Investigation of Milk and Alternatives Intake and the Impact of School Nutrition Programs in First Nations Schoolchildren

Objectives: To assess the intake of milk and alternatives, calcium, and vitamin D in on-reserve First Nations youth in Ontario, Canada; and the relationship of these nutrients to body mass index. To assess the impact of a simple food provision program on the intakes of milk and alternatives among First Nations youth in Kashechewan First Nation and Attawapiskat First Nation, Ontario, Canada. To assess the process of implementing a comprehensive school nutrition education program, as well as its effects on the intake of milk and alternatives, as well as knowledge, intentions, and self-efficacy among First Nations youth in Fort Albany First Nation, Ontario. Methods: Twenty-four hour diet recall data collected by web-based survey between November 2003 and June 2010 (including pre- and post-program) were used to assess intakes. Milk and alternatives, calcium, and vitamin D intakes were described and compared to food and nutrition standards and to intakes in the general population (CCHS cycle 2.2), and related to BMI. Data collected in different years for the same community and season were used to assess yearly effects on milk and alternatives intake (four communities). Data collected in the same year and season but from different communities were used to assess latitudinal effects on milk and alternatives intake (four community pairs). Paired change in intakes was evaluated one week-post snack program implementation in Kashechewan and Attawapiskat, as well as one year post-program in Kashechewan. Change in intakes as well as knowledge, self-efficacy, and intentions were evaluated in Fort Albany after the completion of a comprehensive school-based program. Student (grades 6-8), teacher (from grades K-8), and parent impressions were collected via questionnaires and focus groups. Results: Mean intakes of milk and alternatives, calcium, and vitamin D were below recommendations and levels seen in the general population. No relationship between body mass index and milk and alternatives, calcium, or vitamin D intake was detected. Latitudinal and yearly variation in intakes was detected in the communities under study. Pilot school food provision programs improved intakes in the short-term under close to ideal circumstances, including adequate dedicated personnel and resource support. After one week, calcium intake increased in Kashechewan (p=0.044), while milk and alternatives (p=0.034) and vitamin D (p=0.022) intakes increased in Attawapiskat. Multiple logistical barriers meant that these improvements were not sustained in the long-term. A comprehensive program in Fort Albany was successful in increasing knowledge (p=0.050) and intentions (p=0.010) towards milk and alternatives intake. Students were generally grateful for the snack programs, and especially enjoyed the hands-on lessons in Fort Albany. Teachers in Kashechewan thought that the snack program was very valuable for students and helped with their alertness and attentiveness. In Fort Albany, teachers noted that it was helpful to have an outside person who could devote all of their time to teaching the students about nutrition; they thought that the students gained a whole new perspective about nutrition via the program. Parents in Fort Albany were enthusiastic about the school nutrition program, but noted availability and cost as major barriers to healthy eating. Conclusions: The low milk and alternatives, calcium, and vitamin D intakes seen in the study population parallel results seen in studies of other Canadian Aboriginal populations. Further study is needed to clarify the relationship between milk & alternatives intake and BMI in this population. Latitudinal and yearly variations in intake were identified, and therefore should be accounted for when tailoring interventions to specific First Nations; the needs, opportunities, and barriers in each case may differ significantly. This study demonstrated that school food provision programs were valued by students, parents, and teachers; and were efficacious in improving short-term intakes. Comprehensive programs were shown to improve student knowledge and intentions to make healthy food choices. In order to support long-term effectiveness, the barriers identified through this research, including the need for adequate and sustainable resources, must be addressed

Obesity, Physical Activity and Sedentary Behaviour Among Canadian First Nations Youth: An Exploration of Associated Factors and Evaluation of a School Sports Program

