HealthKick: a nutrition and physical activity intervention for primary schools in low-income settings

<p>Abstract</p> <p>Background</p> <p>The burden of non-communicable diseases, including type 2 diabetes, is growing in South Africa. This country has a complex mix of over- and under-nutrition, especially in low-income communities, and concerning levels of physical inactivity in children and youth. This paper describes HealthKick, a school-based nutrition and physical activity intervention in primary schools in these settings aimed at reducing diabetes risk factors.</p> <p>Methods/Design</p> <p>This study includes schools within historically disadvantaged, low-income communities from an urban area close to the city of Cape Town and from two rural areas outside of Cape Town, South Africa. The three Educational Districts involved are Metropole North, Cape Winelands and the Overberg. The study has three phases: intervention mapping and formative assessment, intervention development, and outcome and process evaluation. Sixteen schools were purposively selected to participate in the study and randomly allocated as intervention (eight schools) and control (eight schools).</p> <p>The primary aims of HealthKick are to promote healthful eating habits and increase regular participation in health-enhancing physical activity in children, parents and teachers, to prevent overweight, and reduce risk of chronic diseases (particularly type 2 diabetes); as well as to promote the development of an environment within the school and community that facilitates the adoption of healthy lifestyles.</p> <p>The components of HealthKick are: action planning, toolkit (resource guide, a resource box and physical activity resource bin), and an Educators' Manual, which includes a curriculum component.</p> <p>Discussion</p> <p>This study continues to highlight the key role that educators play in implementing a school-based intervention, but that developing capacity within school staff and stakeholders is not a simple or easy task. In spite of the challenges experienced thus far, valuable findings are being produced from this study, especially from Phase 1. Materials developed could be disseminated to other schools in low-income settings both within and outside of South Africa. Owing to the novelty of the HealthKick intervention in low-income South African primary schools, the findings of the evaluation phase have the potential to impact on policy and practice within these settings.</p

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Radiological, clinical and genetic markers of ischaemic stroke outcome

© 2018 Dr. Jillian Jane NaylorAcute ischaemic stroke is caused by a blocked blood vessel in the cerebral circulation. It is the most common form of stroke worldwide and a major cause of disability and death. Over the past 20 years, major advances in acute stroke treatment and management have led to a reduction in stroke-related mortality, and thus an unavoidable side effect has been the concomitant rise in survivors living with life-changing disability, requiring ongoing clinical management and care. However, stroke outcome is not entirely represented as mortality rates and level of disability – there are a range of neurological sequelae that contribute an important additional burden to patients. Up to 13% of patients who have suffered an ischaemic stroke will develop seizures within 2 years. For clinicians the development of seizures represents a clinical challenge to manage, is difficult to predict and treat, and associated with poorer patient quality of life. However, at present no indications for antiepileptic drugs in preventing post stroke seizures and epilepsy exist and to date, no blood biomarkers and only few genetic biomarkers have been identified as being associated with an increased risk of post stroke seizure development. This multicentre (China, Brazil and Australia), multidisciplinary thesis examines novel imaging, genetic and clinical markers as methods for identifying patients at higher risk of developing seizures. Reperfusion therapies with thrombolysis and, more recently, endovascular thrombectomy have transformed outcomes for patients. This body of research targeted patient groups treated with modern cerebrovascular stent devices and revascularization techniques, in order to assess the implications of these novel stroke interventions, particularly in terms of the development of post stroke seizures. Multiple advanced neuroimaging techniques were used to determine capacity to identify patients at the highest risk of developing post stroke seizures. Results from these investigations showed that the Alberta Stroke Program Early CT Score on non-contrast CT, cortical involvement on CT perfusion parameters and extent of haemorrhagic transformation on non-contrast CT, can be used as radiological markers for stroke outcome, including the identification of higher risk patients for post stroke seizure development. Additionally, unlike previous work, international sites were included along with Australian sites, allowing the interrogation of whether ethnicity and environment influences the development of post stroke seizures. Results from this investigation revealed that, not only does occurrence of seizures differ across populations from different countries, but certain clinical markers, such as presence and treatment of atrial fibrillation, may influence seizure occurrence across populations. Our exploratory study assessing the genetic influence on the development of post stroke seizures has also laid important groundwork in developing genetic biomarkers for future studies and results from this thesis have identified potential genetic variants warranting further investigation. The results presented in this thesis have the potential to guide identification of individuals at higher risk of developing post stroke seizures and represent a step towards personalised medicine. In the future, if antiepileptogenic drugs become available, these results may inform the selection of an enriched population for trials and guide recruitment for biomarker studies of epileptogenesis

Examining the minimal important difference of patient-reported outcome measures for individuals with knee osteoarthritis : a model using the knee injury and osteoarthritis outcome score

