Systematic review of accelerometer-based methods for 24-h physical behavior assessment in young children (0–5 years old)

Background

Accurate accelerometer-based methods are required for assessment of 24-h physical behavior in young children. We aimed to summarize evidence on measurement properties of accelerometer-based methods for assessing 24-h physical behavior in young children.

Methods

We searched PubMed (MEDLINE) up to June 2021 for studies evaluating reliability or validity of accelerometer-based methods for assessing physical activity (PA), sedentary behavior (SB), or sleep in 0–5-year-olds. Studies using a subjective comparison measure or an accelerometer-based device that did not directly output time series data were excluded. We developed a Checklist for Assessing the Methodological Quality of studies using Accelerometer-based Methods (CAMQAM) inspired by COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN).

Results

Sixty-two studies were included, examining conventional cut-point-based methods or multi-parameter methods. For infants (0—12 months), several multi-parameter methods proved valid for classifying SB and PA. From three months of age, methods were valid for identifying sleep. In toddlers (1—3 years), cut-points appeared valid for distinguishing SB and light PA (LPA) from moderate-to-vigorous PA (MVPA). One multi-parameter method distinguished toddler specific SB. For sleep, no studies were found in toddlers. In preschoolers (3—5 years), valid hip and wrist cut-points for assessing SB, LPA, MVPA, and wrist cut-points for sleep were identified. Several multi-parameter methods proved valid for identifying SB, LPA, and MVPA, and sleep.

Despite promising results of multi-parameter methods, few models were open-source. While most studies used a single device or axis to measure physical behavior, more promising results were found when combining data derived from different sensor placements or multiple axes.

Conclusions

Up to age three, valid cut-points to assess 24-h physical behavior were lacking, while multi-parameter methods proved valid for distinguishing some waking behaviors. For preschoolers, valid cut-points and algorithms were identified for all physical behaviors. Overall, we recommend more high-quality studies evaluating 24-h accelerometer data from multiple sensor placements and axes for physical behavior assessment. Standardized protocols focusing on including well-defined physical behaviors in different settings representative for children’s developmental stage are required. Using our CAMQAM checklist may further improve methodological study quality.

PROSPERO Registration number

CRD42020184751.

     

Antiplatelet and Anticoagulant Drugs in Interventional Radiology

In treating peripheral arterial disease, a profound knowledge of antiplatelet and anticoagulative drug therapy is helpful to assure a positive clinical outcome and to anticipate and avoid complications. Side effects and drug interactions may have fatal consequences for the patient, so interventionalists should be aware of these risks and able to control them. Aspirin remains the first-line agent for antiplatelet monotherapy, with clopidogrel added where dual antiplatelet therapy is required. In case of suspected antiplatelet drug resistance, the dose of clopidogrel may be doubled; prasugrel or ticagrelor may be used alternatively. Glycoprotein IIb/IIIa inhibitors (abciximab or eptifibatide) may help in cases of hypercoagulability or acute embolic complications. Desmopressin, tranexamic acid, or platelet infusions may be used to decrease antiplatelet drug effects in case of bleeding. Intraprocedurally, anticoagulant therapy treatment with unfractionated heparin (UFH) still is the means of choice, although low molecular-weight heparins (LMWH) are suitable, particularly for postinterventional treatment. Adaption of LMWH dose is often required in renal insufficiency, which is frequently found in elderly patients. Protamine sulphate is an effective antagonist for UFH; however, this effect is less for LMWH. Newer antithrombotic drugs, such as direct thrombin inhibitors or factor X inhibitors, have limited importance in periprocedural treatment, with the exception of treating patients with heparin-induced thrombocytopenia (HIT). Nevertheless, knowing pharmacologic properties of the newer drugs facilitate correct bridging of patients treated with such drugs. This article provides a comprehensive overview of antiplatelet and anticoagulant drugs for use before, during, and after interventional radiological procedures.     

Evaluation of the impact of a clinical pathway on the organization of a multidisciplinary dental sleep clinic

Purpose

Clinical pathways are used to organize complex care processes by providing structure and standardization. The multidisciplinary approach of oral appliance (OA) therapy for sleep-disordered breathing (SDB) is a complex and dynamic process suitable for such a structured pathway approach.

Methods

A clinical pathway for patients referred for OA therapy was developed and implemented. The aim of this study was to evaluate the impact of this clinical pathway on the time to delivery of the OA and the organization of the multidisciplinary dental sleep clinic (MDSC). The latter was achieved using the care process self-evaluation tool (CPSET).

Results

First, development and implementation of the clinical pathway gave structure and shortened the mean time to delivery by 102 days (240?±?70 vs. 138?±?33 days) (Mann–Whitney U: P?<?0.001). Second, the CPSET scores were obtained in a cohort of 49 healthcare professionals involved in the pathway. Overall, patient-focused organization received the highest scores (80.5?±?9.0 %), whereas cooperation with primary care received the lowest score (66.7?±?12.4 %).

