Utility of routine screening for alpha-1 antitrypsin deficiency in patients with bronchiectasis

Alpha-1 antitrypsin deficiency (AATD) is a cause of bronchiectasis. Guidelines for bronchiectasis from the British Thoracic Society do not recommend to routinely test patients for AATD. In contrast, guidelines for AATD recommend routine screening. This contradiction, in part, results from the lack of data from large studies performing comprehensive screening. We screened 1600 patients with bronchiectasis at two centres in the UK from 2012 to 2016. In total, only eight individuals with AATD were identified representing 0.5% of the overall population. We conclude that routine screening for AATD in bronchiectasis in the UK has a low rate of detection. Further studies are required in different geographical regions, which may have a higher prevalence of AATD.info:eu-repo/semantics/publishedVersio

A theory-based evaluation of a dissemination intervention to improve childcare cooks\u27 intentions to implement nutritional guidelines on their menus

BACKGROUND: Childcare services represent a key setting to implement nutritional interventions to support the development of healthy eating behaviours in young children. Childcare-specific nutritional guidelines outlining recommendations for provision of food in care have been developed. Despite this, research suggests that few childcare services currently implement these guidelines. This study aimed to examine the impact of providing printed educational materials on childcare service cooks\u27 intentions to use nutritional guidelines and provide fruit and vegetables on their menu. FINDINGS: A randomised controlled trial was conducted with 77 childcare services (38 control and 39 intervention). Intervention service cooks were mailed a two-page educational material together with a menu planning checklist. Intervention development and evaluation was guided by the theory of planned behaviour. Outcome data assessing intentions to use nutritional guidelines and serves of fruit and vegetables provided on menus (primary outcomes) as well as secondary outcomes (attitudes, behavioural regulation and social norms) were collected via a telephone interview with cooks. Relative to the comparison group, cooks in the intervention arm had significantly higher intentions to use the guidelines (p value 0.0005), accompanied by significant changes in perceived behavioural control (p value 0.0008) and attitudes (p value 0.0071). No significant difference in serves of fruit (p value 0.7278) and vegetables (p value 0.0573) was observed. CONCLUSIONS: The use of educational materials can improve childcare service cooks\u27 intentions to use nutritional guidelines; however, as a standalone strategy, it may not improve provision of food on menus

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Adolescent physical activity during school lunch breaks : Same thing, different day

School settings are an essential source of physical activity for adolescents because they provide curricular, co-curricular opportunities in addition to time during scheduled breaks. There has been limited previous research examining the physical activity behaviour of adolescents during break periods. Purpose: The aim of this study was to investigate the inter-day variability of adolescent's physical activity (PA) during school lunchtime periods. Methods: Participants (n = 40) from yr 8 to 10 (mean age = 14.5 ± 0.8 yrs) wore a SPI-Elite Global Positioning System (GPS) unit during five lunchtimes during a school week. Heart rate (HR), speed, distance, global position, and G force were measured for each participant and reported across a range of play spaces including a cricket net area, grassed oval, quadrangle, basketball/netball court area and seated shaded area for each participant across the five days. Analyses were performed on time periods randomly selected from three days for windows of 20 min+. Time spent within the various play spaces was determined by overlaying GPS data with Google Earth images of the school playground. Results: Independent samples t-tests revealed males (mean = 2.5 ± .97 km) covered a greater distance compared to females (mean = 1.5 ± .73 km) at the p < 0.01 level. Males also displayed significantly higher HR than did females during lunch breaks, at the p < 0.01 level. Students spent significantly more time and covered the greatest distance on the oval (grassed area) when compared to other play spaces (p < 0.01), and girls spent significantly more time in the seated shaded area than did males (p < 0.01). There were no significant differences for inter-day variability of average time, distance, HR, speed or G force within adolescent students’ physical activity during lunchtimes. Conclusions: The results suggest adolescents’ physical activity during lunch breaks is relatively stable across days. There are a number of feasibility issues relating to the use of GPS technology within the context of school settings and these are discussed. Future physical activity interventions targeting adolescents should consider the nature of the play space and may need to be tailored differently for males and females

Canteen purchasing practices of year 1-6 primary school children and association with SES and weight status

Objective: To identify sources of food eaten during the school day, the types of foods and frequency of purchases from the canteen and association with SES and weight status in primary school-aged children. Method: This cross-sectional study was conducted in the Hunter region of New South Wales. Primary schools were randomly selected from a list of government schools and 5,206 students in years 1–6 from the 16 participating schools were invited to participate in the study. Results: Findings show the majority of children in the study bring their recess snack and lunch from home. However, the majority of children do use the school canteen and less healthy foods and highsugar drinks are commonly purchased. Conclusions: This study confirms the relevance of the school canteen as a means of affecting children's eating habits. Implications: Improvement in the foods sold through schools provides an important contribution to model supportive environments for healthy food choices. Strategies should also be directed towards affecting the content of lunchboxes and the home environment

Higher prevalence of childhood overweight and obesity in association with gender and socioeconomic status in the Hunter region of New South Wales

Objective: To determine the prevalence of overweight and obesity in primary school-aged children in the Hunter region and examine associations with gender, age, socioeconomic status (SES) and geographical location. Design: Cross-sectional survey of a stratified sample of randomly selected government primary schools in the Hunter region with SES defined by Socio-Economic Index For Areas index and geographical location based on school education areas. Subjects: A total of 2224 out of 5206 (42.7%) primary school children from randomly selected government primary schools representing year 1 to year 6 (x = 9.61 ± 1.7). Setting: Sixteen government primary schools in the Hunter Region of New South Wales. Main outcome measures: Overweight and obesity were assessed using the international body mass index cut points, standardised for both age and gender as defined by Cole. Data analyses: Chi square (∝ = 0.05) was used to compare prevalence across categories of gender, age, SES or geographical location. Results: Of the 2224 children who had their height and weight measured, 28.35% (n = 606) were either overweight (n = 415, 19.3%) or obese (n = 191, 9.06%). Significant differences in the prevalence of combined overweight and obesity were observed between children residing in high and low socioeconomic areas, by ages and between boys and girls. Conclusion or application: The prevalence of childhood obesity is high and appears more prevalent in girls, in children residing in low-income areas and at specific ages. Determinants of the observed differences will need to be investigated in order to address the higher prevalence of childhood obesity in high-risk population groups