Background: Secondary to inequities in several determinants of health, Canadian Aboriginal youth are affected by a higher prevalence rate of obesity and chronic disease than the general population. While the factors contributing to obesity have been extensively studied among the general population, relatively little data are available for First Nations [FN] youth living on reserve. This dissertation will focus on two risk factors, physical inactivity and sedentary behaviour, amenable to change via community-level health promotion initiatives. Purpose: To (a) review quantitative evidence on physical activity [PA], fitness and sedentary behaviour among Canadian Aboriginal youth, (b) explore the potential relationships of socioeconomic, cultural and health behavioural factors with overweight/obesity among FN youth living on reserve, (c) explore the potential relationships of socioeconomic, cultural and health-related factors with high (>1.5 hours/day) levels of television viewing among FN youth living on reserve, (d) conduct a needs assessment for PA programming in one subarctic Ontario FN, and (e) evaluate the implementation and outcomes of a school sport program in this community. Methods: In Study 1, a systematic review of peer-reviewed quantitative research on the PA and fitness of Canadian Aboriginal youth was conducted. The studies, which also described sedentary behaviours, were summarized and the results were presented according to adherence to Canadian guidelines, age and sex differences, and associations with health outcomes. Studies 2 and 3 used data collected for the 12-17 year old subset of the 2008-2010 First Nations Regional Health Survey [RHS]. The relationships between a number of independent variables and (a) overweight/obesity or (b) high television viewing were assessed using logistic regression, stratified by age and sex. Analyses were weighted to account for the sampling strategy. Studies 4 and 5 responded to a subarctic Ontario FN community’s desire for school-based sport programming. A participatory, utilization-focused approach to program evaluation was employed in first conducting a needs assessment for PA and sport in the community (Study 4). Anthropometrics (body mass index [BMI], waist circumference, body fat percentage), PA (3 days of accelerometry) and physical fitness (informed by the Canadian Physical Activity, Fitness and Lifestyles Approach) were measured. Descriptive statistics were compared to reference data and group-level differences (by BMI, waist circumference and body fat status) were tested using Mann-Whitney U and Chi-square tests. Barriers and supports were assessed qualitatively. In Study 5, implementation and outcome evaluations for a school sports program were conducted by repeating the quantitative measures used in Study 4. Changes in these variables were tested using bootstrapped paired samples t-tests. Information on participation, satisfaction and program implementation was collected qualitatively. The qualitative data from Studies 4 and 5 were analyzed inductively for themes by hand, and verified by a second researcher. Results: The systematic review in Study 1 revealed 23 records, 35% (n=8) of which reported on national survey data and 65% (n=15) that reported regional data from several FN sub-populations. National reports showed that about half of youth are ‘active’ and up to two-thirds spend more than 15 hours per week in screen-based sedentary time. Results from regional reports were highly variable. Cardiorespiratory endurance was the only measure of fitness reported in regional studies, and generally appeared low. Girls were almost universally less active than boys. Physical activity was associated with a number of health outcomes; most commonly, an inverse association with BMI or reduced odds of obesity at higher PA levels were reported. Study 2 showed that among 12-17 year old FN youth living on reserve (n=2 888, representing 29 988 individuals in the weighted sample, 56.4% male), overweight/obesity (45.2% prevalence) was associated with younger age (p=0.024), knowledge of a FN language (p=0.015), lower PA level (p=0.001) and lower levels of video game use (p=0.042). Numerous age- and sex-based interactions prompted stratifying the sample for further analysis. No significant relationships were detected for boys aged 12-14 years. Among girls aged 12-14 years, reduced odds of overweight/obesity were observed among those who were moderately active (OR=0.48, 95% CI=0.26, 0.88) or active (OR=0.56, 95% CI=0.32, 0.96) as compared to inactive (p=0.048), and among those who spent more than 1.5 hours using a computer per day (OR=0.66, 95% CI=0.45, 0.96) as compared to those with lesser use (p=0.028). Among boys aged 15-17 years the odds of overweight/obesity were increased among those with parents in the middle education level (high school diploma; OR=1.78, 95% CI=1.15, 2.76) as compared to the lowest level (p=0.032), and those who always or almost always participated in their community’s cultural events (OR=2.06, 95% CI=1.23, 3.44) as compared to less frequent participation (p=0.005). The odds of overweight/obesity were reduced among those playing more than 1.5 hours of video games per day (OR=0.69, 95% CI=0.47, 0.99) as compared to those with lesser use (p=0.044). Among girls aged 15-17 years, the odds of overweight/obesity were increased