Pre-school obesity is associated with an increased risk of childhood fracture:a longitudinal cohort study of 466 997 children and up to 11 years of follow up in Catalonia, Spain

This study aimed to determine if having an overweight or obese range body mass index (BMI) at time of beginning school is associated with increased fracture incidence in childhood. A dynamic cohort was created from children presenting for routine preschool primary care screening, collected in the Information System for Research in Primary Care (SIDIAP) platform in Catalonia, Spain. Data were collected from 296 primary care centers representing 74% of the regional pediatric population. A total of 466,997 children (48.6% female) with a validated weight and height measurement within routine health care screening at age 4 years (±6 months) between 2006 and 2013 were included, and followed up to the age of 15, migration out of region, death, or until December 31, 2016. BMI was calculated at age 4 years and classified using WHO growth tables, and fractures were identified using previously validated ICD10 codes in electronic primary care records, divided by anatomical location. Actuarial lifetables were used to calculate cumulative incidence. Cox regression was used to investigate the association of BMI category and fracture risk with adjustment for socioeconomic status, age, sex, and nationality. Median follow-up was 4.90 years (interquartile range [IQR] 2.50 to 7.61). Cumulative incidence of any fracture during childhood was 9.20% (95% confidence interval [CI] 3.79% to 14.61%) for underweight, 10.06% (9.82% to 10.29%) for normal weight, 11.28% (10.22% to 12.35%) for overweight children, and 13.05% (10.69% to 15.41%) for children with obesity. Compared with children of normal range weight, having an overweight and obese range BMI was associated with an excess risk of lower limb fracture (adjusted hazard ratio [HR] = 1.42 [1.26 to 1.59]; 1.74 [1.46 to 2.06], respectively) and upper limb fracture (adjusted HR = 1.10 [1.03 to 1.17]; 1.19 [1.07 to 1.31]). Overall, preschool children with an overweight or obese range BMI had increased incidence of upper and lower limb fractures in childhood compared with contemporaries of normal weight

Harnessing Change to Create Sustainable Growth; The Visitacion/ Guadalupe Valley

A Regional Perspective is a report authored by Visitacion Valley Community Development Corporation and Asian Neighborhood Design as the first steps in efforts to create a regional planning perspective, collecting and analyzing data to assist in planning efforts towards sustainable growth, building relationships between regional stakeholders and decision-makers, and providing community outreach to inform and encourage community participation

An investigation of the relationship between plasma, erythrocyte and tissue trace element concentrations

Introduction. Trace element status may be important in acutely-inflamed patients. Plasma concentrations of trace elements are known to alter during the evolution of the acute phase response, however, erythrocyte trace element concentrations do not. It is not known whether either erythrocyte or plasma concentrations reflect the status of the tissues where trace elements are utilised. Therefore trace element concentrations were examined in tissues and blood from non-inflamed patients, with plasma and erythrocyte concentration changes studied during the evolution of the acute phase response. Methods: 31 patients undergoing liver resection had liver, rectus muscle, and blood samples obtained pre-operatively, and blood sampling for 3 days post-operatively. Se, Cu and Zn concentrations were obtained by inductively coupled mass spectrometry after nitric acid digestion. Erythrocyte glutathione peroxidase (GPx) was measured by spectrophotometry. C-reactive protein and albumin concentration were measured on each day. Results: C-reactive protein increased and albumin concentration decreased over the 3 days postoperatively. Plasma Zn and Se concentration changed in the 3 days post-operatively (p<0.001); erythrocyte Cu, Zn and Se concentration, GPx activity and plasma Cu concentration did not change. Preoperatively, liver Cu concentration was associated with erythrocyte Cu concentration (r2 15.9%; p=0.036) but not plasma Cu concentration (r2 4.3%; p=0.264); plasma Zn concentration was associated with liver Zn concentration (r2 14.4%; p=0.046) but erythrocyte Zn concentration was not (r2 0.1%; p=0.896); and liver Se concentration was associated with erythrocyte Se concentration (r2 17.1%; p=0.023), erythrocyte glutathione peroxidase (r2 22.6%; 0.008) and plasma Se concentration (r2 43.1%; p<0.001). Conclusions: Erythrocyte Cu and Se concentration, and GPx activity are associated with liver Cu and Se concentration respectively, and do not change during the evolution of the acute phase response. They should be considered as potential markers of Cu and Se status. Plasma Zn is associated with liver Zn concentration but the concentration changes during the acute phase response; caution should be taken interpreting results in patients with inflammation, and further work is required to find a suitable alternative marker of Zn status

