Factors Influencing Pregnancy and Postpartum Weight Management in Women of African and Caribbean Ancestry Living in High Income Countries: Systematic Review and Evidence Synthesis Using a Behavioral Change Theoretical Model

Background: Women of black African heritage living in high income countries (HIC) are at risk of obesity and weight-related complications in pregnancy. This review aimed to synthesize evidence concerning attitudes to weight management-related health behaviors in pregnancy and postpartum, in women of black African ancestry, living in high-income countries. / Methods: A systematic review of the literature and thematic evidence synthesis using the Capability-Opportunity-Motivation Behavioral change theoretical model (COM-B). Databases searched included MEDLINE, EMBASE, Web of Science, and Scopus. The CASP tool was used to assess quality. / Results: Twenty-four papers met the selection criteria, most of which were from the US. Motivational factors were most commonly described as influencers on behavior. Normative beliefs about “eating for two,” weight gain being good for the baby, the baby itself driving food choice, as well as safety concerns about exercising in pregnancy, were evident and were perpetuated by significant others. These and other social norms, including a cultural acceptance of larger body shapes, and daily fast food, created a challenge for healthy behavior change. Women also had low confidence in their ability to lose weight in the postpartum period. Behavior change techniques, such as provision of social support, use of credible sources, and demonstration may be useful to support change. / Conclusions: The women face a range of barriers to engagement in weight-related health behaviors at this life-stage. Using a theoretical behavior change framework can help identify contextual factors that may limit or support behavior change

Birth data accessibility via primary care health records to classify health status in a multi-ethnic population of children: an observational study

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Protocol for a meta-research study of protocols for diet or nutrition-related trials published in indexed journals: general aspects of study design, rationale and reporting limitations.

This is the final version. Available from BMJ Publishing via the DOI in this record. INTRODUCTION: The Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) reporting guideline establishes a minimum set of items to be reported in any randomised controlled trial (RCT) protocol. The Template for Intervention Description and Replication (TIDieR) reporting guideline was developed to improve the reporting of interventions in RCT protocols and results papers. Reporting completeness in protocols of diet or nutrition-related RCTs has not been systematically investigated. We aim to identify published protocols of diet or nutrition-related RCTs, assess their reporting completeness and identify the main reporting limitations remaining in this field. METHODS AND ANALYSIS: We will conduct a meta-research study of RCT protocols published in journals indexed in at least one of six selected databases between 2012 and 2022. We have run a search in PubMed, Embase, CINAHL, Web of Science, PsycINFO and Global Health using a search strategy designed to identify protocols of diet or nutrition-related RCTs. Two reviewers will independently screen the titles and abstracts of records yielded by the search in Rayyan. The full texts will then be read to confirm protocol eligibility. We will collect general study features (publication information, types of participants, interventions, comparators, outcomes and study design) of all eligible published protocols in this contemporary sample. We will assess reporting completeness in a randomly selected sample of them and identify their main reporting limitations. We will compare this subsample with the items in the SPIRIT and TIDieR statements. For all data collection, we will use data extraction forms in REDCap. This protocol is registered on the Open Science Framework (DOI: 10.17605/OSF.IO/YWEVS). ETHICS AND DISSEMINATION: This study will undertake a secondary analysis of published data and does not require ethical approval. The results will be disseminated through journals and conferences targeting stakeholders involved in nutrition research

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Recommended aerobic fi tness level for metabolic health in children and adolescents: a study of diagnostic accuracy

