Aim: In our study, we evaluated if CART gene A1475G and ΔA1457 polymorphisms could be associated with obesity. Patients and methods: We recruited 133 Italian trios from among 103 (50 males and 53 females) overweight children (mean age 10.5 years, range 6–14 years; mean BMI 26.1 ± 3.2 kg/m²), and 30 (16 males and 14 females) obese children (mean age 9.0 years, range 6–11 years; mean BMI 32.3 ± 2.0 kg/m²). We also selected 187 non‐obese unrelated controls. Results: The allele frequencies of the A1475G single nucleotide polymorphism (SNP) were significantly higher in overweight children (0.07) than in control children (0.02) (p = 0.03) and control adults (0.02) (p = 0.02). Moreover, the allele frequencies were significantly different between obese children (0.08) and control children (0.02) (p = 0.03), and between obese children (0.08) and control adults (0.02) (p = 0.02). The ΔA1457 SNP showed no significant association with overweight/obesity. TDT statistic revealed a preferential transmission of the 1475G allele from heterozygous parents to overweight children (p < 0.01) and to obese children (p < 0.05). No statistically significant excess transmission of the ΔA1457 allele was found. Conclusion: Our results supported the hypothesis that inherited variations of the CART gene could influence the development of obesity also in Italian children.