Objective. To examine the influence of different analytical methods, baseline covariates, followup periods, and anchor questions when establishing a minimal important difference (MID) for individuals with knee osteoarthritis (OA). Second, to propose MID for improving and worsening on the Knee injury and Osteoarthritis Outcome Score (KOOS). Methods. Retrospective analysis of prospectively collected data from 272 patients with knee OA undergoing a multidisciplinary nonsurgical management strategy. The magnitude and rate of change as well as the influence of baseline covariates were examined for 5 KOOS subscales over 52 weeks. The MID for improving and worsening were investigated using 4 anchor-based methods. Results. Waitlisted for joint replacement and exhibiting unilateral/bilateral symptoms influenced change in KOOS over time. Generally, low correlations between anchors and KOOS change scores limited calculations of MID; thus, they were only proposed for the pain, activities of daily living, and quality of life subscales. The method used to calculate the MID influenced the cutpoint; however, the type of anchor question only influenced the MID when analyzed with a particular mean change method. Depending on patient and clinical characteristics, the subscale, and the analytical approach used, the MID for KOOS improvement ranged from an absolute change of-1.5 to 20.6 points and worsening ranged from-19.17 to 8.5 points. Conclusion. MID vary with patient and clinical characteristics, KOOS subscale, and analytical approach. Provided the anchor question is relevant to the patient-reported outcome and baseline status is considered, the anchor does not appear to influence the MID for improvement or worsening when using some anchor-based methods.10 page(s

Association between different acute stroke therapies and development of post stroke seizures

Abstract Background Epilepsy is a major complication of stroke. We aimed to establish whether there is an association between intravenous thrombolysis, intra-arterial thrombolysis and post stroke seizure (PSS) development. Improved understanding of the relationship between reperfusion therapies and seizure development may improve post-stroke monitoring and follow-up. Methods This was a retrospective, multicentre cohort study conducted at the Royal Melbourne Hospital and Jingling Hospital Nanjing. We included patients with anterior circulation ischemic stroke admitted 2008–2015. Patients were divided into four treatment groups 1. IV-tPA only, 2. Intra-arterial therapies (IAT) only, 3. IAT + IV-tPA and 4. stroke unit care only (i.e. no IV-tPA or IAT). To assess the association between type of reperfusion treatment and seizure incidence we used multivariable logistic regression models adjusted for age, stroke severity, 3-month functional outcome and prognostic factors. Results There were 1375 stroke unit care-only patients, of whom 28 (2%) developed PSS. There were 363 patients who received only IV-tPA, of whom 21 (5.8%) developed PSS. There were 93 patients who received IAT only, of whom 12 (12.9%) developed PSS and 112 that received both IV-tPA + IAT, of which 5 (4.5%) developed PSS. All reperfusion treatments were associated with seizure development compared to stroke unit care-only patients: IV-tPA only adjusted odds ratio (aOR) 3.7, 95%CI 1.8–7.4, p < 0.0001; IAT aOR 5.5, 95%CI 2.1–14.3, p < 0.0001, IAT + IV-tPA aOR 3.4, 95% CI 0.98–11.8, p = 0.05. These aORs did not differ significantly between treatment groups (IV-tPA + IAT versus IV-tPA p = 0.89, IV-tPA + IAT versus IAT, p = 0.44). Conclusions Patients receiving thrombolytic or intra-arterial reperfusion therapies for acute ischemic stroke are at higher risk of epilepsy and may benefit from longer follow-up. No evidence for an additive or synergistic effect of treatment modality on seizure development was found

Hypertension unawareness among Chinese patients with first-ever stroke

Abstract Background The low rates of hypertension treatment and control, partly due to its unawareness, are the main causes of the high stroke incidence in China. The purpose of this study was to evaluate hypertension unawareness amongst patients with first-ever stroke and to detect factors associated with its unawareness. Methods We selected those diagnosed with hypertension from patients with first-ever stroke registered in the Nanjing Stroke Registry Program between 2004 and 2014. These hypertensives were divided as being aware or unaware of their hypertension by using a brief questionnaire conducted shortly after the stroke. Multivariate logistic regression analysis was performed to identify potential factors associated with hypertension unawareness. Results Of the 5309 patients with first-ever stroke, 3732 (70.3 %) were diagnosed with hypertension. Among which, 593 (15.9 %) were unaware of their hypertension at the time of stroke onset. Lower-level of education (primary school or illiteracy) and smoking were associated positively with hypertension unawareness; while advanced age, overweight, diabetes mellitus, heart diseases and family history of stroke were associated negatively with hypertension unawareness. Annual data analyzed indicated that the rate of hypertension awareness increased during the past 11 years (r = 0.613, P = 0.045 for trends). Conclusions A substantial proportion (15.9 %) of Chinese patients with hypertension had not been aware of this covert risk until an overt stroke occurred. Hypertension unawareness was associated with lower educational levels and smoking, which address the importance of health education especially in these individuals

Additional file 1: of Association between different acute stroke therapies and development of post stroke seizures

Table S1. Univariate logistic regression with baseline risk factors (age, NIHSS and mRS02 at 90 days) and treatment for seizure outcome. Table S2. Logistic regression model with treatment groups plus age for seizure outcome. Table S3. Logistic regression model with treatment groups plus NIHSS for seizure outcome. Table S4. Logistic regression model with treatment groups plus mRS02 for seizure outcome. Table S5. Logistic regression model with treatment groups unadjusted. Table S6. Logistic regression model with treatment groups adjusted for age, NIHSS and mRS02. Table S7. Median (IQR) of the baseline NIHSS and number (percentage) of mRS (0–2) in the sensitivity analysis NIHSS ≥ 6. Table S8. Median (IQR) of the baseline NIHSS and number (percentage) of mRS (0–2) in the sensitivity analysis NIHSS > 8. (DOCX 63 kb