Health professional-delivered obesity prevention interventions during the first 1,000 days: a systematic review of external validity reporting.

Background: Childhood obesity prevention interventions delivered by health professionals during the first 1,000 days show some evidence of effectiveness, particularly in relation to behavioural outcomes. External validity refers to how generalisable interventions are to populations or settings beyond those in the original study. The degree to which external validity elements are reported in such studies is unclear however. This systematic review aimed to determine the extent to which childhood obesity interventions delivered by health professionals during the first 1,000 days report on elements that can be used to inform generalizability across settings and populations. Methods: Eligible studies meeting study inclusion and exclusion criteria were identified through a systematic review of 11 databases and three trial registers. An assessment tool based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to assess the external validity of included studies. It comprised five dimensions: reach and representativeness of individuals, reach and representativeness of settings, implementation and adaptation, outcomes for decision making maintenance and/or institutionalisation. Two authors independently assessed the external validity of 20% of included studies; discrepancies were resolved, and then one author completed assessments of the remaining studies. Results: In total, 39 trials involving 46 interventions published between 1999 and 2019 were identified. The majority of studies were randomized controlled trials (n=24). Reporting varied within and between dimensions. External validity elements that were poorly described included: representativeness of individuals and settings, treatment receipt, intervention mechanisms and moderators, cost effectiveness, and intervention sustainability and acceptability. Conclusions: Our review suggests that more emphasis is needed on research designs that consider generalisability, and the reporting of external validity elements in early life childhood obesity prevention interventions. Important gaps in external validity reporting were identified that could facilitate decisions around the translation and scale-up of interventions from research to practice. Registration: PROSPERO CRD42016050793 03/11/16

Impact of climate change on fishes in complex Antarctic ecosystems

Antarctic marine ecosystems are increasingly threatened by climate change and are considered to be particularly sensitive because of the adaptation of most organisms to cold and stable environmental conditions. Fishes play a central role in the Antarctic marine food web and might be affected by climate change in different ways: (i) directly by increasing water temperatures, decreasing seawater salinity and/or increasing concentrations of CO2; (ii) indirectly by alterations in the food web, in particular by changes in prey composition, and (iii) by alterations and loss of habitat due to sea ice retreat and increased ice scouring on the sea floor. Based on new data and data collected from the literature, we analyzed the vulnerability of the fish community to these threats.The potential vulnerability and acting mechanisms differ among species, developmental stages and habitats. The icefishes (family Channichthyidae) are one group that are especially vulnerable to a changing South Polar Sea, as are the pelagic shoal fish species Pleuragramma antarcticum. Both will almost certainly be negatively affected by abiotic alterations and changes in food web structure associated with climate change, the latter additionally by habitat loss. The major bottleneck for the persistence of the majority of populations appears to be the survival of early developmental stages, which are apparently highly sensitive to many types of alterations. In the long term, if climate projections are realized, species loss seems inevitable: within the demersal fish community, the loss or decline of one species might be compensated by others, whereas the pelagic fish community in contrast is extremely poor in species and dominated by P. antarcticum. The loss of this key species could therefore have especially severe consequences for food web structure and the functioning of the entire ecosystem.Fil: Mintenbeck, Katja. Alfred Wegener Institute For Polar And Marine Research; AlemaniaFil: Barrera Oro, Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Ministerio de Relaciones Exteriores, Comercio Interno y Culto. Dirección Nacional del Antártico. Instituto Antártico Argentino; ArgentinaFil: Brey, Thomas. Alfred Wegener Institute For Polar And Marine Research; AlemaniaFil: Jacob, Ute. Universitat Hamburg; AlemaniaFil: Knust, Rainer. Alfred Wegener Institute For Polar And Marine Research; AlemaniaFil: Mark, Felix C.. Alfred Wegener Institute For Polar And Marine Research; AlemaniaFil: Moreira, María Eugenia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Ministerio de Relaciones Exteriores, Comercio Interno y Culto. Dirección Nacional del Antártico. Instituto Antártico Argentino; ArgentinaFil: Strobel, Anneli. Alfred Wegener Institute For Polar And Marine Research; AlemaniaFil: Arntz, Wolf E.. Alfred Wegener Institute For Polar And Marine Research; Alemani

The impact of obesity on drug prescribing in primary care

Background Healthcare costs attributable to obesity have previously involved estimations based on costs of diseases commonly considered as having obesity as an underlying factor. Aim To quantify the impact of obesity on total primary care drug prescribing. Design of study Review of computer generated and handwritten prescriptions to determine total prescribing volume for all drug classes. Setting Twenty-three general practice surgeries in the UK. Method Stratified random selection of 1150 patients who were obese (body mass index [BMI]> 30 kg/m(2)) and 1150 age-and sex-matched controls of normal weight (BMI 18.5-< 25 kg/m(2)). Retrospective review of medical records over an 18-month period. Results A higher percentage of patients who were obese, compared with those of normal weight, were prescribed at least one drug in the following disease categories: cardiovascular (36% versus 20%), central nervous system (46% versus 35%), endocrine (26% versus 18%), and musculoskeletal and joint disease (30% versus 22%). All of these categories had a P-value of < 0.001. Other categories, such as gastrointestinal (24% versus 18%), infections (42% versus 35%), skin (24% versus 19%) had a P-value of < 0.01, while respiratory diseases (18% versus 21%) had a P-value of < 0.05. Total prescribing volume was significantly higher for the group with obesity and was increased in the region of two- to fourfold in a wide range of prescribing categories: ulcer healing drugs, lipid regulators, P-adrenoreceptor drugs, drugs affecting the rennin angiotensin system, calcium channel blockers, antibacterial drugs, sulphonylureas, biguanides, non-steroidal anti-inflammatories (NSAIDs) (P < 0.001) and fibrates, angiotensin II antagonists, and thyroid drugs (P < 0.05). The main impact on prescribing volumes is from numbers of patients treated, although in some areas there is an effect from greater dosage or longer treatment in those who are obese including calcium channel blockers, antihistamines, hypnotics, drugs used in the treatment of nausea and vertigo, biguanicles, and NSAIDs (P < 0.05) reflected in significantly increased defined daily dose prescribing. Conclusions This large study of contemporary practice indicates that obesity more than doubled prescribing in most drug categories

Correction: Implementation of Genomic Surveillance of SARS-CoV-2 in the Caribbean: Lessons learned for sustainability in resource-limited settings.

[This corrects the article DOI: 10.1371/journal.pgph.0001455.]