Teaching Ignorance: On the Importance of Developing Psychoanalytic Sensibilities in Education

The author advocates for teaching about varieties of ignorance with a psychoanalytic sensibility as one strategy with which to engage the emotional investments that sustain apathy and the ignorant refusal to care in this new era of suffering and spectatorship. Ignorance, here conceived, is complex, far from consisting only in some passive lack of knowledge. It is understood multidimensionally, as activity, rarely innocent, always inevitable, and entirely ineradicable; it is a powerful agent in the maintenance of oppression, but it is also an important resource on which we can draw to promote curiosity and less defensive encounters with difficult knowledge and different Others. In diagnosing different forms of ignorance, we can distinguish between the varieties that are culturally produced and disseminated for profit from those forms which might serve as impetus for investigation

Development of a core outcome set for behavioural weight management programmes for adults with overweight and obesity:protocol for obtaining expert consensus using Delphi methodology

Introduction: Weight management interventions in research studies and in clinical practice differ in length, advice, frequency of meetings, staff and cost. Very few real-world programmes have published patient-related outcomes, and those that have published used different ways of reporting the information, making it impossible to compare interventions and further develop the evidence base. Developing a core outcome set for behavioural weight management programmes (BWMPs) for adults with overweight and obesity will allow different BWMPs to be compared and reveal which interventions work best for which members of the population. Methods and analysis: An expert group, comprised of 40 people who work in, refer to, or attend BWMPs for adults with overweight and obesity, will be asked to decide which outcomes services should report. An online Delphi process will be employed to help the group reach consensus as to which outcomes should be measured and reported, and which definitions/instruments should be used in order to do so. The first stage of the Delphi process (three rounds of questionnaires) will focus on outcomes while the second stage (three additional rounds of questionnaires) will focus on definition/instrument selection. Ethics and dissemination: Ethical approval for this study has been received from the University of Glasgow College of Medical, Veterinary and Life Sciences Ethics Committee. With regard to disseminating results, a report will be submitted to our funding body, the Chief Scientist Office of the Scottish Government Health Department. In addition, early findings will be shared with Public Health England and Health Scotland, and results communicated via conference presentations, peer review publication and our institutions’ social media platforms

Associations of statin adherence and lipid targets with adverse outcomes in myocardial infarction survivors:a retrospective cohort study

Objectives: To examine associations between statin adherence and lipid target achievement in myocardial infarction (MI) survivors, and their associations with mortality and recurrent MIs. Design: Retrospective cohort study using linked clinical records within the National Health Service Greater Glasgow and Clyde (NHS GGC) Data Safe Haven. Setting: Routine clinical practice in the NHS GGC area between January 2009 and July 2017. Participants: Patients ≥18 years who experienced a non-fatal MI hospital admission (ICD10: I21, I22) between January 2009 and July 2014 (n=11 031), followed up from the date of MI admission until July 2017 or death, whichever occurred first. Primary and secondary outcome measures: Statin adherence was estimated using encashed prescriptions and lipid results from routine biochemistry data. Primary lipid and statin adherence targets were LDL ≤1.8 mmol/L and adherence ≥50%, and were related to all-cause death, deaths due to cardiovascular disease (CVD) (ICD10: I00–I99 as the underlying cause), and recurrent MI in unadjusted models and models adjusting for age, sex, socioeconomic deprivation and year of MI. Results: Over 4.5 years follow-up, 76% achieved LDL ≤1.8 mmol/L, and 84.5% had average adherence ≥50%. Patients with adherence &lt;50% had an increased risk of not meeting LDL ≤1.8 mmol/L, in adjusted models (OR 2.03, 95% CI 1.78 to 2.31, p&lt;0.0001). In univariable models, not meeting LDL ≤1.8 mmol/L was associated with increased risks of all-cause mortality (HR 1.27, 95% CI 1.16 to 1.39, p&lt;0.0001) and CVD mortality (HR 1.29, 95% CI 1.11 to 1.51, p=0.0013). Adherence &lt;50% was associated with increased risks of all-cause mortality (HR 1.58, 95% CI 1.44 to 1.74, p&lt;0.0001) and CVD mortality (HR 1.60, 95% CI 1.36 to 1.88, p&lt;0.0001). Adjustment for confounders did not abrogate these associations. Neither exposure was associated with recurrent MIs. Conclusions: Non-achievement of lipid and adherence targets are associated with increased risks of all-cause and CVD mortality. Further work is required to optimise their use to improve outcomes in clinical practice

