The effects of objectively measured sedentary behavior on all-cause mortality in a national sample of adults with diabetes

BackgroundDiabetes is a highly prevalent chronic disease that has been increasing globally and is the seventh leading cause of death in the United States. Sedentary behavior is associated with increased risk of diabetes and is unfavorably related to all-cause mortality, but there are limited studies examining the sedentary–mortality relationship among those with diabetes, which was the purpose of this study.MethodsUsing data from the 2003–2006 NHANES, 712 adult participants with evidence of diabetes had complete data on the study variables. A multivariable Cox proportional hazard model was used to examine the association between objectively measured sedentary behavior and all-cause mortality among this diabetic sample.ResultsResults showed that for every 60 min/day increase in sedentary behavior, independent of moderate-to-vigorous physical activity (MVPA) and other covariates, adults with diabetes had a 13% increased risk of all-cause mortality (HR_adjusted = 1.13; 95% CI = 1.03–1.24; P = 0.01). However, after adjusting for total physical activity (light and MVPA), sedentary behavior was no longer associated with mortality risk (HR_adjusted = 1.04; 95% CI = 0.92–1.16; P = 0.46).ConclusionAmong those with diabetes, sedentary behavior may not have increased mortality risk independent of total physical activity behavior.     

Trends in prolonged sitting time among European adults: 27 country analysis

ObjectiveTo examine trends in adult sitting time across 27 European countries.MethodData were from the Eurobarometer surveys collected in 2002, 2005, and 2013. Sitting time data were used to categorise respondents into ‘low’ (0 to 4h30min), ‘middle’ (4h31min to 7h30min), and ‘high’ levels of sitting (>7h30min). We modelled the likelihood of being in the high sitting group within a given country and overall across the three time points, controlling for age, gender, education, employment status, and physical activity.ResultsIn total 17 countries had sitting data at all three time points; among these countries the prevalence of ‘high sitting’ decreased steadily from 23.1% (95% CI = 22.2–24.1) in 2002 to 21.8% (95% CI = 20.8–22.8) in 2005, and 17.8% (95% CI = 16.9–18.7) in 2013. A further 10 countries had data only over the latter two time points; among these countries the prevalence of high sitting decreased from 27.7% (95% CI = 26.0–29.4) in 2005 to 19.0% (95% CI = 17.6–20.5) in 2013.ConclusionTime spent in sedentary behaviour may not be increasing in the European region, and prolonged sitting may, in fact, be decreasing. This finding has important implications for the sedentary behaviour debate and the policy response.     

Co-occurrence of chronic disease lifestyle risk factors in middle-aged and older immigrants: A cross-sectional analysis of 264,102 Australians

BackgroundThe way in which lifestyle risk factors for chronic disease co-occur among people with different cultural backgrounds is largely unknown.MethodsThis study investigated chronic disease risk among immigrants aged ≥ 45 years in Australia by combining common lifestyle risk factors into a weighted chronic disease risk index (CDRI). Among 64,194 immigrants and 199,908 Australian-born participants in the 45 and Up Study (2006–2009), Poisson regression was used to derive relative risks (RR) and 95% confidence intervals (CI) for five risk factors (smoking, alcohol use, overweight/obesity, physical activity, diet) by place of birth adjusting for socio-demographic characteristics. Multiple linear regression was used to determine adjusted mean differences (AMDs) in CDRI score by place of birth and years lived in Australia.ResultsImmigrants had higher RRs of smoking than Australian-born participants, lower RRs of excessive alcohol consumption and overweight/obesity, and no difference in RR for physical inactivity and insufficient fruit/vegetable intake. Participants born in the Middle East/North Africa (AMD 3.5, 95% CI 2.7, 4.3), Eastern/Central Europe (1.3, 0.8, 1.9), and Western Europe (0.5, 0.1, 0.8) had higher mean CDRI scores than Australian-born participants, while participants born in East Asia (− 7.2, − 7.8, − 6.6), Southeast Asia (− 6.6, − 7.2, − 6.1), Central/South Asia (− 3.1, − 4.0, − 2.1), Sub-Saharan Africa (− 1.9, − 2.6, − 1.2) and the United Kingdom/Ireland (− 0.2, − 0.5, 0.0) had lower scores. CDRI score among immigrants generally approximated that of Australian-born participants with greater years lived in Australia.ConclusionsThis study reveals differences in potential risk of chronic disease among different immigrant groups in Australia.     

