School Wellness Committees Are Associated With Lower Body Mass Index Z‐Scores and Improved Dietary Intakes in US Children: The Healthy Communities Study

BACKGROUND

Our objective was to examine the association between school wellness committees and implementation of nutrition wellness policies and children's weight status and obesity‐related dietary outcomes.

METHODS

A cross‐sectional study was conducted of 4790 children aged 4‐15 years recruited from 130 communities in the Healthy Communities Study. Multilevel statistical models assessed associations between school wellness policies and anthropometric (body mass index z‐score [BMIz]) and nutrition measures, adjusting for child and community‐level covariates.

RESULTS

Children had lower BMI z‐scores (?0.11, 95% confidence interval [CI]: ?0.19, ?0.03) and ate breakfast more frequently (0.14 days/week, 95% CI: 0.02‐0.25) if attending a school with a wellness committee that met once or more in the past year compared to attending a school with a wellness committee that did not meet/did not exist. Children had lower added sugar (p < .0001), lower energy‐dense foods (p = .0004), lower sugar intake from sugar‐sweetened beverages (p = .0002), and lower dairy consumption (p = .001) if attending a school with similar or stronger implementation of the nutrition components of the school wellness policies compared to other schools in the district.

CONCLUSIONS

A more active wellness committee was associated with lower BMI z‐scores in US schoolchildren. Active school engagement in wellness policy implementation appears to play a positive role in efforts to reduce childhood obesity.

     

Altered tension cost in (TG(mREN-2)27) rats overexpressing the mouse renin gene

The present study aimed to characterize cardiac hypertrophy induced by activation of the renin–angiotensin system in terms of functional alterations on the level of the contractile proteins, employing transgenic rats harboring the mouse renin gene (TGR(mREN2)27). Ca²⁺-dependent tension and myosin ATPase activity were measured in skinned fiber preparations obtained from TGR(mREN2)27 and from age-matched Sprague–Dawley rats (SPDR). Western blots for troponin I (TnI) and troponin T (TnT) were performed and the phosphorylation status of TnI were evaluated in myocardial preparations. TnT and myosin heavy chain (MHC) isoforms were analyzed by RT-PCR. The pCa/tension relationship was shifted to the right in TGR(mREN2)27 compared to SPDR as indicated by increased Ca²⁺-concentrations required for half maximal activation of tension (SPDR 5.80, 95% confidence limits 5.77–5.82 vs. TGR(mREN2)27 5.69, 95% confidence limits 5.67–5.72, pCa units), while maximal developed tension was unaltered. Even more pronounced was the shift in the relationship between pCa and myosin–ATPase (SPDR 6.01, 95% confidence limits 5.99–6.03 vs. TGR(mREN2)27 5.77, 95% confidence limits 5.73–5.79, pCa units). The maximal myosin–ATPase activity was reduced in TGR(mREN2)27 compared to SPDR, respectively (211.0 ± 28.77 μmol ADP/s vs. 271.6 ± 43.66 μmol ADP/s, P < 0.05). Tension cost (ATPase activity/tension) was significantly reduced in TGR(mREN2)27. The β-MHC expression was significantly increased in TGR(mREN2)27. There was no isoform shift for TnT (protein and mRNA), as well as TnI, and no alteration of the phosphorylation of TnI in TGR(mREN2)27 compared to SPRD. The present study demonstrates that cardiac hypertrophy, induced by an activation of the renin–angiotensin system, leads to adapting alterations on the level of the contractile filaments, which reduce tension cost.     

Effects of plasma nitric oxide levels on platelet activation in single donor apheresis and random donor concentrates.

P-selectin is an useful marker to determine platelet activation and nitric oxide inhibits platelet activation, secretion, adhesion and aggregation. The aim of this study was to investigate the relationship between nitric oxide and P-selectin values in both single donor apheresis and random donor platelet concentrates. According to the results of this study, we found that the best platelet concentrate is freshly prepared single donor apheresis concentrate and it is important to prevent activation at the beginning of the donation. Nitric oxide, which is synthesized from platelets during the storage period, is not sufficient to prevent platelet activation.     

Interprofessional Communication Patterns During Patient Discharges: A Social Network Analysis

BACKGROUND

Optimal care delivery requires timely, efficient, and accurate communication among numerous providers and their patients, especially during hospital discharge. Little is known about communication patterns during this process.

OBJECTIVE

Our aim was to assess the frequency and patterns of communication between patients and providers during patient discharges from a hospital-based medicine unit.