Conclusions

This is the first project on clinical pathways in OA therapy for SDB. The implementation of the pathway in our MDSC has created a significant shortening of the time to delivery. A first evaluation of the clinical pathway using the CPSET scores indicates that all disciplines involved should be thoroughly informed in an ongoing approach.     

Tizanidine Protects Mice against Convulsions Induced by Lidocaine: Involvement of α2-Adrenoceptors

Abstract: The effects of α-adrenoceptors agents on seizures induced by intraperitoneal administration of lidocaine (75 mg/kg) were studied in mice. Pretreatment with the selective α₂-adrenoceptor agonist, tizanidine, decreased the incidence of seizures induced by lidocaine. Tizanidine increased the latency to the first seizure in those animals which progressed to seizures. The blockade of α₂-adrenoceptors with yohimbine or phentolamine counteracted the protection induced by tizanidine. The seletive α₂-adrenoceptor antagonist, prazosin, did not modify the protection induced by tizanidine. The α₂-adrenoceptor agonist clonidine also increased the latency to the first seizure induced by lidocaine. The protective effect of clonidine was also reversed by pretreatment with the selective α₂-adrenoceptor antagonist yohimbine. Taken together, these results suggest that α₂-adrenoceptors are involved in seizures induced by lidocaine.     

Report on trends of incidence (1970–2002) of and mortality (1952–2002) from cancer in Germany

Purpose The paper presents the statistical analysis of current and past trends of cancer mortality rates in Germany in terms of annual percent change, overall and for the major sites, and contrasts them with trends in incidence of the Cancer Registry of the Saarland, the only registry in this country with long-term completeness. It addresses also the issue of a cross-over of cancer mortality and mortality from cardiovascular diseases (CVD) in the near future, as suggested by various authors.Material and methods Analyses are based on the mortality data of the official mortality statistics as published by the Federal Statistical Office and reported annually to the WHO, and the regularly reported incidence data of the Cancer Registry of the Saarland. The data was age-standardised and analysed by piecewise regression using a freely available dedicated software package.Results The report shows a downward trend of mortality rates for all cancers combined based on declining rates for many individual sites with only few exceptions affecting mainly females (e.g. lung cancer). Recently, the long-term increase of cancer incidence also flattened out with rather heterogeneous underlying site-specific trends increasing for some sites (e.g. cancers of the intestine, breast, prostate, or some lymphoma) and decreasing for others (e.g. cancers of the stomach, gall bladder in females, larynx, and lung in males). A crossover of cancer mortality and mortality from CVD might occur—if at all—after 2,020 in males and 2,030 in females.Conclusions Depending on cancer site, primary prevention (e.g. lung cancer among males), early detection (cervical cancer), and treatment (e.g. breast and testicular cancer, lymphoma) contributed to the current decline of mortality rates. Absence of a turnaround (e.g. lung cancer among females), slower decline than in other countries (e.g. cervical cancer), or later turnaround (e.g. breast cancer) may be related to failures in promoting prevention (lung cancer among females), early detection programmes (cervical cancer), or delays in the translation of modern treatment into routine health care (breast cancer) and indicate major challenges for current and future health policy.     

l-Arginine enhances the triglyceride-lowering effect of simvastatin in patients with elevated plasma triglycerides

We recently noticed a possible triglyceride-lowering effect during dietary supplementation with l-arginine. The major limitation of prior studies on l-arginine, however, was that triglyceride levels were not the primary end point, and patients were not necessarily hypertriglyceridemic. Therefore, we conducted a 2-arm, randomized, double-blind study in 33 hypertriglyceridemic patients to investigate the hypothesis that oral l-arginine may lower serum triglyceride levels in hypertriglyceridemic patients on and off statins. The study consisted of a 6-week run-in phase, 6 weeks of treatment with l-arginine (n = 22, 1.5 g bid) or placebo (n = 11), and a 6-week extension period where simvastatin (20 mg qd) was added. All patients received dietary advice during each study visit. Routine and lipid laboratory parameters were determined in the local routine clinical laboratory. Treatment with l-arginine alone had no effects on serum lipids compared to placebo. The combination of l-arginine with simvastatin led to a significantly stronger reduction in triglycerides compared to placebo plus simvastatin (−140.5 ± 149.2 mg/dL vs −56.1 ± 85.0 mg/dL; P = .048). In addition, we found simvastatin-induced increases in aspartate transaminase and fibrinogen to be attenuated by l-arginine as compared to placebo. We conclude from our data that l-arginine enhances the effects of simvastatin on lipid metabolism, but it has no triglyceride-lowering effects when given alone.