among those with knowledge of a FN language (OR=1.67, 95% CI=1.15, 2.42) as compared to those without (p=0.007). The odds of overweight/obesity were reduced for those playing more than 1.5 hours of video games per day (OR=0.43, 95% CI=0.27, 0.67) as compared to those with lesser use (p=0.009), and those who reported sometimes (OR=0.43, 95% CI=0.27, 0.67) or always (OR=0.51, 95% CI=0.30, 0.87) eating a nutritious diet as compared to those reporting rarely or never (p=0.001). In all cases, the bivariate relationships remained significant in the multivariate adjusted analyses. Study 3 showed that among on-reserve FN youth (n=3 658, representing 40 462 individuals in the weighted sample, 53.1% male), 39.9% watched more than 1.5 hours of television daily. For the group, only attendance at community cultural events was associated with high television viewing (p=0.005). No significant effects of the tested independent variables were detected for younger (12-14 year old) youth. Among boys aged 15-17 years the odds of high television watching were increased among those with parents having a higher education level (OR=1.73, 95% CI=1.11, 2.69 for high school diploma; OR=1.74, 95% CI=1.16, 2.60 for post-secondary education) as compared to the lowest level (p=0.010), those who always or almost always participated in their community’s cultural events (OR=1.84, 95% CI=1.23, 2.75) as compared to less frequent participation (p=0.003), and those who were overweight or obese (OR=1.44, 95% CI=1.04, 2.00) as compared to normal weight (p=0.028). Among 15-17 year old girls the odds of high television viewing were reduced among those in the largest household size (OR=0.64, 95% CI=0.46, 0.89) as compared to the smallest size (p=0.030), and those reporting very good or excellent mental health (OR=0.63, 95% CI=0.45, 0.86) as compared to poorer mental health (p=0.004). The community needs assessment in Study 4 revealed that in a subarctic Ontario FN, 63% of participating youth in grades 6-7 (n=72, 61.1% male) were overweight or obese, 51% were abdominally obese and 21% had excess body fat. Meanwhile, 86% met Canadian PA guidelines. Cardiorespiratory endurance appeared low in comparison to Canadian Health Measures Survey findings for the general population. Those who were overweight, obese, and/or abdominally obese had lower cardiorespiratory endurance than other youth (p<0.001). Barriers and supports to youth PA fell under the themes of motivation, role modelling, personnel and facilities, and environment and programs. The findings informed a locally implemented school sports program. In Study 5, after a 9-months (one school year) of the program, 57 youth (12.8±1.0 years, 59.6% male) provided at least one of the process and outcome evaluation measures. Over the course of the program, youth increased their mean participation in moderate-to-vigorous PA by 47.9 minutes/day (p=0.016). Boys completed an average additional 10.5 shuttle run stages (p=0.006), and showed a non-significant trend toward improved cardiorespiratory endurance (p=0.057). Girls did not experience significant improvement in cardiorespiratory endurance. Both boys (+8.2 kg, p=0.002) and girls (+5.6 kg, p=0.012) improved their muscular strength. Flexibility improved for the group (+2.2 cm, p=0.015). Boys appeared to participate in the program more often than girls (not statistically significant); 28% of boys reported daily participation as compared to 15% of girls. Qualitative findings revealed barriers to implementation that were related to resource and infrastructure limitations. These were somewhat overcome by mobilizing of the few available resources and volunteer personnel. Conclusions: Many Canadian Aboriginal youth fail to meet established PA and sedentary behaviour guidelines, and physical fitness appears low among a few FN populations. Available data support an inverse association for both higher amounts of PA and lesser time in sedentary behaviour relative to overweight and obesity, providing impetus for PA programming in vulnerable communities. Data from the RHS showed that among FN youth living on reserve, overweight/obesity and high levels of television viewing are prevalent across all age and sex groups. The identification of several factors affecting the odds of overweight/obesity and television viewing has provided some evidence that may inform health promotion initiatives, however more research is needed to fully understand the observed relationships. The findings suggest that programming will need to be tailored to various and and sex categories. In a remote, northern Ontario FN community, although the majority of youth met Canadian PA guidelines, low physical fitness (particularly cardiorespiratory endurance) and a high prevalence of obesity and abdominal obesity supported the community’s desire for school-based PA programming. In the same community, many pre-existing barriers were overcome to implement a school sports program, which was well received. The program was associated with positive outcomes, more so among boys. Thus, future programming should target the participation of girls specifically. Nonetheless, this work demonstrates the many beneficial outcomes that can be achieved when a community with relatively few pre-existing resources is empowered to implement local, sustainable programming supporting the health of their youth

