Study of Healthcare Personnel with Influenza and other Respiratory Viruses in Israel (SHIRI): study protocol

Abstract Background The Study of Healthcare Personnel with Influenza and other Respiratory Viruses in Israel (SHIRI) prospectively follows a cohort of healthcare personnel (HCP) in two hospitals in Israel. SHIRI will describe the frequency of influenza virus infections among HCP, identify predictors of vaccine acceptance, examine how repeated influenza vaccination may modify immunogenicity, and evaluate influenza vaccine effectiveness in preventing influenza illness and missed work. Methods Cohort enrollment began in October, 2016; a second year of the study and a second wave of cohort enrollment began in June 2017. The study will run for at least 3 years and will follow approximately 2000 HCP (who are both employees and members of Clalit Health Services [CHS]) with routine direct patient contact. Eligible HCP are recruited using a stratified sampling strategy. After informed consent, participants complete a brief enrollment survey with questions about occupational responsibilities and knowledge, attitudes, and practices about influenza vaccines. Blood samples are collected at enrollment and at the end of influenza season; HCP who choose to be vaccinated contribute additional blood one month after vaccination. During the influenza season, participants receive twice-weekly short message service (SMS) messages asking them if they have acute respiratory illness or febrile illness (ARFI) symptoms. Ill participants receive follow-up SMS messages to confirm illness symptoms and duration and are asked to self-collect a nasal swab. Information on socio-economic characteristics, current and past medical conditions, medical care utilization and vaccination history is extracted from the CHS database. Information about missed work due to illness is obtained by self-report and from employee records. Respiratory specimens from self-collected nasal swabs are tested for influenza A and B viruses, respiratory syncytial virus, human metapneumovirus, and coronaviruses using validated multiplex quantitative real-time reverse transcription polymerase chain reaction assays. The hemagglutination inhibition assay will be used to detect the presence of neutralizing influenza antibodies in serum. Discussion SHIRI will expand our knowledge of the burden of respiratory viral infections among HCP and the effectiveness of current and repeated annual influenza vaccination in preventing influenza illness, medical utilization, and missed workdays among HCP who are in direct contact with patients. Trial registration NCT03331991 . Registered on November 6, 2017.https://deepblue.lib.umich.edu/bitstream/2027.42/146186/1/12879_2018_Article_3444.pd

Diabetes screening intervals based on risk stratification

Background Guidelines for frequency of Type 2 diabetes mellitus (DM) screening remain unclear, with proposed screening intervals typically based on expert opinion. This study aims to demonstrate that HbA1c screening intervals may differ substantially when considering individual risk for diabetes. Methods This was a multi-institutional retrospective open cohort study. Data were collected between April 1999 to March 2014 from one urban and one rural cohort in Japan. After categorization by age, we stratified individuals based on cardiovascular disease risk (Framingham 10-year cardiovascular risk score) and body mass index (BMI). We adapted a signal-to-noise method for distinguishing true HbA1c change from measurement error by constructing a linear random effect model to calculate signal and noise of HbA1c. Screening interval for HbA1c was defined as informative when the signal-to-noise ratio exceeded 1. Results Among 96,456 healthy adults, 46,284 (48.0%) were male; age (range) and mean HbA1c (SD) were 48 (30–74) years old and 5.4 (0.4)%, respectively. As risk increased among those 30–44 years old, HbA1c screening intervals for detecting Type 2 DM consistently decreased: from 10.5 (BMI 30) years, and from 8.0 (Framingham Risk Score Conclusions HbA1c screening intervals for identification of DM vary substantially by risk factors. Risk stratification should be applied when deciding an optimal HbA1c screening interval in the general population to minimize overdiagnosis and overtreatment.</p

The Feasibility of Collecting Longitudinal Cardiovascular and Fitness Outcomes From a Neighborhood Park-Based Fitness Program in Ethnically Diverse Older Adults: A Proof-of-Concept Study

This proof-of-concept study examined feasibility of assessing longitudinal changes in body mass index, strength, mobility, and cardiovascular health outcomes in older, racial/ethnic minority adults participating in a park-based physical activity program. Study feasibility was based on follow-through data collection procedures and ability to manage and implement data collection, enrollment, and repeated measures data collection in older adults (≥50 years; n = 380; 45% Hispanic, 41% non-Hispanic Black) over a 28-month period. Mixed models were developed to estimate the effects of program participation over time on participant cardiovascular and fitness outcomes and across poverty and age subgroups. Model estimates adjusted for individual-level sociodemographics showed improvements across each 4 month time point in arm strength (0.55 arm curl; 95% confidence interval [0.33, 0.77]) and systolic (−0.68 mmHg; 95% confidence interval [−1.22, −0.13]) and diastolic (−0.47 mmHg; 95% confidence interval [−0.79, −0.16]) blood pressure. An Age × Poverty interaction found greater improvements in systolic and diastolic blood pressure among younger participants living in low poverty (vs. older in higher poverty). Study of the longitudinal association between fitness class participation and health outcomes was feasible in park-based settings