ABSTRACT Objective To defi ne the optimal cut-off for low aerobic fi tness and to evaluate its accuracy to predict clustering of risk factors for cardiovascular disease in children and adolescents. Design Study of diagnostic accuracy using a crosssectional database. Setting European Youth Heart Study including Denmark, Portugal, Estonia and Norway. Participants 4500 schoolchildren aged 9 or 15 years. Main Outcome Measure Aerobic fi tness was expressed as peak oxygen consumption relative to bodyweight (mlO 2 /min/kg). Results Risk factors included in the composite risk score (mean of z-scores) were systolic blood pressure, triglyceride, total cholesterol/HDL-cholesterol ratio, insulin resistance and sum of four skinfolds. 14.5% of the sample, with a risk score above one SD, were defi ned as being at risk. Receiver operating characteristic analysis was used to defi ne the optimal cut-off for sex and age-specifi c distribution. In girls, the optimal cut-offs for identifying individuals at risk were: 37.4 mlO 2 /min/kg (9-year-old) and 33.0 mlO 2 /min/kg (15-year-old). In boys, the optimal cut-offs were 43.6 mlO 2 /min/kg (9-year-old) and 46.0 mlO 2 /min/kg (15-year-old). Specifi city (range 79.3-86.4%) was markedly higher than sensitivity (range 29.7-55.6%) for all cut-offs. Positive predictive values ranged from 19% to 41% and negative predictive values ranged from 88% to 90%. The diagnostic accuracy for identifying children at risk, measured by the area under the curve (AUC), was signifi cantly higher than what would be expected by chance (AUC >0.5) for all cut-offs. Conclusions Aerobic fi tness is easy to measure, and is an accurate tool for screening children with clustering of cardiovascular risk factors. Promoting physical activity in children with aerobic fi tness level lower than the suggested cut-points might improve their health. There are many simple anthropometric (eg, body mass index; BMI) and physiological measures (eg, aerobic fi tness level) that may predict the onset and progression of cardiovascular and metabolic diseases, yet widespread screening of schoolchildren is not in place. 1 2 BMI, known to be associated with cardiovascular disease, is an accepted measure for this purpose. 2 However, aerobic fi tness level is still not well recognised as a screening tool in paediatric populations. A growing body of evidence suggests that aerobic fi tness level is inversely associated with the presence of clustering of cardiovascular risk factors among children and adolescents 1 3 4 and cardiometabolic events later in life. 5 By assessing aerobic fi tness simple risk stratifi cation can be performed in the school setting and a strategy for selecting children 'at risk' for potential further investigation can then be created. Most of the published cut-offs defi ning low aerobic fi tness in childhood have been based on population distributions (<10 th , 25 th , 50th percentiles for sex and age-specifi c distribution). 5 6 Although the choice of percentile cut-offs is usually arbitrary and vulnerable to changes over time, as the population distribution changes, these cutoffs are strongly correlated to health outcomes. 1 7 Correlation analysis is a useful technique for describing associations between aerobic fi tness and metabolic risk and for making recommendations for prediction equations. Nevertheless, correlation analysis cannot describe the nature and extent of misclassifi cations when the purpose is to identify individuals at risk. 8 Therefore, the accuracy of a diagnostic test to distinguish between the presence and absence of a certain health condition or trait will depend on the cut-off chosen and not only the degree of closeness between the predictor and the predicted variable. Cut-off points could in principle be arbitrary, biologically based, which would make sense if the association between the exposure and outcome was not linear or they could be the best trade-off between selecting individuals at risk and minimising misclassifi cation (the number of false-positive and false-negative individuals). A threshold value that accurately distinguishes between healthy and ill individuals is the most signifi cant decision in the area of clinical diagnosis. METHODS Study population and design This study used cross-sectional data from the European Youth Heart Study (EYHS) from which 9-year-old and 15-year-old schoolchildren were randomly selected from Denmark (city of Odense) BJSM Online First

Agreement between recalled and registered BW, with 95% limits of agreement, confidence intervals and regression line

<p><b>Copyright information:</b></p><p>Taken from "Accuracy and correlates of maternal recall of birthweight and gestational age"</p><p></p><p>Bjog 2008;115(7):886-893.</p><p>Published online Jan 2008</p><p>PMCID:PMC2438372.</p><p>© 2008 The Authors Journal compilation © RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology</p

Repeatability of maternal report on prenatal, perinatal and early postnatal factors: findings from the IDEFICS parental questionnaire

Objective: To investigate the repeatability of maternal self-reported prenatal, perinatal and early postnatal factors within the IDEFICS (Identification and prevention of dietary-and lifestyle-induced health effects in children and infants) study. Design: Data are from the baseline survey of the longitudinal cohort study IDEFICS in eight European countries. Subjects: A total of 420 parents from eight countries (43-61 per country) were asked to complete the parental questionnaire (PQ) twice at least 1 month apart. Measurements: The PQ assesses prenatal (maternal weight gain), perinatal (child's birth weight and length, Caesarean (C)-section, week of delivery) and early postnatal factors (exclusive breastfeeding, breastfeeding, introduction of solid food). Intra-class correlation coefficients (ICCs) were calculated to compare maternal reports on prenatal, perinatal and early postnatal factors between the first and second PQ. Results: In total, 249 data sets were considered for the analyses. Overall, maternal reports for prenatal and perinatal factors showed higher repeatability (ICC = 0.81-1.00, P <= 0.05 for all) than those for early infant nutrition (ICC = 0.33-0.88, P <= 0.05 for all). Perfect agreement was found for parental reports on C-section (ICCall = 1.00, P <= 0.05). There was stronger agreement for duration of breastfeeding (ICC = 0.71, P <= 0.05) compared with exclusive breastfeeding (ICC = 0.33, P <= 0.05). Maternal reports showed moderate correlation for the introduction of several types of food (cereals ICC = 0.64, P <= 0.05; fruits ICC = 0.70, P <= 0.05; meat ICC = 0.83, P <= 0.05; vegetables ICC = 0.75, P <= 0.05), and high correlation (ICC = 0.88, P <= 0.05) for cow's milk. Conclusion: Maternal reports on pregnancy and birth were highly reproducible, but parental recall of early infant nutrition was weaker and should be interpreted more cautiousl