Cardiorespiratory fitness and development of childhood cardiovascular risk: The EXAMIN YOUTH follow-up study

Background: Obesity- and hypertension-related cardiovascular (CV) risk has been shown to originate in childhood. Higher body mass index (BMI) and blood pressure (BP) have been associated with increased large artery stiffness and a lower microvascular arteriolar-to-venular diameter ratio (AVR) in children. This study aimed to investigate the association of cardiorespiratory fitness (CRF) with development of BMI, BP and vascular health during childhood.Methods: In our prospective cohort study, 1,171 children aged 6–8 years were screened for CRF, BMI, BP, retinal vessel diameters and pulse wave velocity using standardized protocols. Endurance capacity was assessed by 20 m shuttle run test. After 4 years, all parameters were assessed in 664 children using the same protocols.Results: Children with a higher CRF at baseline developed a significantly lower BMI (β [95% CI] −0.09 [−0.11 to −0.06] kg/m2, p < 0.001), a lower systolic BP (β [95% CI] −0.09 [−0.15 to −0.03] mmHg, p = 0.004) and a higher AVR (β [95% CI] 0.0004 [0.00004 to 0.0007] units, p = 0.027) after 4 years. The indirect association of CRF with development of retinal arteriolar diameters was mediated by changes in BMI.Conclusion: Our results identify CRF as a key modulator for the risk trajectories of BMI, BP and microvascular health in children. Obesity-related CV risk has been shown to track into adulthood, and achieving higher CRF levels in children may help counteract the development of CV risk and disease not only in pediatric populations, but may also help reduce the burden of CVD in adulthood.Registration:http://www.clinicaltrials.gov/ (NCT02853747)

Secular change in selected motor performance parameters and BMI in Swiss primary school children from 2014-2021: the Sportcheck+ study

Background Motor performance is known to be a meaningful marker for healthy child development. It is therefore important to monitor secular trends in children's motor performance, as healthy and physically active children are more likely to be healthy and physically active during adulthood. However, studies with regular and standardized monitoring of motor performance in childhood are scarce. Additionally, the impact of Covid-19 mitigation measures on secular trends is unknown. Methods The aim of this study was to describe secular changes in motor performance (balancing backwards, jumping sidewards, 20-m sprint and 20-m Shuttle Run Test (SRT)) and anthropometric data (BMI) in Swiss first graders from 2014 to 2021. The sample included a total of 10’953 children. Multilevel mixed-effects models were used to estimate secular trends for boys vs. girls, lean vs. overweight as well as fit vs. unfit children. The influence of Covid-19 mitigation measures was also analysed. Results Balance performance decreased (2.8% per year), whereas we found improvements for jumping (1.3% per year) and BMI (-0.7% per year). 20-m SRT performance increased by 0.6% per year in unfit children. Secular trend revealed enhanced jump performance development for boys when compared to girls, but also more pronounced decrease in 20-m SRT in fit girls compared to fit boys. Covid-19 was associated with increased BMI, but motor performance was not negatively affected. Conclusion In our sample, secular changes in motor performance show promising tendencies from 2014 to 2021. The effects of Covid-19 mitigation measures on BMI should be monitored in additional birth cohorts and follow-up studies

Concepts and System Architectures for the Management of Very Large Spatial Raster Objects in a Database Framework

The efficient management of very large spatial raster objects is becoming an important new feature of Geo-Information Systems. This paper investigates and summarises the main requirements that must be fulfilled by a spatial raster management solution. The investigations primarily focus on the management of very large raster mosaics, as a typical example for future requirements, both in terms of data volume and functionality. The aspects investigated include spatial objects access, spatial partitioning and partition indexing, multi-resolution, georeferencing and storage management. The paper then presents two system architectures which approach the problem at different levels of abstraction. The first architecture, GrIdS, is a DBMS application which investigates spatial raster management concepts and techniques available at a middleware layer. The paper discusses some of the key features of the GrIdS project, including a tile-based multi-resolution concept for very large raster mosaics. The section on GrIdS is concluded by the presentation of results which demonstrate the capabilities and limitations of this approach. CONCERT, the second architecture presented, enables the investigation of extensible database concepts and techniques supporting the efficient management of large objects, in particular spatial raster objects

Improvements in fitness and motor performance from the first to fifth grade in Basel