The effect of walking on risk factors for cardiovascular disease: An updated systematic review and meta-analysis of randomised control trials

ObjectiveTo conduct a systematic review and meta-analysis of randomised control trials that examined the effect of walking on risk factors for cardiovascular disease.MethodsFour electronic databases and reference lists were searched (Jan 1971–June 2012). Two authors identified randomised control trials of interventions ≥ 4 weeks in duration that included at least one group with walking as the only treatment and a no-exercise comparator group. Participants were inactive at baseline. Pooled results were reported as weighted mean treatment effects and 95% confidence intervals using a random effects model.Results32 articles reported the effects of walking interventions on cardiovascular disease risk factors. Walking increased aerobic capacity (3.04 mL/kg/min, 95% CI 2.48 to 3.60) and reduced systolic (− 3.58 mm Hg, 95% CI − 5.19 to − 1.97) and diastolic (− 1.54 mm Hg, 95% CI − 2.83 to − 0.26) blood pressure, waist circumference (− 1.51 cm, 95% CI − 2.34 to − 0.68), weight (− 1.37 kg, 95% CI − 1.75 to − 1.00), percentage body fat (− 1.22%, 95% CI − 1.70 to − 0.73) and body mass index (− 0.53 kg/m², 95% CI − 0.72 to − 0.35) but failed to alter blood lipids.ConclusionsWalking interventions improve many risk factors for cardiovascular disease.This underscores the central role of walking in physical activity for health promotion.     

Effects of aerobic,resistance, and combined exercise training on insulin resistance markers in overweight or obese children and adolescents: A systematic review and meta-analysis

ObjectiveTo assess the associations of aerobic, resistance, and combined exercise with changes in insulin resistance, fasting glucose, and fasting insulin in children and adolescents who are overweight or obese.Data SearchesMEDLINE via Pubmed, Cochrane-CENTRAL, SPORTDiscus, and LILACS.Study SelectionRandomized clinical trials of at least six weeks of duration that evaluated the ability of exercise training to lower at least one of the following outcomes: insulin resistance-HOMA, fasting glucose, and fasting insulin in children and/or adolescents classified as obese or overweight.Data Extraction and analysisTwo independent reviewers extracted data and assessed the quality of the included studies. Differences (exercise training group minus control group) in the outcomes evaluated were analyzed using a random effects model.ResultsOf 1853 articles retrieved, 17 studies were included. The meta-analysis showed that physical training in general was not associated with a reduction in fasting glucose levels compared to the control, but it was associated with reductions in fasting insulin levels (− 3.37 μU/ml; CI 95%, − 5.16 μU/ml to − 1.57 μU/ml; I², 54%, p = 0.003) and HOMA (− 0.61; CI 95%, − 1.19 to − 0.02; I², 49%, p = 0.040). In addition, each modality (aerobic, resistance, and combined) was compared to the control group. Aerobic exercise was associated with declines in fasting insulin levels (− 4.52 μU/ml; CI 95%, − 7.40 to − 1.65; I², 65%, p = 0.002) and in HOMA (− 1.33; 95% confidence interval, − 2.47 to − 0.18; I², 73%, p = 0.005).ConclusionsExercise training, especially aerobic training, is associated with the reduction of fasting insulin levels and HOMA in children and adolescents with obesity and overweight, and may prevent metabolic syndrome and type 2 diabetes.     