Minimally Invasive Necrosectomy Techniques in Severe Acute Pancreatitis: Role of Percutaneous Necrosectomy and Video-Assisted Retroperitoneal Debridement

Consensus advocating a principle of early organ support, nutritional optimisation, followed ideally by delayed minimally invasive intervention within a “step-up” framework where possible has radically changed the surgical approach to complications of acute pancreatitis in the last 20 years. The 2012 revision of the Atlanta Classification incorporates these changes, and provides a background which underpins the complexities of individual patient management decisions. This paper discusses the place for delayed minimally invasive surgical intervention (percutaneous necrosectomy, video-assisted retroperitoneal debridement (VARD)), and the rationale for opting to adopt a percutaneous approach over endoscopic or laparoscopic approaches in different clinical situations

Equivalence in Ventilation and Indoor Air Quality

We ventilate buildings to provide acceptable indoor air quality (IAQ). Ventilation standards (such as American Society of Heating, Refrigerating, and Air-Conditioning Enginners [ASHRAE] Standard 62) specify minimum ventilation rates without taking into account the impact of those rates on IAQ. Innovative ventilation management is often a desirable element of reducing energy consumption or improving IAQ or comfort. Variable ventilation is one innovative strategy. To use variable ventilation in a way that meets standards, it is necessary to have a method for determining equivalence in terms of either ventilation or indoor air quality. This study develops methods to calculate either equivalent ventilation or equivalent IAQ. We demonstrate that equivalent ventilation can be used as the basis for dynamic ventilation control, reducing peak load and infiltration of outdoor contaminants. We also show that equivalent IAQ could allow some contaminants to exceed current standards if other contaminants are more stringently controlled

A systematic review of the association of diet quality with the mental health of university students:implications in health education practice

University students are at risk of experiencing mental health problems during the transition from home to university. This transition can also adversely affect their diet quality. This review aims to examine bidirectional associations from observational studies regarding the influence of diet quality on the mental health of university students, and vice versa. The databases PubMed, CINAHL, EMBASE, PsycINFO, The Cochrane Library and Web of Science were searched using relevant search terms. The searches were last updated on 15 July 2022. Majority of studies (36 out of 45) found that good diet quality of students was associated with better mental health in terms of depression, anxiety, stress and overall general mental well-being. Moreover, majority of studies (19 out of 23) found that stress and anxiety of students were associated with poorer diet quality. The effect sizes observed were generally small–moderate. Healthy diets of students have been associated with better mental health in terms of depression, anxiety, stress or other mental health issues. Stress experienced by university students has been associated with unhealthy diets. There are implications for health education research, as interventions to improve diet quality at the university level could reduce mental health issues; additionally, interventions to support students under stress may lead to healthier dietary habits when living on campuses. Randomized controlled trials and intervention studies are needed to further investigate these implications

Why We Ventilate

It is widely accepted that ventilation is critical for providing good indoor air quality (IAQ) in homes. However, the definition of&quot;good&quot; IAQ, and the most effective, energy efficient methods for delivering it are still matters of research and debate. This paper presents the results of work done at the Lawrence Berkeley National Lab to identify the air pollutants that drive the need for ventilation as part of a larger effort to develop a health-based ventilation standard. First, we present results of a hazard analysis that identified the pollutants that most commonly reach concentrations in homes that exceed health-based standards or guidelines for chronic or acute exposures. Second, we present results of an impact assessment that identified the air pollutants that cause the most harm to the U.S. population from chronic inhalation in residences. Lastly, we describe the implications of our findings for developing effective ventilation standards