Concentrations and Size Distributions of Airborne Particulate Matter and Bacteria in an Experimental Aviary Laying-Hen Chamber

High levels of airborne particulate matter (PM) and bacteria may exist in animal housing, which can be detrimental to the health of animals and workers. The sizes of these bioaerosols determine their aerial transport behaviors and depositions in the respiratory tracts of animals and humans. However, little is known regarding the size distribution of airborne PM and bacteria in livestock houses, especially in alternative animal housing systems that aim to enhance animal welfare, such as aviary hen-housing systems. The study reported here was therefore conducted to characterize the concentrations and size distributions of airborne bacteria (in count) and PM (both in count and in mass) in a pilot-scale aviary laying-hen chamber. Thirty-four laying hens were kept in the environmentally controlled aviary chamber (L × W × H = 2.2 × 2.3 × 2.4 m) for three months. The hens were given a 16L:8D photoperiod (lights on at 6:00 h and off at 22:00 h) and access to the litter floor from 12:00 h to 22:00 h daily. Airborne bacteria and PM were simultaneously sampled for 15 min at 1.5 m above the litter floor every fourth day at 5:45 h, 9:45 h, 13:45 h, 17:45 h, and 21:45 h. Concentrations of airborne bacteria at six size ranges (0.65 to 1.1 µm, 1.1 to 2.1 µm, 2.1 to 3.3 µm, 3.3 to 4.7 µm, 4.7 to 7.1 µm, and \u3e7.1 µm) and PM concentrations (0.523 to 20.535 µm) were determined. The daily mean (±SD) concentrations of PM count, PM mass, and airborne bacteria were 1.70 (±0.66) × 107 particles m-3, 1.12 (±0.47) mg m-3, and 3.39 (±2.38) × 105 cfu m-3, respectively. Concentrations of airborne PM and bacteria during the litter-access period (12:00 to 22:00 h) were significantly higher than those during the rest of the day when the hens were off the floor (p \u3c 0.05). Median diameter and geometric standard deviation (GSD) for the PM count (0.523 to 20.535 µm) were 2.11 and 2.34 µm, respectively. Median diameter and GSD for the PM mass (0.523 to 20.535 µm) were 7.45 and 4.58 µm, respectively. PM \u3c10 µm accounted for more than 95% of the total PM count, whereas PM \u3e2.5 µm accounted for more than 90% of the total PM mass, in the size range of 0.523 to 20.535 µm. The majority (\u3e95%) of the airborne bacteria were carried by particles \u3e3.3 µm. Airborne bacteria count concentration was positively related to PM mass concentration (p \u3c 0.05) with a slope of 3.84 (±2.70) × 105 cfu mg-1 PM. Results of the study are useful for improving understanding of transport behaviors of aerosols in aviary hen systems, assessing potential respiratory risks to humans and animals, and exploring mitigation techniques

Concentrations and Size Distributions of Airborne Particulate Matter and Bacteria in an Experimental Aviary Laying-Hen Housing System

