Strategies to reduce attrition in managing paediatric obesity:A systematic review

OBJECTIVE: To conduct a systematic review of the literature for strategies designed to reduce attrition in managing paediatric obesity. METHODS: We searched Ovid Medline (1946 to May 6, 2020), Ovid Embase (1974 to May 6, 2020), EBSCO CINAHL (inception to May 6, 2020), Elsevier Scopus (inception to April 14, 2020), and ProQuest Dissertations & Theses (inception to April 14, 2020). Reports were eligible if they included any obesity management intervention, included 2 to 18 year olds with overweight or obesity (or if the mean age of participants fell within this age range), were in English, included experimental study designs, and had attrition reduction as a main outcome. Two team members screened studies, abstracted data, and appraised study quality. RESULTS: Our search yielded 5,415 original reports; six met inclusion criteria. In three studies, orientation sessions (n = 2) and motivational interviewing (MI) (n = 1) were used as attrition-reduction strategies before treatment enrollment; in three others, text messaging (n = 2) and MI (n = 1) supplemented existing obesity management interventions. Attrition-reduction strategies led to decreased attrition in two studies, increased in one, and no difference in three. For the two strategies that reduced attrition, (a) pre-treatment orientation and (b) text messaging between children and intervention providers were beneficial. The quality of the six included studies varied (good [n = 4]; poor [n = 2]). CONCLUSION: Some evidence suggests that attrition can be reduced. The heterogeneity of approaches applied and small number of studies included highlight the need for well-designed, experimental research to test the efficacy and effectiveness of strategies to reduce attrition in managing paediatric obesity

A protocol for a systematic review of knowledge translation strategies in the allied health professions

<p>Abstract</p> <p>Background</p> <p>Knowledge translation (KT) aims to close the gap between knowledge and practice in order to realize the benefits of research through (a) improved health outcomes, (b) more effective health services and products, and (c) strengthened healthcare systems. While there is some understanding of strategies to put research findings into practice within nursing and medicine, we have limited knowledge of KT strategies in allied health professions. Given the interprofessional nature of healthcare, a lack of guidance for supporting KT strategies in the allied health professions is concerning. Our objective in this study is to systematically review published research on KT strategies in five allied health disciplines.</p> <p>Methods</p> <p>A medical research librarian will develop and implement search strategies designed to identify evidence that is relevant to each question of the review. Two reviewers will perform study selection and quality assessment using standard forms. For study selection, data will be extracted by two reviewers. For quality assessment, data will be extracted by one reviewer and verified by a second. Disagreements will be resolved through discussion or third party adjudication. Within each profession, data will be grouped and analyzed by research design and KT strategies using the Effective Practice and Organisation of Care Review Group classification scheme. An overall synthesis across professions will be conducted.</p> <p>Significance</p> <p>A uniprofessional approach to KT does not represent the interprofessional context it targets. Our findings will provide the first systematic overview of KT strategies used in allied health professionals' clinical practice, as well as a foundation to inform future KT interventions in allied healthcare settings.</p

In search of quality evidence for lifestyle management and glycemic control in children and adolescents with type 2 diabetes: A systematic review

<p>Abstract</p> <p>Background</p> <p>Our purpose was to evaluate the impact of lifestyle behavior modification on glycemic control among children and youth with clinically defined Type 2 Diabetes (T2D).</p> <p>Methods</p> <p>We conducted a systematic review of studies (randomized trials, quasi-experimental studies) evaluating lifestyle (diet and/or physical activity) modification and glycemic control (HbA1c). Our data sources included bibliographic databases (EMBASE, CINAHL^®, Cochrane Library, Medline^®, PASCAL, PsycINFO^®, and Sociological Abstracts), manual reference search, and contact with study authors. Two reviewers independently selected studies that included any intervention targeting diet and/or physical activity alone or in combination as a means to reduce HbA1c in children and youth under the age of 18 with T2D.</p> <p>Results</p> <p>Our search strategy generated 4,572 citations. The majority of citations were not relevant to the study objective. One study met inclusion criteria. In this retrospective study, morbidly obese youth with T2D were treated with a very low carbohydrate diet. This single study received a quality index score of < 11, indicating poor study quality and thus limiting confidence in the study's conclusions.</p> <p>Conclusions</p> <p>There is no high quality evidence to suggest lifestyle modification improves either short- or long-term glycemic control in children and youth with T2D. Additional research is clearly warranted to define optimal lifestyle behaviour strategies for young people with T2D.</p

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Patterns of weekday and weekend physical activity in youth in 2 Canadian provinces

Few Canadian children are meeting physical activity (PA) guidelines for optimal growth and health. There is little information describing the patterns of PA among Canadian youth, so it is difficult to determine where the deficits occur. The purpose of this study was to identify subgroups of youth and windows of time characterized by low PA and high sedentary behaviour. We conducted a cross-sectional study of 626 youth (aged 10–15 years) in 2 Canadian provinces. The primary exposure variables included geographic setting (rural vs. urban), sex, and days of the week (weekend days vs. weekdays). The primary outcome measures were minutes of light PA, moderate to vigorous physical activity (MVPA), and sedentary behavior, assessed with accelerometry. Compared with weekdays, MVPA was ∼30% lower on weekend days (55.8 ± 23.0 min vs. 38.7 ± 26.7 min; <i>p</i> < 0.001), whereas light PA was ∼15% higher. Significantly more youth achieved an average of >60 min of MVPA on weekdays than on weekend days (46% vs. 22%; <i>p</i> < 0.001). Sex-specific differences in MVPA were more pronounced on weekdays than on weekend days (∼13 vs ∼8 min per day; <i>p</i> < 0.01). Youth in rural settings achieved ∼9 fewer minutes of MVPA daily than youth in urban settings (<i>p</i> < 0.001). In youth 10 to 15 years of age, daily MVPA is lower and light PA is higher on weekend days than on weekdays. Girls and students living in rural areas were particularly vulnerable to low levels of MVPA

Severe obesity in children 17 to 24 months of age: a cross-sectional study of TARGet Kids! and Better Outcomes Registry & Network (BORN) Ontario

OBJECTIVES: International data suggests the prevalence of severe obesity in young children may be increasing, yet no Canadian data are available. The objectives of this study were to examine definitions of severe obesity and to evaluate associated risk factors among young children in Ontario. METHODS: A cross-sectional study was conducted in children 17 to 24 months of age using two Ontario data sources: TARGet Kids! (n=3713) and BORN Ontario (n=768). Body mass index z-score (zBMI) definitions were adapted from the World Health Organization (WHO) (z-score > 3) and the US Centers for Disease Control (CDC) (>120% of the 95th percentile) and applied to define severe obesity in young children. Multinomial logistic regression was used to evaluate associations between demographic and pregnancy risk factors and zBMI categories. RESULTS: 1.1% (95% CI: 0.8-1.4) of children met the adapted WHO definition of severe obesity compared to 0.3% (95% CI: 0.2-0.6) using the CDC definition. Median neighborhood household income (OR=0.80, 95%CI 0.69-0.93) and maternal pre-pregnancy BMI (OR=1.08, 95% CI: 1.01-1.15) were associated with severe obesity in unadjusted analyses. After adjustment for potential confounders, the OR for the association between maternal pre-pregnancy and severe obesity was 1.04 (95% CI: 0.94-1.15). CONCLUSION: More than 1% of Ontario children met the WHO definition of severe obesity in very early childhood. Modifiable risk factors were identified. Future studies are needed to understand the terminology, prevalence and risk factors for severe obesity in young children across Canada.Funding for this study was received from the Canadian Institutes of Health Research