Longitudinal analysis of cardiovascular disease risk profile in neighbourhood poverty subgroups: 5-year results from an afterschool fitness programme in the USA

BackgroundThe WHO calls for affordable population-based prevention strategies for reducing the global burden of cardiovascular disease (CVD) on morbidity and mortality; however, effective, sustainable and accessible community-based approaches for CVD prevention in at-risk youth have yet to be identified. We examined the effects of implementing a daily park-based afterschool fitness programme on youth CVD risk profiles over 5 years and across area poverty subgroups.MethodsThe study included 2264 youth (mean age 9.4 years, 54% male, 50% Hispanic, 47% non-Hispanic black, 70% high/very high area poverty) in Miami, Florida, USA. We used three-level repeated measures mixed models to determine the longitudinal effects of programme participation on modifiable CVD outcomes (2010–2016).ResultsDuration of programme participation was significantly associated with CVD risk profile improvements, including body mass index (BMI) z-score, diastolic/systolic blood pressure, skinfold thicknesses, waist–hip ratio, sit-ups, push-ups, Progressive Aerobic Cardiovascular Endurance Run (PACER) score, 400 m run time, probability of developing systolic/diastolic hypertension and overweight/obesity in high/very high poverty neighbourhoods (P<0.001). Diastolic blood pressure decreased 3.4 percentile points (95% CI −5.85 to −0.85), 8.1 percentile points (95% CI –11.98 to −4.26), 6.1 percentile points (95% CI −11.49 to −0.66), 7.6 percentile points (95% CI −15.33 to –0.15) and 11.4 percentile points (95% CI −25.32 to 2.61) for 1–5 years, respectively, in high/very high poverty areas. In contrast, significant improvements were found only for PACER score and waist–hip ratio in low/mid poverty areas.ConclusionThis analysis presents compelling evidence demonstrating that park-based afterschool programmes can successfully maintain or improve at-risk youth CVD profiles over multiple years

Flipping the Script: An Initial Exploration of Flipped Learning as an Enhanced Alternative to Traditional Physical Education Lessons

Background: Physical activity (PA) is related to a variety of positive outcomes for youth and physical education (PE) represents a primary school-based environment where students can engage in moderate-to-vigorous physical activity (MVPA). Limitations exist in secondary schools with low socio-economic status, where MVPA engagement is generally below the recommended 50% of lesson time. Growing evidence suggests that using a flipped learning approach (FLA) may naturally enhance PE lessons as outlined by The Theory of Expanded, Extended, and Enhanced Opportunities for Youth Physical Activity Promotion. Purpose: The purpose of this study was to compare the impact of the FLA to traditional instruction on student MVPA, lesson context, and teacher involvement during middle school PE lessons. Methods: Participants were 56 male students from two 7th-grade classes from a low-SES, suburban school. This study employed the System for Observing Fitness Instruction Time (SOFIT). Data were examined through descriptive statistics. Linear regression models were used to predict SOFIT outcomes as a function of FLA versus traditional instruction. Results: Students in the FLA class spent significantly more class time in MVPA (p &lt; 0.01). Regression models predicted participants in FLA classes would spend 55% more class time in MVPA (p &lt; 0.01). After adjusting for covariates, models showed students in FLA classes would spend almost 18 more minutes in MVPA than students in traditional classes (p &lt; 0.01). Discussion/Conclusion: The FLA may be a practical lesson enhancement strategy to increase student MVPA and improve PE opportunities for students in low SES schools when compared to the use of traditional instruction. The results of this study demonstrated positive potential of using FLA in PE but should be considered within the context of their limitations. Further examination of the FLA is warranted

Flipping the Script: An Initial Exploration of Flipped Learning as an Enhanced Alternative to Traditional Physical Education Lessons