High levels of airborne particulate matter (PM) and bacteria may exist in animal housing, which can be detrimental to the health of animals and workers. The sizes of these bioaerosols determine their aerial-transport behaviors and depositions in the respiratory tracts of animals and humans. However, little is known regarding the size distribution of airborne PM and bacteria in livestock houses, especially alternative animal housing systems that aim to enhance animal welfare, such as aviary hen-housing systems. The study reported here was therefore conducted to characterize the concentrations (both in count and in mass) and size distributions of airborne bacteria (in count) and PM (both in count and in mass) in a pilot-scale welfare-oriented aviary laying-hen setting. Thirty-four laying hens were kept in the environmentally-controlled aviary setting (L × W × H = 2.2 × 2.3 × 2.4 m) for 3 months. The hens were given a 16L:8D photoperiod (lights on at 6:00h and off at 22:00h); and access to the litter floor from 12:00h to 22:00h daily. Airborne bacteria and PM were simultaneously sampled for 15 min at 1.5 m height above the litter floor every fourth day at 5:45h, 9:45h, 13:45h,17:45h, and 21:45h. Concentrations of airborne bacteria at six size ranges (0.65-1.1 µm, 1.1-2.1 µm, 2.1-3.3 µm, 3.3-4.7 µm, 4.7-7.1 µm, and \u3e7.1 µm) and the PM concentrations (0.5-20 µm) were determined. The daily mean (±SD) concentrations of PM count, PM mass and total bacterial concentration were, respectively, 1.70 (± 0.66) ×107 particles m-3, 1.12 (± 0.47) mg m-3 and 3.39 (± 2.38) ×105 CFU m-3. Concentrations of PM and total bacteria during the litter-access period (12:00h-22:00h) were significantly higher than those during the rest of the day when the hens were off the floor (P \u3c0.05). Median diameters for the PM count and mass were, respectively, 2.11 µm and 7.45 µm. PM \u3c10 µm accounted for more than 95% of the total PM count, whereas PM \u3e2.5 µm accounted for more than 90% of the total PM mass. The majority (\u3e95%) of the airborne bacteria were contained in particles \u3e3.3 µm. Airborne bacteria count was positively related to PM mass concentration (P \u3c0.05) with a slope of 3.84(± 2.70) ×105 CFU mg-1 PM. Results of the study are useful for improving understanding of transport behaviors of aerosols in the aviary hen setting, assessing potential respiratory risks to humans and animals, and exploring mitigation techniques

Airborne Particulate Matter and Bacteria Reduction from Spraying Slightly Acidic Electrolyzed Water in an Experimental Aviary Laying-Hen Housing System

Compared to conventional cage systems for laying hens, aviary housing systems generally have much higher concentrations of airborne dust and bacteria due to generation of bioaerosols by the hens from their litter access. Hence solutions to reduce these health-degrading agents are required to safeguard the indoor environment in such systems. Spraying slightly acidic electrolyzed water (SAEW) has been considered as a novel approach to reducing airborne bacteria and dust levels in hen houses. The objective of this study was to evaluate reduction of airborne bacteria and particulate matter (PM) by spraying SAEW (Trt) in an experimental aviary setting, as compared to no spraying (Ctrlns) or spraying tap water (Ctrlw). The hens were provided 16-hr light and 8-hr dark (16L:8D), with lights on at 6:00h and off at 22:00h, and were given access to the litter floor from 12:00h to 22:00h. The Trt regimen consisted of spraying SAEW at 14:00h for approximately 15 min at a dosage of 80 mL m-2; the Ctrlns regimen had no spraying; and the Ctrlw regimen consisted of spraying tap water following the same procedure as with Trt. Concentrations of airborne bacteria and PM were measured at 1.5 m above the floor in the center of the room. Airborne bacteria and PM concentrations in six size ranges (0.65-1.1, 1.1-2.1, 2.1-3.3, 3.3-4.7, 4.7-7.1, and \u3e 7.1 µm) were measured at 13:45-14:00h and 14:45-15:00h for 15 min each. Compared to Ctrlns, spraying SAEW significantly reduced the airborne bacteria (\u3e 2.1 µm) by up to 49±10% (P \u3c 0.05), while Ctrlw did not show the reduction effect. No significant difference was found between Trt and Ctrlw in reducing airborne PM, although both reduced or tended to suppress PM \u3e7.1 µm in size. The results show that spraying SAEW can effectively inactivate airborne bacteria attached to the PM, thus is a promising technique for minimizing the adverse impacts of bioaerosols in aviary laying-hen housing systems

Airborne Particulate Matter and Culturable Bacteria Reduction from Spraying Slightly Acidic Electrolyzed Water in an Experimental Aviary Laying-Hen Housing Chamber