Food environments in schools and in the immediate vicinity are associated with unhealthy food consumption among Brazilian adolescents

BackgroundEvidence of the influence of the school food environment on adolescent diet is still little explored in low- and middle-income countries. We aimed to evaluate the association between food environment in schools and the immediate vicinity and the regular consumption of unhealthy food among adolescents.MethodsWe used cross-sectional data collected by the Brazilian National Survey of School Health (PeNSE) from a representative sample of adolescents attending 9th grade public and private schools in Brazil, in 2012. We estimated students' regular consumption (> 5 days/week) of unhealthy food (soft drinks, bagged salty snacks, deep fried salty snacks and sweets) and school availability, in the cafeteria or an alternative outlet, of the same food plus some healthy options (fruit and natural fruit juice). We performed multilevel logistic regression models.ResultsHaving a cafeteria inside school selling soft drinks (private schools OR = 1.23; 95% CI = 1.14–1.33; public schools OR = 1.13; 95% CI = 1.06–1.20) and deep fried salty snacks (private schools OR = 1.41 95% CI = 1.26–1.57; public schools OR = 1.16 95% CI = 1.08–1.24) was associated with a higher consumption of these unhealthy foods of among students. In private schools, cafeteria selling fruit and natural fruit juice was associated with lower student consumption of bagged salty snacks (OR = 0.86; 95% CI 0.77–0.96) and soft drinks (OR = 0.85; 95% CI = 0.76–0.94). In addition, eating meals from the Brazilian School Food Program in public schools was associated with a lower consumption of unhealthy foods.ConclusionsFoods available in the school food environment are associated with the consumption of unhealthy food among adolescents in Brazil.     

Is change in availability of sports facilities associated with change in physical activity? A prospective cohort study

ObjectiveWe examined whether change in distance to or number of sports facilities is related to change in metabolic equivalent task (MET) hours/week.Method25,834 Finnish Public Sector study cohort participants reported their weekly physical activity in 2000 and 2008. Distances from each participant's home to the nearest facility and number of facilities within 500 m from home were calculated from geographic coordinates. We assessed changes in weekly MET hours of physical activity between the baseline and the follow-up in relation to change in distance to the nearest facility (remained close, decreased, remained distant, increased) and number of facilities < 500 m from home (remained high, increased, remained low, decreased).ResultsThe average decrease in MET hours was greater for those whose distance to a sports facility increased (− 1.4 (95% CI − 3.8–−0.96)) (vs. remained close). The same was observed for those for whom the number of facilities near home decreased (− 2.35 (95% CI − 4.84–0.14)) (vs. remained high). Increase in availability was not related to increase in MET hours.ConclusionsAn increase in distance to and decrease in number of sports facilities were associated with a decrease in physical activity suggesting that changes in availability of facilities may affect physical activity levels.     

Levels of physical activity and relationship with markers of diabetes and cardiovascular disease risk in 5474 white European and South Asian adults screened for type 2 diabetes

ObjectiveInvestigate levels of physical activity and their association with health in a white European (WE) and South Asian (SA) population.MethodsThis study reports data from a diabetes screening programme, 2004–2007, Leicester, UK. Physical activity was measured using the International Physical Activity Questionnaire; additional outcomes included fasting and 2-h post-challenge glucose, lipid profile, body mass index (BMI) and waist circumference.Results1164 SA (female = 48%) and 4310 WE (female = 53%) were included. SAs were more likely fall below the minimum physical activity recommendations for health compared to WEs (age-adjusted OR for SA men = 2.35; 95% CI = 1.89–2.93, age adjusted OR for SA women = 2.25; 95% CI = 1.81–2.80). There were significant associations between levels of physical activity and BMI (men and women), waist circumference (men and women), 2-h glucose (women), HDL-cholesterol (men) and triglycerides (men) in WEs and waist circumference (women) and HDL-cholesterol (men) in SAs. Significant interactions between ethnicity and physical activity existed in the relationship with BMI and waist circumference in men.ConclusionsSAs are substantially less physically active than WEs. There may also be differences between SAs and WEs in the health benefits associated with higher physical activity that warrant further investigation.     

A community based primary prevention programme for type 2 diabetes integrating identification and lifestyle intervention for prevention: the Let's Prevent Diabetes cluster randomised controlled trial

