Preliminary findings from the evaluation of Project ESCAPE 25-Alive

This study was conducted as part of the evaluation process of a federally funded physical activity initiative undertaken by a large urban school district. The purpose of this study was two-fold: (1) to provide evidence of effectiveness of Project ESCAPE 25- Alive, an innovative physical activity promotion initiative; and (2) to examine the relationships among a number of factors related to observed changes in the health promoting physical activity levels of high school students. The sample for the evaluation process consisted of 26 high school physical education teachers and their respective students enrolled in physical education class. Each teacher was observed three times while teaching physical education. Observations resulted in objective measures of the level and duration of physical activity in the classroom. Each teacher also was asked to complete a survey designed to measure his or her intent to adopt the Project ESCAPE 25-Alive program into their class curriculum. Finally, teachers were asked to complete a survey designed to measure self-efficacy related to teaching physical education. The data from the class observations suggested that initially, physical education teachers conducted what could only be called sedentary class activities. However, activity levels did appear to improve over time. When the correlation between the levels of program adoption, teacher self-efficacy, and observed physical activity level were examined, only one significant association was found. The one positive significant correlation that was found was between the teacher adoption scores and the class observation scores obtained during the second observation. While there were almost no significant correlations in this study, the study had merit. Over time the observed health promoting physical activity in physical education classes increased. This suggested that Project ESCAPE 25-Alive positively impacted the way physical education classes were run in the school district. With continued observation and training of teachers, the levels of health promoting physical activity were expected to continue to rise

A qualitative analysis of the social and cultural contexts that shape screen time use in Latino families living on the U.S.-Mexico border

Purpose: The purpose of this study was to understand how first generation Latino parents, whose primary language is Spanish and live in a colonia on the U.S.-Mexico border, use screen time in their homes. Methods: A purposeful sampling approach was used to recruit eligible parents of pre-adolescents (ages 9–14) who were native Spanish speakers, and living on the U.S.-Mexico border. Three focus groups in Spanish (two with mothers and one with fathers) were conducted. Data were codified using a general inductive approach based on grounded theory. A consensus process was repeated until a final codebook was developed. Results: Screen time allowed parents to foster familismo (family cohesiveness and bonding) and respeto (respect). Parents knew that a healthy balance of media use is important, but broader social contexts (marital discord and economics) challenged the enforcement of familial screen time rules and parents were often permissive. Conclusions: Our study addressed research gaps by examining the understudied social and cultural contexts (practices, routines, rules, and beliefs) that shape children’s screen time use among a sample of Latino immigrants living on the U.S.-Mexico border. This sample of parents indicated that familismo and respeto (i.e., cohesiveness and bonding) influence familial decision-making including screen time

Hyperparathyroidism, platelet intracellular free calcium and hypertension in chronic renal failure

Hyperparathyroidism, platelet intracellular free calcium and hypertension in chronic renal failure. To investigate possible relationships between hyperparathyroidism, alterations in intracellular free calcium concentration ([Ca2+]i and hypertension in chronic renal failure, serum concentrations of intact parathyroid hormone (PTH) were measured by two-site immunometric assay, and platelet ([Ca2+]i) was assessed using the fluorescent indicator fura-2. Thirty-six patients with chronic renal failure were studied, 10 with normal serum PTH concentrations (mean 8.0 ± 0.6 pmol/liter), 17 with elevated serum PTH (35.0 ± 7.2 pmol/liter) and 9 patients with elevated PTH (36.2 ±5.9 pmol/liter) who were receiving nifedipine. Platelet [Ca2+]i was increased in patients with elevated PTH, compared with those in whom PTH was normal (138 ± 16 vs. 83 ± 7 nmol/liter, P < 0.01). A linear relation was observed between serum PTH and platelet [Ca2+]i in these patients (r = 0.818, P < 0.001). In contrast, platelet [Ca2+]i was not elevated (84 ± 9 nmol/liter) in the patients with elevated PTH who were receiving nifedipine. A linear relation was also present between both serum PTH (r = 0.616, P < 0.001) and platelet [Ca2+]i (r = 0.576, P < 0.005) and mean blood pressure. Nine patients with hyperparathyroidism were restudied after treatment with the vitamin D analogue alfacalcidol. This resulted in significant decreases in serum PTH (P < 0.01), platelet [Ca2+]i (P < 0.02), and mean blood pressure (P < 0.05). These studies indicate that [Ca2+]i may be increased early in renal failure, and that this increase occurs in association with both hyperparathyroidism and hypertension. Furthermore, treatment of hyperparathyroidism with alfacalcidol may result in reductions in both [Ca2+]i and blood pressure. The lack of elevation in [Ca2+]i in nifedipine-treated patients with hyperparathyroidism suggests that, in uremia, increases in cytosolic calcium induced by PTH or other factors may be mediated in part by dihydropyridine-sensitive mechanisms