Compared to conventional cage laying-hen houses, aviary hen houses generally have much higher concentrations of airborne dust and bacteria due to generation of bioaerosols by the hens’ access to and activities on the litter floor. Hence, reducing these airborne agents is important to safeguard the health of the animals and workers in such housing systems. Spraying slightly acidic electrolyzed water (SAEW) is a novel approach to reducing airborne culturable bacteria (CB) and particulate matter (PM) levels in hen houses. The objective of this study was to evaluate the efficacy of reducing airborne CB and PM in an experimental aviary chamber by periodic spraying of SAEW (Trt), as compared to no spraying (Ctrlns) or spraying of tap water (Ctrlw). The hens were provided 16 h light and 8 h dark (lights on at 6:00 h and off at 22:00 h) and were given access to the litter floor from 12:00 h to 22:00 h. The Trt regimen sprayed SAEW at 14:00 h for 15 min at a dosage of 80 mL m-2; the Ctrlns regimen had no spraying; and the Ctrlw regimen sprayed tap water following the same procedure as with Trt. Concentrations of airborne CB and PM in six aerodynamic size ranges (0.65-1.1, 1.1-2.1, 2.1-3.3, 3.3-4.7, 4.7-7.1, and \u3e7.1 μm) were measured at 1.5 m above the floor in the center of the room during the periods of 13:45-14:00 h and 14:45-15:00 h. Compared to Ctrlns, spraying SAEW significantly reduced airborne CB (\u3e2.1 μm) by up to 49% ±10% (p \u3c 0.05), while Ctrlw did not show a reduction effect. No significant difference was found between Trt and Ctrlw in reducing airborne PM, although both reduced or tended to suppress PM \u3e7.1 μm in size. The results show that spraying SAEW can inactivate airborne CB attached to PM. Thus, this is a promising technique for alleviating the adverse health impacts of bioaerosols in aviary laying-hen housing systems

Self-management interventions for epilepsy in people with intellectual disabilities: A Scoping Review

This document is the Accepted Manuscript of an article accepted for publication in SEIZURE: European Journal of Epilepsy (2016), , http://dx.doi.org/10.1016/j.seizure.2016.06.022.Purpose People with intellectual disabilities (ID) experience higher incidences of chronic health conditions, poorer health outcomes, and increased risk of premature death. Epilepsy is 20 times more common in people with ID than in the general population. It tends to be more difficult to diagnose, more severe, and more difficult to treat. Improving epilepsy self-management in this group is advocated in guidelines for best practice. However, few self-management interventions exist, and a robust examination of their effectiveness is missing. Our aim was to identify existing self-management interventions for epilepsy in people with ID and to analyze their impact. Methods A scoping review using Arksey and O’Malley's framework was conducted. Medline, EMBASE, CINAHL, PsycInfo, OpenSIGLE, the Cochrane Database of Systematic Reviews, and Web of Science were searched from inception until June 2015. Using a piloted charting tool, selected articles were thematically analyzed. Results An initial search identified 570 articles, of which five met the inclusion criteria. Pilot and randomized controlled feasibility study findings suggest that self-management interventions targeted at people with ID are acceptable to this population, improve epilepsy-related knowledge, improve seizure frequency, and show potential to improve quality of life. A randomised controlled trial of a self-management intervention is currently underway. Conclusion Studies evaluating self-management interventions for people with epilepsy and ID are sparse. Our findings demonstrate the potential for self-management interventions to improve outcomes in this population. Controlled studies with comparable measures and longer follow-ups are needed to rigorously assess the impact of self-management interventions on this patient population.Peer reviewe

Gene expression patterns following unilateral traumatic brain injury reveals a local pro-inflammatory and remote anti-inflammatory response.