DESIGN AND APPROACH

On the day of the patient’s discharge, the patient and all healthcare providers involved in the discharge were interviewed using structured questions related to information exchange during the discharge process. Each interview identified the frequency and method of communication between participants, including synchronous (e.g., face-to-face) and asynchronous (e.g., through electronic medical record) routes. Communication patterns were visually diagramed using social network analysis.

PARTICIPANTS

Forty-six patients were screened for inclusion in the network analysis. Of those, seven patients who were fully oriented and able to complete an interview and all providers who participated in their care during the discharge were selected for inclusion in the analysis. In all, 72 healthcare professionals contributing to the discharge process were interviewed, including physicians, nurses, therapists, pharmacists, care coordinators, social workers, and nutritionists.

KEY RESULTS

Patients’ mean age was 63, length-of-stay was 7.8 days, and most (86 %) were discharged to home. On average, 11 roles were involved with each discharge. The majority of communication was synchronous (562 events vs. 469 asynchronous events, p = 0.004). Most communication events occurred between the primary nurse and patient and the care coordinator and primary nurse (mean 3.9 and 2.3 events/discharge, respectively). Participants identified intern physicians as most important in the discharge process, followed by primary nurses and care coordinators.

CONCLUSIONS

In patients being discharged from the medicine service, communication was more frequently synchronous, and occurred between intern physicians, primary nurses, and patients. Potential improvements in coordinating patients’ discharges are possible by reorganizing systems to optimize efficient communication.

Electronic supplementary material

The online version of this article (doi:10.1007/s11606-015-3415-2) contains supplementary material, which is available to authorized users.     

Differences in gastroprotective processes in 6- to 8- and 14- to 16-week-old rats

The gastroprotective effect of opioid peptides, prostaglandin E₂ and capsaicin against acidified ethanol-induced gastric mucosal damage in young mature rats of different (6–8 and 14–16 weeks) ages has been investigated. It was found that gastric mucosal damage was more severe in 14–16 weeks old rats. The gastroprotective effect of opioid peptides - [D-Ala², D-Leu⁵]-enkephalin (DADLE), deltorphin II, [D-Ala², Phe⁴, Gly⁵ -ol]-enkephalin (DAGO) and -endorphin - given either intracerebroventricularly (0.6, 3.3., 0.2, and 0.01 nmol/rat, respectively) or subcutaneously (825 and 960 nmol/kg, respectively) was highly reduced in 14–16 weeks old rats. The mucosal protective action of orally administered capsaicin (1600–3200 nmol/kg) and PGE₂ (280–560 nmol/kg) was also diminished in 14–16 weeks old animals. Both ACTH and corticosterone plasma levels were significantly higher in 14–16 weeks old rats. These results suggest that the gastric mucosal susceptibility to ethanol and the gastroprotective effect of opioid peptides, capsaicin and PGE₂ are age-related.     

Profiling of Patients with Temporomandibular Disorders: Experience of One Tertiary Care Center

ObjectivesThe aim of this study was to assess typical and most prevalent characteristics of patients suffering from temporomandibular disorders (TMD) by a retrospective assessment of their medical records.Material and MethodsDemographic data and data on the characteristics of TMD were collected from the existing medical documentation of 304 TMD patients (250 females and 54 males) who had been referred to the Department of Dentistry, Clinical Hospital Center Zagreb from October 2016 to October 2020 due to temporomandibular pain. For the purpose of analysis, three age groups were formed: i) “children and adolescents” (up to 19 years of age); ii) “middle age” (from 20 to 50 years of age); iii) “older age” (>50 year- olds). A two-step cluster analysis was performed with the aim of classifying TMD patients into homogenous groups.ResultsThe mean age of patients whose data were included in the study was 33.8 ± 16.66, with a significantly higher age in the group of women (p<0.001). Most of the patients had chronic pain (67.4%), with the ratio in favor of chronic patients being significantly higher in women than in men (p=0.001). Data on parafunctional behavior were confirmed in 14.5% of patients. Data on the onset of symptoms during/just after orthodontic treatment were present in 14.5% of patients. Data on spontaneous pain, assessed with a visual analogue scale, were recorded in 87 patients, with a mean of 6.14 ± 1.79 and with the highest pain in the “older age” group. Physical therapy was the most common therapeutic modality (56.3%) followed by an occlusal splint (40.5%). The analysis revealed 5 different clusters in the TMD patient data set.ConclusionsOur results are largely in line with current epidemiological knowledge on TMD. Women predominated in all age groups and most of the patients experienced chronic pain. Classifying patients into homogeneous groups using the clustering method could provide better identification of subgroups of conditions that mainly occur together in these patients, thus providing the basis for more specific management.