ObjectivesPrevention of type 2 diabetes (T2DM) is a priority in healthcare, but there is a lack of evidence investigating how to effectively translate prevention research into a UK primary care setting. We assessed whether a structured education programme targeting lifestyle and behaviour change was effective at preventing progression to T2DM in people with pre-diabetes.Materials and methodsForty-four general practices were randomised to receive either standard care or a 6 hour group structured education programme with an annual refresher course, and regular phone contact. Participants were followed up for 3 years. The primary outcome was progression to T2DM.ResultsEight hundred and eighty participants were included (36% female, mean age 64 years, 16% ethnic minority group); 131 participants developed T2DM. There was a non-significant 26% reduced risk of developing T2DM in the intervention arm compared to standard care (HR 0.74, 95% CI 0.48, 1.14, p = 0.18). The reduction in T2DM risk when excluding those who did not attend the initial education session was also non-significant (HR 0.65, 0.41, 1.03, p = 0.07). There were statistically significant improvements in HbA1c (− 0.06, − 0.11, − 0.01), LDL cholesterol (− 0.08, − 0.15, − 0.01), sedentary time (− 26.29, − 45.26, − 7.32) and step count (498.15, 162.10, 834.20) when data were analysed across all time points.ConclusionsThis study suggests that a relatively low resource, pragmatic diabetes prevention programme resulted in modest benefits to biomedical, lifestyle and psychosocial outcomes, however the reduction to the risk of T2DM did not reach significance. The findings have important implications for future research and primary care.     

Bidirectional association between mental health and physical activity in older adults: Whitehall II prospective cohort study

ObjectiveTo investigate longitudinal and bidirectional associations between mental health and physical activity from midlife into old age.MethodsAnalysis was based on data from 6909 participants (aged 45 to 69 in 1997/99) from the Whitehall II cohort in the UK. Latent growth curve analysis examined possible bidirectional associations between the SF-36 Mental Component Summary and weekly physical activity measured at three time-points over ten years.ResultsMental health and physical activity were associated at baseline (β = 0.17, 95% CI 0.13, 0.21) and associations persisted into old age. In the latent growth curve model, both mental health and physical activity increased and their rates of change ‘moved together’ over time (β = 0.24, 95% CI 0.11, 0.37). Relatively high baseline levels of either variable were associated with slightly slower increases in the other outcome (β = − 0.02, 95% CI − 0.03, − 0.01; β = − 0.07, 95% CI − 0.11, − 0.13), which are thought to reflect regression to the mean. However, those who started high on either variable remained the most advantaged at end of follow-up.ConclusionsFrom midlife to old age, greater physical activity is associated with better mental health and vice versa. These findings suggest persistent longitudinal and bidirectional associations between physical activity and mental health.     

Energy and fat intake are not associated with abdominal adiposity

Background and objectiveCentral or abdominal obesity (AA) is a highly prevalent determinant of the metabolic syndrome and its control requires intervention strategies. This study investigated the risk factors associated with the presence of AA in hospitalized individuals.Patients and methodsA total of 1626 patients were studied. The investigated risk factors possibly associated with AA were gender, age, body mass index (BMI), habitual energy intake (HEI) and fat intake (FI). AA was determined by waist circumference (WC) and waist-to-hip ratio (WHR). The chi², Mann-Whitney and Kruskal-Wallis tests were used to compare the data and univariate and multiple logistic regressions were used to identify the predictive factors of AA.ResultsWomen were at higher risk of developing AA than men (P < 0.0001). The HEI and FI of individuals with and without AA and of women and men were not significantly different. According to multivariate analysis, HEI was not a predictive factor of AA, contrary to gender and age. The risk factors for AA, determined by WC, were gender (OR = 6.8; CI = 5.3–8.7) and age (OR = 1.0; CI = 1.0–1.0). Women were six times more likely to develop AA than men.ConclusionsEvidence of an association between AA and HEI or FI was not found, but gender and age were associated with AA.     

Lack of private health insurance is associated with higher mortality from cancer and other chronic diseases,poor diet quality,and inflammatory biomarkers in the United States