Introduction A well-developed motor performance is one key aspect of being able to participate in organised sports and to establish and maintain lifelong physical activity. Furthermore, a good fitness is an early indicator of beneficial health in adult life. The development of motor performance and fitness can be influenced by many facets like education, environment, nutrition and family habits. It could be important to identify factors that are negatively associated with motor development and fitness in order to propose interventions tackling them or specifically targeting disadvantaged children. The aim of this study is to identify intrinsic and extrinsic factors associated with the magnitude of motor performance and fitness development from the first to fifth grade in children in the city of Basel. Methods Children were tested in the first and the fifth grade for motor performance and anthropometrics. Parents were asked in the first grade to fill out a questionnaire. Motor performance tests included 20-meter shuttle run, 20-meter sprint, balancing backwards and side hopping tasks. The questionnaire asked among other things about socio economic status (SES) of the household in seven categories (up to CHF 2,000 per month, 2,000-3,000, 3,000-4,000, 4,000-5,000, 5,000-7,000, 7,000-9,000 and more than 9,000). Age, sex, height, BMI and SES were linearly regressed with changes in motor performance while controlling for baseline performance and the other factors. Mean and standard deviations are presented for descriptive data and effect sizes (standardized beta coefficients) for regression results. Results Thousand five-hundred and sixty-four children were assessed in both grades and 418 questionnaires were returned. Children were 50% male, 7.4 (±0.4) years of age in first grade, BMI was 16.3 (±2.4) kg/m2, and SES was 5.4 (±1.8). Motor performance improved by 60.2 (±77.3)%, 57.9 (±134)%, 71.3 (±39.2)% and 14.1 (±7.45)% for shuttle run, balancing backwards, side hopping and sprint, respectively. The proportion of overweight and obese children increased from 18.8 (±3.9) to 25.8 (±4.4)% and from 10.4 (±3.0) to 13.3 (±3.4)%, respectively. Neither age (β < 0.12) nor SES (β < 0.08) were meaningfully related to improvements in motor performance or fitness. Girls showed slightly larger improvements in sprint (β = 0.12) and balance (β = 0.08) performance while boys had larger improvements in shuttle run (β = 0.39) and jumping (β = 0.14) performance. Girls also showed substantially larger gains in BMI than boys (β = 0.68). BMI in first grade was negatively associated with improvements in shuttle run (β = 0.23) and sprint (β = 0.17) performance, but also slightly with balancing (β = 0.07) and jumping (β = 0.08) performance. Discussion/Conclusion A high BMI in first grade is negatively associated with development of motor performance and fitness and respective children should receive additional attention. Fortunately, children from economically disadvantaged families or younger children at school entry, showed a normal development in motor performance and fitness. The difference between boys and girls could be related to different developments in body composition for body weight related parameters (jumping and fitness). Based on these results, targeting interventions (exercise or nutrition) at children with a high BMI in first grade might be advisable, regardless of SES, age or sex

Moderating Effects of Exercise Duration and Intensity in Neuromuscular vs. Endurance Exercise Interventions for the Treatment of Depression: A Meta-Analytical Review

Background: Exercise training is a beneficial treatment strategy for depression. Previous meta-analytical reviews mainly examined the effect of aerobic exercise on depressive symptoms neglecting comparisons with neuromuscular training and meta-regression considering relevant exercise training prescriptors such as exercise duration, intensity, number of exercise sessions (volume) and frequency. Methods: A structured literature search was conducted in biomedical and psychological databases and study selection was conducted following the PICOS approach. (Randomized) controlled trials that compared supervised neuromuscular or endurance exercise interventions with an inactive control group (CON) in clinically depressed in-or out-patients over 18 years were included. Eligibility and study quality were evaluated by two independent researchers. Standardized mean differences (SMD) for the reduction of depressive symptoms, measured with different evaluation scales (e.g., BDI, HAM-D, PHQ-9, HRSD, MADRS, GDS) were calculated with the adjusted Hedges'g equation as main outcome for the comparison of endurance and neuromuscular exercise interventions vs. CON. Statistical analyses were conducted using a random effects inverse-variance model. Multivariate meta-regression analysis was performed in order to examine the modulating effects of exercise training prescriptors. Results: Twenty seven trials with 1,452 clinically depressed adults were included. 20 out of 27 included trials reached a PEDro score of at least 6, representing high-quality. Irrespective of the exercise mode and study quality, large effects in favor of exercise compared to the control condition were found. Compared to CON, sensitivity analyses revealed a moderate to large effect in favor of endurance exercise [SMD: -0.79 (90% CI: -1.10, -0.48); p < 0.00001, I-2 = 84%] and a large effect size in favor of neuromuscular exercise [SMD: -1.14 (90 CI: -1.50, -0.78); p < 0.00001, I-2 = 80%]. These effects decreased to moderate for endurance and remained large for neuromuscular trials when considering studies of high quality, indicating a significant difference (p = 0.04). Multivariate meta-regression revealed that exercise duration in endurance trials and exercise intensity in neuromuscular trials had a significantly moderating effect. Conclusions: Strong neuromuscular exercise interventions can be slightly more effective than endurance exercise interventions. Interestingly, exercise duration and exercise intensity moderated the effect size meaningfully. This result might be used on exercise in depression to increase efficacy

Impact of Covid-19 pandemic on the secular trends in motor performance, overweight and obesity of first graders in Basel