Senate Bill 42: Implementation and Impact on Physical Activity in Middle Schools

Purpose In 2005, the Texas State Legislature passed Senate Bill 42 (SB42), which required public middle school students (grades 6–8) to participate in 30 minutes of daily structured physical activity. The purpose of this study was to assess awareness of and adherence to SB42 in Texas middle schools, and to assess the impact of SB42 on the frequency and quality of structured physical activity. Methods Key informant (school principals, physical education [PE] instructors, nurses, or designated personnel) telephone interviews on the implementation of SB42 were conducted from a statewide representative sample of public middle schools (n = 112). Direct observation, key informant, and student report of physical activity in PE classes at 17 Texas–Mexico border middle schools assessed the frequency and quality of structured physical activity. Results State level (94% ± 4.5%) and border district (94% ± 13.5%) key informants reported a high level of overall awareness of SB42. Postimplementation of SB42 border districts reported a minimum of 4 days per week of PE instruction and more than 58 minutes per PE class, exceeding the 30-minute minimum of structured physical activity per day or 135 minutes per week as required by SB42 (range: 58.2–61.4 minutes). A significant increase in the number of days of PE class was observed in the border sample between 2004 and 2005 and 2006 and 2008, with eighth grade students reporting an average of 2.0 days and 3.7 days of PE per week, respectively (p \u3c .001). Additionally, border districts met the Healthy People 2010 objective of 50% time in moderate-to-vigorous physical activity (mean 54.9% ± 5.1%) during PE class. Conclusions Implementation of SB42 appears to have impacted the frequency of school PE in Texas and the prevalence of child self-reported physical activity behaviors along the Texas–Mexico border. General awareness of and adherence to SB42 was high in both statewide and among the border districts. Our mixed findings on adherence to specific components of the legislation suggest the need for further investigation of the factors that both facilitate and inhibit local leadership around school policy and the mechanisms to ensure the school policy is being implemented

Clinical Utility of Random Anti–Tumor Necrosis Factor Drug–Level Testing and Measurement of Antidrug Antibodies on the Long-Term Treatment Response in Rheumatoid Arthritis

Objective: To investigate whether antidrug antibodies and/or drug non-trough levels predict the long-term treatment response in a large cohort of patients with rheumatoid arthritis (RA) treated with adalimumab or etanercept and to identify factors influencing antidrug antibody and drug levels to optimize future treatment decisions.  Methods: A total of 331 patients from an observational prospective cohort were selected (160 patients treated with adalimumab and 171 treated with etanercept). Antidrug antibody levels were measured by radioimmunoassay, and drug levels were measured by enzyme-linked immunosorbent assay in 835 serial serum samples obtained 3, 6, and 12 months after initiation of therapy. The association between antidrug antibodies and drug non-trough levels and the treatment response (change in the Disease Activity Score in 28 joints) was evaluated.  Results: Among patients who completed 12 months of followup, antidrug antibodies were detected in 24.8% of those receiving adalimumab (31 of 125) and in none of those receiving etanercept. At 3 months, antidrug antibody formation and low adalimumab levels were significant predictors of no response according to the European League Against Rheumatism (EULAR) criteria at 12 months (area under the receiver operating characteristic curve 0.71 [95% confidence interval (95% CI) 0.57, 0.85]). Antidrug antibody–positive patients received lower median dosages of methotrexate compared with antidrug antibody–negative patients (15 mg/week versus 20 mg/week; P = 0.01) and had a longer disease duration (14.0 versus 7.7 years; P = 0.03). The adalimumab level was the best predictor of change in the DAS28 at 12 months, after adjustment for confounders (regression coefficient 0.060 [95% CI 0.015, 0.10], P = 0.009). Etanercept levels were associated with the EULAR response at 12 months (regression coefficient 0.088 [95% CI 0.019, 0.16], P = 0.012); however, this difference was not significant after adjustment. A body mass index of ≥30 kg/m2 and poor adherence were associated with lower drug levels.  Conclusion: Pharmacologic testing in anti–tumor necrosis factor–treated patients is clinically useful even in the absence of trough levels. At 3 months, antidrug antibodies and low adalimumab levels are significant predictors of no response according to the EULAR criteria at 12 months

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

Christopher Ledingham Interview

Interview with Dr. Christopher Ledingham describing the history of the Department of Health and Human Performance. Dr. Christopher Ledingham was hired at UTB/TSC in 2007. He is a health education and online teaching specialist and teaches personal health, community health, epidemiology and lifetime fitness courses. He also sponsors the HHP student organization

Interview with Susan Hart

Interview with Dr. Susan Hart describing the history of the Department of Health and Human Performance at UTB/TSC. Dr. Susan Hart was hired at UTB/TSC in 2001. She is a motor development specialist and teaches elementary methods and curriculum, sport psychology, outdoor education courses and conducts sport camps. She has sponsored the HHP student organization

Phillip Conatser Interview

Interview with Dr. Phillip Conatser describing the history of the Department of Health and Human Performance at UTB/TSC. Dr. Phillip Conatser was hired in 2005. He is an adapted physical education and aquatics specialist. He teaches first aid, adapted tests and measurement courses and sponsors the HHP student organization

Murat Karabalut Interview

Interview with Dr. Murat Karabalut describing his experience at the Department of Health and Human Performance at UTB/TSC. Dr. Murat Karabalut was hired at UTB/TSC in 2008. He is an exercise physiology and exercise science specialist and teaches exercise physiology, research methods and exercise prescription courses. He also directs the exercise physiology laboratory and sponsors the exercise physiology student organization