ObjectiveThe lack of health insurance reduces access to care and often results in poorer health outcomes. The present study simultaneously assessed the effects of health insurance on cancer and chronic disease mortality, as well as the inter-relationships with diet, obesity, smoking, and inflammatory biomarkers. We hypothesized that public/no insurance versus private insurance would result in increased cancer/chronic disease mortality due to the increased prevalence of inflammation-related lifestyle factors in the underinsured population.MethodsData from the Third National Health and Nutrition Examination Survey participants (NHANES III;1988–1994) were prospectively examined to assess the effects of public/no insurance versus private insurance and inflammation-related lifestyle factors on mortality risk from cancer, all causes, cardiovascular disease (CVD) and diabetes. Cox proportional hazards regression was performed to assess these relationships.ResultsMultivariate regression analyses revealed substantially greater risks of mortality ranging from 35% to 245% for public/no insurance versus private insurance for cancer (HR = 1.35; 95% CI = 1.09,1.66), all causes (HR = 1.54; 95% CI = 1.39,1.70), CVD (HR = 1.62; 95% CI = 1.38,1.90) and diabetes (HR = 2.45; 95% CI = 1.45,4.14). Elevated CRP, smoking, reduced diet quality and higher BMI were more prevalent in those with public insurance, and were also associated with increased risks of cancer/chronic disease mortality.DiscussionInsurance status was strongly associated with cancer/chronic disease mortality after adjusting for lifestyle factors. The results suggest that inadequate health insurance coverage results in a substantially greater need for preventive strategies that focus on tobacco control, obesity, and improved dietary quality. These efforts should be incorporated into comprehensive insurance coverage programs for all Americans.     

Objectively measured physical activity,sedentary time and subclinical vascular disease: Cross-sectional study in older British men

Low physical activity (PA) and high levels of sedentary time (ST) are associated with higher cardiovascular disease (CVD) risk among older people. However, their independent contribution and importance of duration of PA and ST bouts remain unclear. We investigated associations between objectively measured PA, ST and non-invasive vascular measures, markers of CVD risk.Cross-sectional study of 1216 men from the British Regional Heart Study, mean age 78.5 years, measured in 2010–2012. Carotid intima thickness (CIMT), distensibility coefficient (DC) and plaque presence were measured using ultrasound; pulse wave velocity (cfPWV) and augmentation index (AIx) using a Vicorder. PA and ST were measured using hip-worn ActiGraph GT3X accelerometers.After adjusting for covariates, each additional 1000 steps per day was associated with a 0.038 m/s lower cfPWV (95% CI = − 0.076, 0.0003), 0.095 10^− 3 kPa^− 1 higher DC (95% CI = 0.006, 0.185), 0.26% lower AIx (95% CI = − 0.40, − 0.12) and a 0.005 mm lower CIMT (95% CI = − 0.008, − 0.001). Moderate and vigorous PA (MVPA) was associated with lower AIx and CIMT, light PA (LPA) with lower cfPWV and CIMT and ST with higher cfPWV, AIx and CIMT and lower DC. LPA and ST were highly correlated (r = − 0.62). The independence of MVPA and ST or MVPA and LPA was inconsistent across vascular measures. Bout lengths for both PA and ST were not associated with vascular measures.In our cross-sectional study of older men, all PA regardless of intensity or bout duration was beneficially associated with vascular measures, as was lower ST. LPA was particularly relevant for cfPWV and CIMT.     

Immunogenicity and safety of a quadrivalent inactivated influenza virus vaccine compared with a comparator quadrivalent inactivated influenza vaccine in a pediatric population: A phase 3, randomized noninferiority study