BackgroundTraumatic brain injury (TBI) results in irreversible damage at the site of impact and initiates cellular and molecular processes that lead to secondary neural injury in the surrounding tissue. We used microarray analysis to determine which genes, pathways and networks were significantly altered using a rat model of TBI. Adult rats received a unilateral controlled cortical impact (CCI) and were sacrificed 24 h post-injury. The ipsilateral hemi-brain tissue at the site of the injury, the corresponding contralateral hemi-brain tissue, and naïve (control) brain tissue were used for microarray analysis. Ingenuity Pathway Analysis (IPA) software was used to identify molecular pathways and networks that were associated with the altered gene expression in brain tissues following TBI.ResultsInspection of the top fifteen biological functions in IPA associated with TBI in the ipsilateral tissues revealed that all had an inflammatory component. IPA analysis also indicated that inflammatory genes were altered on the contralateral side, but many of the genes were inversely expressed compared to the ipsilateral side. The contralateral gene expression pattern suggests a remote anti-inflammatory molecular response. We created a network of the inversely expressed common (i.e., same gene changed on both sides of the brain) inflammatory response (IR) genes and those IR genes included in pathways and networks identified by IPA that changed on only one side. We ranked the genes by the number of direct connections each had in the network, creating a gene interaction hierarchy (GIH). Two well characterized signaling pathways, toll-like receptor/NF-kappaB signaling and JAK/STAT signaling, were prominent in our GIH.ConclusionsBioinformatic analysis of microarray data following TBI identified key molecular pathways and networks associated with neural injury following TBI. The GIH created here provides a starting point for investigating therapeutic targets in a ranked order that is somewhat different than what has been presented previously. In addition to being a vehicle for identifying potential targets for post-TBI therapeutic strategies, our findings can also provide a context for evaluating the potential of therapeutic agents currently in development

Quality and risk of bias appraisals of systematic reviews are inconsistent across reviewers and centers

© 2020 The Authors. Published by Elsevier Inc. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Objective: The objective of the study was to evaluate the inter-rater and intercenter reliability, usability, and utility of A MeaSurement Tool to Assess systematic Reviews (AMSTAR), AMSTAR 2, and Risk Of Bias In Systematic reviews (ROBIS). Study design and setting: This is a prospective evaluation using 30 systematic reviews of randomized trials, undertaken at three international centers. Results: Reviewers completed AMSTAR, AMSTAR 2, and ROBIS in median (interquartile range) 15.7 (11.3), 19.7 (12.1), and 28.7 (17.4) minutes and reached consensus in 2.6 (3.2), 4.6 (5.3), and 10.9 (10.8) minutes, respectively. Across all centers, inter-rater reliability was substantial to almost perfect for 8/11 AMSTAR, 9/16 AMSTAR 2, and 12/24 ROBIS items. Intercenter reliability was substantial to almost perfect for 6/11 AMSTAR, 12/16 AMSTAR 2, and 7/24 ROBIS items. Intercenter reliability for confidence in the results of the review or overall risk of bias was moderate (Gwet's first-order agreement coefficient (AC1) 0.58, 95% confidence intervals [CI]: 0.30 to 0.85) to substantial (AC1 0.74, 95% CI: 0.30 to 0.85) for AMSTAR 2 and poor (AC1 -0.21, 95% CI: -0.55 to 0.13) to moderate (AC1 0.56, 95% CI: 0.30 to 0.83) for ROBIS. It is not clear whether using the appraisals of any tool as an inclusion criterion would alter an overview's findings. Conclusions: Improved guidance may be needed to facilitate the consistent interpretation and application of the newer tools (especially ROBIS).info:eu-repo/semantics/publishedVersio

Tapping the “Town and Gown” Potential for Correctional Health Research Collaborations

Background: Collaborations between juvenile justice systems (town) and academia (gown) promise to significantly enhance what we understand about high rates of sexually transmitted infections (STIs) found among detained populations, particularly African American young women. However, research related to the sexual health of adolescent detainees has not occurred in proportion to the magnitude of issues found in the population. While there are many challenges to conducting research with this population, there are also lessons learned and best practices from other studies that may provide guidance. Methods: In 2015, we implemented a pilot project with young women in a detention center to understand the association between STIs and relationship dynamics. Using a formative assessment-based approach, the team periodically compared expectations to actual milestones and outcomes. This approach has provided feedback, guidance and lessons learned that we will use to adjust our pilot project. Results: Three challenges emerged from our review: concerns related to different agendas, bureaucratic difficulties and human protection. In addressing these challenges, we identified study procedures to revise and to incorporate into future works. Conclusions: Juvenile justice and academic partnerships require extensive pre-research work to account for the many challenges to implementing and conducting projects with this population. However, “town and gown” approaches to understanding and improving the sexual health of detainees can result in a more complete assessment of these issues compared to either a solely academic or juvenile justice investigation