Effects of an exercise program on cardiometabolic and mental health in children with overweight or obesity: a secondary analysis of a randomized clinical trial

Importance: Childhood obesity is a risk factor associated with type 2 diabetes, cardiovascular disease, and mental disorders later in life. Investigation of the parallel effects of a defined exercise program on cardiometabolic and mental health in children with overweight or obesity may provide new insights on the potential benefits of exercise on overall health. Objective: To investigate the effects of a 20-week exercise program on cardiometabolic and mental health in children with overweight or obesity. Design, Setting, and Participants: This secondary analysis of a parallel-group randomized clinical trial was conducted in Granada, Spain, from November 1, 2014, to June 30, 2016. Data analyses were performed between February 1, 2020, and July 14, 2022. Children with overweight or obesity aged 8 to 11 years were eligible, and the study was performed in an out-of-school context. Intervention: The exercise program included 3 to 5 sessions/wk (90 min/session) of aerobic plus resistance training for 20 weeks. The wait-list control group continued with their usual routines. Main Outcomes and Measures: Cardiometabolic outcomes as specified in the trial protocol included body composition (fat mass, fat-free mass, and visceral adipose tissue), physical fitness (cardiorespiratory, speed-agility, and muscular), and traditional risk factors (waist circumference, blood lipid levels, glucose levels, insulin levels, and blood pressure). Cardiometabolic risk score (z score) was calculated based on age and sex reference values for levels of triglycerides, inverted high-density lipoprotein cholesterol, and glucose, the mean of systolic and diastolic blood pressure, and waist circumference. An additional cardiometabolic risk score also included cardiorespiratory fitness. Mental health outcomes included an array of psychological well-being and ill-being indicators. Results: The 92 participants included in the per-protocol analyses (36 girls [39%] and 56 boys [61%]) had a mean (SD) age of 10.0 (1.1) years. The exercise program reduced the cardiometabolic risk score by approximately 0.38 (95% CI, -0.74 to -0.02) SDs; decreased low-density lipoprotein cholesterol level by -7.00 (95% CI, -14.27 to 0.37) mg/dL (to convert to mmol/L, multiply by 0.0259), body mass index (calculated as weight in kilograms divided by height in meters squared) by -0.59 (95% CI, -1.06 to -0.12), fat mass index by -0.67 (95% CI, -1.01 to -0.33), and visceral adipose tissue by -31.44 (95% CI, -58.99 to -3.90) g; and improved cardiorespiratory fitness by 2.75 (95% CI, 0.22-5.28) laps in the exercise group compared with the control group. No effects were observed on mental health outcomes. Conclusions and Relevance: In this secondary analysis of a randomized clinical trial, an aerobic plus resistance exercise program improved cardiometabolic health in children with overweight or obesity but had no effect on mental health. Trial Registration: ClinicalTrials.gov Identifier: NCT02295072.This project was supported with grants DEP2013-47540, DEP2016-79512-R, DEP2017-91544-EXP, and RYC-2011-09011 from the Spanish Ministry of Economy and Competitiveness and the Fondo Europeo de Desarrollo Regional (FEDER) and by grant PID2020-120249RB-I00 from the MCIN/AEI /10.13039/501100011033. Additional funding was obtained from the Andalusian Operational Programme supported with grant B-CTS-355-UGR18 from the European Regional Development Fund (FEDER in Spanish). Dr Cardenas-Sanchez is supported by grant FJC2018-037925-I from the Spanish Ministry of Science and Innovation and by a grant from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement No 101028929. Dr Migueles is supported by grant FPU15/02645 from the Spanish Ministry of Education, Culture and Sport, and grant 2012–00036 from the Swedish Research Council for Health, Working Life and Welfare. Dr Torres-Lopez is supported by grant FPU17/04802 from the Spanish Ministry of Science, Innovation and Universities. Dr Rodriquez-Ayllon was funded by grant DEP2017-91544-EXP from the Ramón Areces Foundation. Additional support was obtained from grant ALICIAK-2018 from the Alicia Koplowitz Foundation, University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence, Unit of Excellence on Exercise, Nutrition and Health, the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades; and grant DEP2005-00046/ACTI from the EXERNET Research Network on Exercise and Health in Special Populations. This research was supported by grant CB22/03/00058 from the Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea–European Regional Development Fund

Global matrix 4.0 physical activity report card grades for children and adolescents : results and analyses from 57 countries