BackgroundSeqirus 2010 Southern Hemisphere split-virion trivalent inactivated influenza vaccine (IIV3) was associated with increased febrile reactions in children. Studies in vitro concluded that increasing concentrations of splitting agent decreased residual lipids and attenuated proinflammatory cytokine signals associated with fever. We assessed immunogenicity and safety of a quadrivalent inactivated influenza vaccine (IIV4; produced using higher concentration of splitting agent) versus a United States-licensed comparator IIV4 in healthy children aged 5–17 years.MethodsParticipants (N = 2278) were randomized 3:1 and stratified by age (5–8 years; 9–17 years) to receive IIV4 (n = 1709) or comparator IIV4 (n = 569). Primary objective was to demonstrate noninferiority of IIV4 versus comparator IIV4 as assessed by hemagglutination inhibition (HI) geometric mean titer (GMT) ratio (upper bound of two-sided 95% confidence interval [CI] ≤ 1.5) and difference in seroconversion rate (upper bound of two-sided 95% CI ≤ 10%) for all four vaccine strains. HI antibody titers were assessed at baseline and 28 days postvaccination. Solicited and unsolicited adverse events were assessed during each 7- and 28-day postvaccination period, respectively.ResultsIIV4 met immunogenicity criteria for noninferiority. Adjusted GMT ratios (comparator IIV4/IIV4) for A/H1N1, A/H3N2, B/Yamagata, and B/Victoria strains were 1.01 (95% CI; 0.93, 1.09), 1.05 (0.96, 1.15), 0.89 (0.81, 0.98), and 0.92 (0.83, 1.02), respectively. Corresponding values for differences (95% CI) in seroconversion rates (comparator IIV4 minus IIV4) were −3.1 (−8.0, 1.8), 0.4 (−4.5, 5.3), −3.4 (−8.3, 1.5), and −2.0 (−6.9, 2.9). Fever rates were numerically higher, but not statistically different, with IIV4 versus comparator IIV4. No new safety signals were reported.ConclusionIIV4 demonstrated immunological noninferiority to the comparator IIV4 with a clinically acceptable safety profile in children aged 5–17 years. Increased levels of virus splitting agent seem to have reduced fever rates observed in children with Seqirus IIV3, particularly those aged 5–8 years.Funding: Seqirus Pty Ltd; Clinicaltrials.gov identifier: NCT02545543.     

Cardiorespiratory fitness levels and moderators in people with HIV: A systematic review and meta-analysis

Cardiorespiratory fitness (CRF) is a modifiable risk factor for cardiovascular disease and premature mortality. CRF levels and moderators among people living with HIV (PLWH) are unknown. The aim of the current meta-analysis was to (1) determine mean CRF in PLWH and compare levels with age- and gender-matched healthy controls (HCs), (2) explore moderators of CRF, (3) and (4) explore moderators of CRF outcomes following physical activity (PA) interventions. Major electronic databases were searched systematically for articles reporting CRF expressed as maximum or peak oxygen uptake (ml/min/kg) in PLWH. A random effects meta-analysis calculating the pooled mean CRF including subgroup- and meta-regression analyses was undertaken. Across 21 eligible studies, the CRF level was 26.4 ml/kg/min (95% CI = 24.6 to 28.1) (n = 1010; mean age = 41 years). There were insufficient data to compare CRF levels with HCs. A higher body mass index (β = − 0.99, 95% CI = − 1.93 to − 0.06, P = 0.04), older age (β = − 0.31, 95% CI = − 0.58 to − 0.04, P = 0.02) and the presence of lipodystrophy (β = − 4.63, 95% CI = − 7.88 to − 1.39, P = 0.005) were significant moderators of lower CRF levels. Higher CD4 + counts (β = 0.004, 95% CI = 0.0007 to 0.007, P = 0.016), supervised interventions (P < 0.001) and interventions with a lower frequency of weekly sessions (2 or 3 versus 4 times) (P < 0.001) predicted a better CRF-outcome following PA. CRF levels of PLWH are among the lowest in comparison to other vulnerable populations. More research on the most optimal physical activity intervention characteristics is needed.     

The effects of shift work on free-living physical activity and sedentary behavior

ObjectiveAlthough occupation may influence physical activity and shift work schedule may influence cardiovascular disease risk factors, our understanding of the effects of shift work schedule on overall physical activity behavior and sedentary behavior is limited.MethodsData from the 2005–2006 National Health and Nutrition Examination Survey were used. Shift work schedule was defined as regular daytime shift, evening, night, rotating or another schedule. Physical activity and sedentary behavior were assessed via accelerometry. 1536 adult participants (≥ 20 years) indicated they currently work and provided data on all study variables.ResultsAfter adjustments, and compared to adults working a regular daytime shift, those working an evening (RR = 0.41, p = 0.001) and night (RR = 0.30, p = 0.001) shift, respectively, engaged in 59% and 70% less sustained (bouts) moderate-to-vigorous physical activity, but no differences occurred for overall moderate-to-vigorous physical activity. After adjustments, and compared to those working a regular daytime shift, those working a rotating shift engaged in more light-intensity physical activity (overall: β = 26.3 min/day; p = 0.03; bouts: β = 37.5, p = 0.01) and less sedentary behavior (β = − 28.5 min/day, p = 0.01).ConclusionsShift work schedule differentially influences physical activity and sedentary behavior. Physical activity and sedentary intervention strategies may need to be tailored based on shift work schedule.     

