A smartphone intervention for adolescent obesity: study protocol for a randomised controlled non-inferiority trial

Background There are few evidence-based mobile health solutions for treating adolescent obesity. The primary aim of this parallel non-inferiority trial is to assess the effectiveness of an experimental smartphone application in reducing obesity at 12 months, compared to the Temple Street W82GO Healthy Lifestyles intervention. Methods/design The primary outcome measure is change in body mass index standardised deviation score at 12 months. The secondary aim is to compare the effect of treatment on secondary outcomes, including waist circumference, insulin sensitivity, quality of life, physical activity and psychosocial health. Adolescents with a body mass index at or above the 98th percentile (12 to 17 years) will be recruited from the Obesity clinic at Temple Street Children’s University Hospital in Dublin, Ireland. W82GO is a family-based lifestyle change intervention delivered in two phases over 12 months. In the current study, participants will be randomised for phase two of treatment to either usual care or care delivered via smartphone application. One hundred and thirty-four participants will be randomised between the two study arms. An intention-to-treat analysis will be used to compare treatment differences between the groups at 12 months. Discussion The results of this study will be disseminated via open access publication and will provide important information for clinicians, patients and policy makers regarding the use of mobile health interventions in the management of adolescent obesity. Trial registration Clinicaltrials.gov NCT01804855

Extreme genome diversity in the hyper-prevalent parasitic eukaryote Blastocystis

Blastocystis is the most prevalent eukaryotic microbe colonizing the human gut, infecting approximately 1 billion individuals worldwide. Although Blastocystis has been linked to intestinal disorders, its pathogenicity remains controversial because most carriers are asymptomatic. Here, the genome sequence of Blastocystis subtype (ST) 1 is presented and compared to previously published sequences for ST4 and ST7. Despite a conserved core of genes, there is unexpected diversity between these STs in terms of their genome sizes, guanine-cytosine (GC) content, intron numbers, and gene content. ST1 has 6,544 protein-coding genes, which is several hundred more than reported for ST4 and ST7. The percentage of proteins unique to each ST ranges from 6.2% to 20.5%, greatly exceeding the differences observed within parasite genera. Orthologous proteins also display extreme divergence in amino acid sequence identity between STs (i.e., 59%–61%median identity), on par with observations of the most distantly related species pairs of parasite genera. The STs also display substantial variation in gene family distributions and sizes, especially for protein kinase and protease gene families, which could reflect differences in virulence. It remains to be seen to what extent these inter-ST differences persist at the intra-ST level. A full 26% of genes in ST1 have stop codons that are created on the mRNA level by a novel polyadenylation mechanism found only in Blastocystis. Reconstructions of pathways and organellar systems revealed that ST1 has a relatively complete membrane-trafficking system and a near-complete meiotic toolkit, possibly indicating a sexual cycle. Unlike some intestinal protistan parasites, Blastocystis ST1 has near-complete de novo pyrimidine, purine, and thiamine biosynthesis pathways and is unique amongst studied stramenopiles in being able to metabolize ?-glucans rather than ?-glucans. It lacks all genes encoding heme-containing cytochrome P450 proteins. Predictions of the mitochondrion-related organelle (MRO) proteome reveal an expanded repertoire of functions, including lipid, cofactor, and vitamin biosynthesis, as well as proteins that may be involved in regulating mitochondrial morphology and MRO/endoplasmic reticulum (ER) interactions. In sharp contrast, genes for peroxisome-associated functions are absent, suggesting Blastocystis STs lack this organelle. Overall, this study provides an important window into the biology of Blastocystis, showcasing significant differences between STs that can guide future experimental investigations into differences in their virulence and clarifying the roles of these organisms in gut health and disease

O Movimento Cidades/Municípios Saudáveis: um compromisso com a qualidade de vida The Healthy Cities Movement: a commitement with quality of life

O Movimento Cidades/Municípios Saudáveis, desde a década de 1970, vem envolvendo cada vez maior número de cidades e atores em vários países e divulgando uma prática que representa uma nova forma de pensar e fazer saúde. O movimento tem como objetivo um produto social, a qualidade de vida da população e pressupõe a existência de problemas concretos de pessoas vivendo em um território. Representa uma nova forma de gestão municipal, baseada na ação intersetorial e exige, ao mesmo tempo, um protagonismo do Estado e a participação da sociedade civil como parceira na consecução dos objetivos. No Brasil há, até o momento, 19 municípios envolvidos com a proposta, mas somente 13 estão com projetos ativos. Os resultados dos esforços estão começando a ser visualizados, trazendo novas perspectivas em termos de desenvolvimento social e sustentado, bem como de melhoria das condições de saúde e qualidade de vida.<br>The Healthy Cities Movement has been involving an increasing number of cities and actors in several countries of the world since the 70's, and has been divulging a practice that represents a new form of thinking and working on health which aims at constructing a social product - quality of life of the population. This new proposal presupposes the existence of people living in a territory with concrete problem. It represents a new form of city administration based on intersectorial action and demands the protagonism of the state, as well as the participation of civil society in the accomplishment of new objectives aiming at changing the city profile. In Brazil there are so far 19 municipal districts involved with Healthy Cities' proposal but only 13 with active projects. The results of the efforts of these municipal districts are beginning to become visible and to bring new perspectives in terms of social and sustained development and the improvement of health conditions and quality of life