Background: The Global Matrix 4.0 on physical activity (PA) for children and adolescents was developed to achieve a comprehensive understanding of the global variation in children’s and adolescents’ (5–17 y) PA, related measures, and key sources of influence. The objectives of this article were (1) to summarize the findings from the Global Matrix 4.0 Report Cards, (2) to compare indicators across countries, and (3) to explore trends related to the Human Development Index and geo-cultural regions. Methods: A total of 57 Report Card teams followed a harmonized process to grade the 10 common PA indicators. An online survey was conducted to collect Report Card Leaders’ top 3 priorities for each PA indicator and their opinions on how the COVID-19 pandemic impacted child and adolescent PA indicators in their country. Results: Overall Physical Activity was the indicator with the lowest global average grade (D), while School and Community and Environment were the indicators with the highest global average grade (C+). An overview of the global situation in terms of surveillance and prevalence is provided for all 10 common PA indicators, followed by priorities and examples to support the development of strategies and policies internationally. Conclusions: The Global Matrix 4.0 represents the largest compilation of children’s and adolescents’ PA indicators to date. While variation in data sources informing the grades across countries was observed, this initiative highlighted low PA levels in children and adolescents globally. Measures to contain the COVID-19 pandemic, local/international conflicts, climate change, and economic change threaten to worsen this situation

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Family, where life begins and the love never ends : An ethnographic study of the staff’s work situation at an orphanage in Nepal.

Barn i Nepal kan ses som en särskilt utsatt grupp då en av landets utmaningar är att hantera de barn vars levnadsförhållanden kränks och därmed placeras på barnhem (Conley Wright et al. 2014, s. 135). Då personal på barnhem arbetar med en målgrupp som lever med social pro- blematik kan det ses som viktigt att fokusera på deras perspektiv. Syftet med denna studie är att undersöka personalens arbetssituation på ett barnhem i Nepal. Studien har en etnografisk ansats och är baserad på såväl observationer som intervjuer av personal på ett barnhem. Vid bearbetning och analys av materialet har analysmetoden grounded theory tillämpats. Studiens teoretiska utgångspunkter består av Meads (1976) teoribildning symbolisk interaktionism samt Durkheims (1978) definition av begreppet socialisation. Resultaten har analyserats uti- från dessa teoretiker samt den forskning som presenteras. Studiens resultat visar att persona- len definierar sig själva och varandra utifrån familjeroller och att arbetet till stor del influeras av denna rolluppsättning. Resultaten visar att det finns en koppling mellan personalens roller och arbetsfördelning på barnhemmet, där dessa komponenter ständigt påverkar varandra. Vi- dare visar resultaten att personalens arbete till stor del grundar sig i att socialisera samt eta- blera flickorna i samhället och att deras arbete påverkas av yttre faktorer från samhälleliga normer. Slutligen lyfter resultaten fram betydelsen av den samhällsstruktur och hur de förut- sättningar som finns inom Nepal påverkar barnhemmets utformning.

Family, where life begins and the love never ends : An ethnographic study of the staff’s work situation at an orphanage in Nepal.

Barn i Nepal kan ses som en särskilt utsatt grupp då en av landets utmaningar är att hantera de barn vars levnadsförhållanden kränks och därmed placeras på barnhem (Conley Wright et al. 2014, s. 135). Då personal på barnhem arbetar med en målgrupp som lever med social pro- blematik kan det ses som viktigt att fokusera på deras perspektiv. Syftet med denna studie är att undersöka personalens arbetssituation på ett barnhem i Nepal. Studien har en etnografisk ansats och är baserad på såväl observationer som intervjuer av personal på ett barnhem. Vid bearbetning och analys av materialet har analysmetoden grounded theory tillämpats. Studiens teoretiska utgångspunkter består av Meads (1976) teoribildning symbolisk interaktionism samt Durkheims (1978) definition av begreppet socialisation. Resultaten har analyserats uti- från dessa teoretiker samt den forskning som presenteras. Studiens resultat visar att persona- len definierar sig själva och varandra utifrån familjeroller och att arbetet till stor del influeras av denna rolluppsättning. Resultaten visar att det finns en koppling mellan personalens roller och arbetsfördelning på barnhemmet, där dessa komponenter ständigt påverkar varandra. Vi- dare visar resultaten att personalens arbete till stor del grundar sig i att socialisera samt eta- blera flickorna i samhället och att deras arbete påverkas av yttre faktorer från samhälleliga normer. Slutligen lyfter resultaten fram betydelsen av den samhällsstruktur och hur de förut- sättningar som finns inom Nepal påverkar barnhemmets utformning.