Immunogenicity and safety of a quadrivalent inactivated influenza vaccine compared with two trivalent inactivated influenza vaccines containing alternate B strains in adults: A phase 3, randomized noninferiority study

BackgroundVaccination is the most effective means of influenza prevention. Efficacy of trivalent vaccines may be enhanced by including both B strain lineages. This phase 3, double-blind study assessed the immunogenicity and safety/tolerability of a quadrivalent inactivated influenza vaccine (IIV4) versus the United States (US)-licensed 2014–2015 trivalent inactivated influenza vaccine (IIV3-Yamagata [IIV3-YAM]; Afluria) and IIV3 containing the alternate Victoria B strain (IIV3-VIC) in adults ≥18 years.MethodsParticipants (n = 3484) were randomized 2:1:1 and stratified by age to receive IIV4 (n = 1741), IIV3-YAM (n = 871), or IIV3-VIC (n = 872). The primary objective was to demonstrate noninferiority of the immunological response to IIV4 versus IIV3-YAM and IIV3-VIC. Noninferiority was assessed by hemagglutination inhibition geometric mean titer (GMT) ratio (IIV3/IIV4; upper bound of two-sided 95% confidence interval [CI] ≤ 1.5) and seroconversion rate (SCR) difference (IIV3 – IIV4; upper bound of two-sided 95% CI ≤ 10%) for vaccine strains. Solicited local and systemic adverse events (AEs) were assessed for 7 days postvaccination, AEs recorded for 28 days postvaccination, and serious AEs for 6 months postvaccination.ResultsIIV4 elicited a noninferior immune response for matched strains, and superior response for unmatched B strains not contained in IIV3 comparators. Adjusted GMT ratios (95% CI) for A/H1N1, A/H3N2, B/YAM, and B/VIC strains were 0.93 (0.88, 0.99), 0.93 (0.88, 0.98), 0.87 (IIV3-YAM; 0.82, 0.93), and 0.95 (IIV3-VIC; 0.88, 1.03), respectively. Corresponding values for SCR differences (95% CI) were −1.1 (−4.5, 2.3), −1.7 (−5.0, 1.7), −3.2 (IIV3-YAM; −7.4, 0.9), and −1.6 (IIV3-VIC; −5.8, 2.5). AEs were generally mild and experienced by 52.9% of participants. Serious AEs were reported with a slightly higher frequency with IIV4 (2.3%) versus IIV3-YAM (1.6%) and IIV3-VIC (1.5%).ConclusionsIIV4 demonstrated immunological noninferiority to the US-licensed IIV3, and superiority for unmatched B strains not contained in IIV3 comparators. Safety/tolerability profiles were similar across vaccine groups.Funding: Seqirus; Clinicaltrials.gov: NCT02214225.     

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.     

Correlates between risk perceptions of cervical cancer and screening practice

ObjectivesTo identify the correlates between risk perceptions and cervical cancer screening among urban Malaysian women.MethodA cross-sectional household survey was conducted among 231 women in Petaling Jaya city in 2007. The association of risk perceptions of cervical cancer and screening practice was analyzed using Poisson regression.Results56% of the respondents ever had a Pap smear test. Knowledge of signs and symptoms (aPR = 1.11, 95% CI = 1.03–1.19), age (aPR = 1.02, 95% CI = 1.01–1.03), number of pregnancies (aPR = 1.06, 95% CI = 1.01–1.11), marital status, education level and religion were found to be significant correlates of Pap smear screening. Respondents who were never married were less likely to have had a Pap smear. Those who had no education or primary education were less likely to have had a Pap smear compared to those with degree qualification. The prevalence of screening was significantly higher among Christians and others (aPR = 1.35; 95% CI = 1.01–1.81) and Buddhists (aPR = 1.38; 95% CI = 1.03–1.84), compared to Muslims.ConclusionEliminating anecdotal beliefs as risks via targeted knowledge on established risk factors and culturally sensitive screening processes are strategic for increasing and sustaining uptake of Pap smear screening versus current opportunistic screening practices.