Introduction The development of appropriate motor skills early in life enhances the likelihood of lifelong physical activity (Hulteen et al., 2018). Furthermore, good fitness has direct health implications for child and youth development (Ortega et al., 2008). Physical fitness and the development of motor performance may be influenced by various factors like the Covid-19 pandemic as current example over the last two years. The pandemic affected children’s life, particularly regarding the reduced ability to attend structured leisure time sports activities. This study aims to describe the impact of the Covid-19 pandemic on secular trends in motor performance and body composition in first graders in the city of Basel. Methods In the city of Basel, Switzerland, all first graders were tested yearly since 2014 with four motor performance parameters and anthropometrics: 20-meter shuttle run, 20-meter sprint, jumping sidewards, balancing backward, body weight and height. Children are categorized as overweight when they are above 90. Percentile for their age and sex in BMI and as obese when above 97. Percentile. Linear regression for motor performance parameters and logistic regression for weight status was used to predict 2021 and 2022 performance parameters based on data from 2014 to 2020. These predictions were compared to the performance achieved in 2021 and 2022. Results Four thousand six-hundred sixty-two children were tested from 2014 to 2020, 728 in 2021, and 708 in 2022. The cohorts in 2021 and 2022 outperformed the predicted values by 6.1% [95 % CI: 1.8; 10.4] and 5.5% [1.0; 10.1] for shuttle run, 0.2% [-0.6; 1.0] and 3.5% [2.7; 4.4] for 20-meter sprint, 6.4% [3.7; 9.2] and 2.7% [-0.2; 5.5] for jumping sidewards and 4.0% [-0.5; 8.4] and 17.3% [12.1; 22.5] for balancing backward. The proportion of overweight children in 2021 (16.4%) and 2022 (15.5%) was 47.4% [31.4; 63.3] and 62.2% [26.4; 98.1] higher than predicted. The percentage of obese children deviated strongly by 55.9% [33.9; 77.9] and 61.8% [14.1; 113.0] from predicted values. Boys were more affected by the impact of Covid-19 showing a 70.4% [38.5; 102.3] and 79.4% [14.0; 145.9] higher proportion of obesity than expected from secular trends for both cohorts compared to girls (34.8% [-1.0; 70.6] and 34.5% [-42.8; 111.7]). Conclusion Although more children were classified as overweight and obese than expected, the children performed better in all motor performance parameters. Preserving the possibility for unstructured activities and outdoor play at all times during the Covid-19 restrictions is a potential reason that the pandemic situation did not limit motor development. Nevertheless, the increased number of overweight and obese children is alarming. Potential reasons like changes in eating behaviour or mental health due to the pandemic situation remain speculative. However, public health interventions for these cohorts focusing on healthy body composition are strongly recommended. References Hulteen, R. M., Morgan, P. J., Barnett, L. M., Stotten, D. F., &amp; Lubans, D. E. (2018). Development of foundational movement skills: A conceptual model for physical activity across the lifespan. Sports Medicine, 48(7), 1533–1540. https://doi.org/10.1007/s40279-018-0892-6 Ortega, F. B., Ruiz, J. R., Castillo, M. J., &amp; Sjöström, M. (2008). Physical fitness in childhood and adolescence: A powerful marker of health. International Journal of Obesity, 32(1), 1–11. https://doi.org/10.1038/sj.ijo.080377

Evaluating the optimal timing of surgical antimicrobial prophylaxis: study protocol for a randomized controlled trial

BACKGROUND Surgical site infections are the most common hospital-acquired infections among surgical patients. The administration of surgical antimicrobial prophylaxis reduces the risk of surgical site infections . The optimal timing of this procedure is still a matter of debate. While most studies suggest that it should be given as close to the incision time as possible, others conclude that this may be too late for optimal prevention of surgical site infections. A large observational study suggests that surgical antimicrobial prophylaxis should be administered 74 to 30 minutes before surgery. The aim of this article is to report the design and protocol of a randomized controlled trial investigating the optimal timing of surgical antimicrobial prophylaxis.Methods/design: In this bi-center randomized controlled trial conducted at two tertiary referral centers in Switzerland, we plan to include 5,000 patients undergoing general, oncologic, vascular and orthopedic trauma procedures. Patients are randomized in a 1:1 ratio into two groups: one receiving surgical antimicrobial prophylaxis in the anesthesia room (75 to 30 minutes before incision) and the other receiving surgical antimicrobial prophylaxis in the operating room (less than 30 minutes before incision). We expect a significantly lower rate of surgical site infections with surgical antimicrobial prophylaxis administered more than 30 minutes before the scheduled incision. The primary outcome is the occurrence of surgical site infections during a 30-day follow-up period (one year with an implant in place). When assuming a 5 surgical site infection risk with administration of surgical antimicrobial prophylaxis in the operating room, the planned sample size has an 80% power to detect a relative risk reduction for surgical site infections of 33% when administering surgical antimicrobial prophylaxis in the anesthesia room (with a two-sided type I error of 5%). We expect the study to be completed within three years. DISCUSSION The results of this randomized controlled trial will have an important impact on current international guidelines for infection control strategies in the hospital. Moreover, the results of this randomized controlled trial are of significant interest for patient safety and healthcare economics.Trial registration: This trial is registered on ClinicalTrials.gov under the identifier NCT01790529