People’s experiences of life after a kidney transplant – a literature review on the subject of nursing

Bakgrund: Cirka 1 100 svenskar drabbas varje år av en njursjukdom och ungefär 4 000 personer behandlas med dialys i Sverige. Antalet patienter som behandlas med dialys och/eller njurtransplantation ökar kraftigt. Tiden före en njurtransplantation är krävande och personerna lever med svåra biverkningar av sjukdomen och behandlingarna. Njurtransplantation är en eftertraktad behandlingsform som följs av livslång behandling med immunsuppressiva läkemedel. En njursjukdom medför en förändrad livsvärld och livsrytm för personerna. Syfte: Syftet med detta examensarbete var att belysa personers upplevelser av livet efter en njurtransplantation. Metod: Metoden som användes var en litteraturöversikt med tio kvalitativa artiklar. Resultat: I resultatet framkom fyra huvudteman. Dessa var; positiva upplevelser av livet efter en njurtransplantation, negativa upplevelser av livet efter en njurtransplantation, personer som genomgått en njurtransplantations upplevelse av det sociala stödets betydelse, personer som genomgått en njurtransplantations upplevda behov och brister kring information. Konklusion: Examensarbetet visade att personer upplevde ökad livskvalitet och förbättrad hälsa efter njurtransplantationen men att det fanns en ständig närvaro av oro och rädsla inför framtiden. Information, utbildning och kommunikation var faktorer som påverkade personernas upplevelser.Background: Around 1,100 Swedes suffer from a kidney disease every year and approximately 4,000 people are treated with dialysis in Sweden. The number of patients treated with dialysis and/or kidney transplantation is increasing sharply. The time before a kidney transplantation is demanding and the people live with severe side effects of the disease and the treatment. Kidney transplantation is a desirable form of treatment that is followed by life-long treatment with immunosuppressive drugs. A kidney disease may cause a changed world of life and rhythm of life for the persons. Aim: The aim of this bachelor’s essay was to highlight people’s experiences of life after a kidney transplantation. Method: The method used was a literature review with ten qualitative articles. Findings: Four main themes emerged in the results. These were; positive experiences of the time after a kidney transplantation, negative experiences of the time after a kidney transplantation, people who have gone through a kidney transplantations experience of the importance of social support, people who have gone through a transplantations experience of needs and lack of information. Conclusion: The bachelor’s essay showed that people experienced increased quality of life and improved health after the kidney transplantation but that there was a constant presence of worry and fear about the future. Information, education and communication were factors that influenced the people’s experiences

Upplevelse av samverkan i förhållande till styrdokumentens krav : en studie om samverkan mellan hem och skola, som innefattar pedagoger, föräldrar och elever

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Sleep patterns are associated with cardiometabolic risk factors in nine-year-old Swedish children

Aim Sleep duration and bedtime may play a role in children's cardiometabolic health, but research is lacking. This study examined associations between sleep patterns and cardiometabolic risk factors in Swedish nine-year-olds. Methods This cross-sectional study used data from three studies, where identical outcome measures were conducted in 411 nine-year-olds, 51% boys, between 2016 and 2020. Sleep was assessed with wrist-worn accelerometers and sleep journals. Children were grouped based on meeting the sleep guidelines of 9–11 h and going to bed early or late based on the median bedtime. Analysis of covariance was used to examine associations between sleep patterns and cardiometabolic risk factors. Results Meeting sleep guidelines and going to bed early were associated with lower metabolic syndrome score (−0.15 vs. 0.42, p = 0.029), insulin resistance (0.30 vs. 0.60, p = 0.025) and insulin levels (6.80 vs. 8.87 mIU/L, p = 0.034), compared with their peers who did not meet the guidelines and went to bed later. When adjusting for total sleep time, analyses still showed associations with the metabolic syndrome score (−0.19 vs. 0.50, p = 0.011). Conclusion The findings indicate that good sleep patterns could help mediate positive overall cardiometabolic health in children.Swedish Research Council (grant number 2012–2883)Swedish Research Council for Health, Working Life and Welfare (grant number 2012–0906 and 2021–00036)Bo and Vera Axson Johnsons FoundationKarolinska InstitutetJoanna Cocozza Foundatio