Background: Physical activity (PA) is related to a variety of positive outcomes for youth and physical education (PE) represents a primary school-based environment where students can engage in moderate-to-vigorous physical activity (MVPA). Limitations exist in secondary schools with low socio-economic status, where MVPA engagement is generally below the recommended 50% of lesson time. Growing evidence suggests that using a flipped learning approach (FLA) may naturally enhance PE lessons as outlined by The Theory of Expanded, Extended, and Enhanced Opportunities for Youth Physical Activity Promotion. Purpose: The purpose of this study was to compare the impact of the FLA to traditional instruction on student MVPA, lesson context, and teacher involvement during middle school PE lessons. Methods: Participants were 56 male students from two 7th-grade classes from a low-SES, suburban school. This study employed the System for Observing Fitness Instruction Time (SOFIT). Data were examined through descriptive statistics. Linear regression models were used to predict SOFIT outcomes as a function of FLA versus traditional instruction. Results: Students in the FLA class spent significantly more class time in MVPA (p < 0.01). Regression models predicted participants in FLA classes would spend 55% more class time in MVPA (p < 0.01). After adjusting for covariates, models showed students in FLA classes would spend almost 18 more minutes in MVPA than students in traditional classes (p < 0.01). Discussion/Conclusion: The FLA may be a practical lesson enhancement strategy to increase student MVPA and improve PE opportunities for students in low SES schools when compared to the use of traditional instruction. The results of this study demonstrated positive potential of using FLA in PE but should be considered within the context of their limitations. Further examination of the FLA is warranted

Objective Measurement of Physical Activity Attributed to a Park-Based Afterschool Program

Background: Only 24% of US youth meet physical activity recommendations set by the Centers for Disease Control and Prevention. Research demonstrates that community-based programs provide underresourced minority youth with opportunities for routine physical activity, although limited work draws from accelerometry data. This study objectively assessed youth physical activity attributable to participation (vs nonparticipation) days in a park-based afterschool program in Miami-Dade County, Miami, FL. Methods: Participants’ (n = 66; 60% male; 57% white Hispanic, 25% non-Hispanic black, 14% Black Hispanic, mean age = 10.2 y) physical activity was assessed April to May 2019 over 10 days across 7 park sites using Fitbit (Charge 2) devices. Separate repeated-measures multilevel models were developed to assess the relationship between program daily attendance and total (1) moderate to vigorous physical activity minutes and (2) step counts per day. Results: Models adjusted for individual-level age, sex, race/ethnicity, poverty, and clustering by park showed significantly higher moderate to vigorous physical activity minutes (β = 25.33 more minutes per day; 95% confidence interval, 7.0 to 43.7, P < .01) and step counts (β = 4067.8 more steps per day; 95% confidence interval, 3171.8 to 4963.8, P < .001) on days when youth did versus did not attend the program. Conclusions: Study findings suggest that park-based programs may support underserved youth in achieving daily physical activity recommendations

Natural experiment examining the longitudinal association between change in residential segregation and youth cardiovascular health across race/ethnicity and gender in the USA

BackgroundIdentifying how racial/ethnic residential segregation and mobility may impact health can guide innovative strategies for reducing youth disparities.MethodsThis natural experiment examined the association between change in residential segregation and cardiovascular health outcomes across race/ethnicity and gender for youth (n=2250, mean age 9.1 years, 54% male; 51% Hispanic, 49% non-Hispanic black (NHB); 49% high area poverty) attending a multisite park-based afterschool fitness programme in Florida, USA. Two-level generalised linear mixed models with random intercepts for park effects were fit to test the change in segregation–cardiovascular health association over two school years.ResultsAfter covariate adjustment (individual-level gender, race/ethnicity, age, time and park-area poverty), greater improvements in cardiovascular health including body mass index percentile, sum of skinfold thicknesses, systolic/diastolic blood pressure percentiles and 400 m run time were found for youth who attended the program in a less segregated area compared with their home area (p<0.05 for all outcomes). NHB girls showed the greatest cardiovascular health improvements. Specifically, compared with the reference group (no change in segregation), skinfold thicknesses and systolic blood pressure percentiles decreased 17% (incidence rate ratio (IRR) 95% CI 0.81 to 0.86) and 16% (IRR 95% CI 0.82 to 0.87), respectively, versus 1% increase for both outcomes (IRR 95% CI 0.98 to 1.05) and (IRR 95% CI 0.98 to 1.05), respectively, for movement to less versus more segregated areas.ConclusionIn light of a continually expanding youth obesity epidemic, the global effort to reduce health inequities may be supported through Parks and Recreation Departments given potential to expand geographic mobility for low resource subgroups