Barriers to and ways of facilitating the implementation of Aragon’s Health-Promoting School network

Background: The Health-Promoting School (HPS) framework offers a comprehensive approach to promoting health in schools. Aragon’s HPS network is a local organisation which has identified the need for closer cooperation between the education and health sectors as the main challenge facing its programme. Objectives: Previous studies from countries implementing HPS approaches have identified various outcomes and challenges. However, there is insufficient evidence to identify potential barriers to HPS implementation in Spain. This study therefore set out to explore these issues within the context of the HPS network in Aragon. Method: Three focus groups were held in different cities (Zaragoza, Huesca and Teruel) between April and May 2020. The total sample comprised 18 adults ( M = 45.21; SD = 12.61), 60% of whom were men. Eleven participants were HPS stakeholders (i.e. teachers, HPS coordinators) and seven were external collaborators (e.g. university professors, researchers). Results: The main barriers identified were the excessive workload for professionals involved in the network, limitations imposed by contextual factors such as lack of teacher and family involvement, and lack of supervision and communication within the HPS network. Strengthening collaboration with work in other settings, the provision of continuing education for teaching staff and more systematic evaluation were identified as potential ways forward. Conclusion: Using the principles identified in this paper, Aragon’s HPS network should be further developed to enhance effective implementation and improve sustainability

Factors associated with compliance with physical activity recommendations among adolescents in Huesca.

BACKGROUND: Schools have been identified as environments of choice for physical activity promotion. This study examines factors associated with compliance with objectively assessed physical activity recommendations for early adolescents taking part in “Sigue la Huella”, a school-based intervention guided by a social ecological framework and Self-Determination Theory (Deci & Ryan, 2002). METHODS: A total of 200 students (108 boys) aged 12-13 years (M = 12.16; SD = ± 0.51), wore accelerometers during a 7-day period and completed a questionnaire. Participants were considered compliant to the recommendations if their moderate to vigorous physical activity, averaged over 7 days, was =60 minutes a day. RESULTS: 57.4% of boys and 9.9% of girls met recommendations. In a mixed logistic regression model, compliance was higher among boys and students attending private schools, and lower for obese students. Compliance was also associated with higher perceptions of physical competence, higher perceptions of autonomy in physical education, greater importance attached to physical education and less sedentary behavior. CONCLUSIONS: Assessed objectively, gender differences in compliance with physical activity recommendations were greater than expected. Self-Determination Theory emerged as a useful framework to identify motivational factors that can be addressed in school-based physical activity interventions and programs for early adolescents

Feasibility and Reliability of a Questionnaire to Assess the Mode, Frequency, Distance and Time of Commuting to and from School: The PACO Study

Active commuting to and from school has several health implications. Self-reporting is the most common assessment tool, but there is a high heterogeneity of questionnaires in the scientific literature. The purpose of this study was to analyse the feasibility and reliability of the Spanish “New Version of Mode and Frequency of Commuting To and From School” questionnaire in children and adolescents. A total of 635 children (5–12 years old) and 362 adolescents (12–18 years old) filled out the questionnaire twice (14 days apart). Feasibility was evaluated using an observational checklist. The test-retest reliability of the “New Version of Mode and Frequency of Commuting To and From School” questionnaire and the distance and time to school were examined using the kappa and weight kappa coefficient (κ). No misunderstanding of questions was reported. The time to complete the questionnaire was 15 ± 3.62 and 9 ± 2.26 min for children and adolescents, respectively. The questionnaire showed substantial and almost perfect kappa coefficients for the overall six items (k = 0.61–0.94) in children and adolescents. The “New Version of Mode and Frequency of Commuting To and From School” questionnaire is a feasible and reliable questionnaire in Spanish children and adolescents.Spanish Ministry of Economy, Industry and CompetitivenessEuropean Union (EU) DEP2016-75598-RUniversity of Granada, Plan Propio de Investigacion 2016, excellence actions: Units of ExcellenceUnit of Excellence on Exercise and Health (UCEES)Junta de AndaluciaConsejeria de Conocimiento, Investigacion y UniversidadesEuropean Union (EU) SOMM17/6107/UGREuropean Social Fund (ESF

Actividad Física y apoyo de la autonomía: el rol del profesor de Educación Física

hysical Education (PE) teachers play an essential role in promoting physical activity (PA) with their teaching activity. The purpose of this study was to analyse the influence that perceived autonomy support from PE teachers exercises on regular engagement in PA, both from the students’ and from the teachers’ viewpoint. A total of 831 adolescents took part (M = 14.32; DT = .73; 372 boys and 459 girls) and 18 PE teachers (9 men and 9 women) from the cities of Huesca (Spain) and Tarbes (France). A linear regression analysis in stages was performed, which showed that both greater perceived autonomy support from the PE teachers by the students, and highly autonomous orientation of the PE teachers, positively predict greater engagement in regular PA in adolescents. The development of an autonomy-oriented climate in PE must construct one of the major pillars of the entire education process. That favourable climate must be based on the teaching intervention and discourse of the PE teachers as determining elements of the adolescents’ behaviour, being able to contribute to their development as more active people in their free time

Psychometric characteristics of a commuting-to-school behaviour questionnaire for families

The purposes of this study were: (a) to describe the patterns of modes of commuting to school (children) and to work (parents) separated by gender and age, (b) to validate the questions on children’s mode of commuting to and from school according to their parents, and (c) to analyse the reliability of a family questionnaire focused on commuting to school behaviours. A total of 611 parents (mean age: 43.28 ± 6.25 years old) from Granada (Spain) completed “Family commuting-to-school behaviour” questionnaire in two sessions separated by 14 days, (2016 and 2018). The validation between family and children’s questions was assessed using the Kappa and Spearman correlation coefficients, and the test–retest reliability within the family questions was assessed using the Kappa and the weighted Kappa. The children’s modes of commuting to school (mean age: 11.44 ± 2.77 years old) were mainly passive (57.7% to school) while parents’ modes of commuting to work were mainly active (71.6%). The validity of the mode of commuting was significant with high Kappa and Spearman coefficients. The test–retest reliability presented a good agreement for the mode of commuting to school in children, distance and time to school, and the mode of commuting to work in parents, while the questions on acceptable distance to walk or cycle to school showed a moderate to good agreement. The “Family commuting-to-school behaviour” questionnaire could be a useful tool to assess the mode of commuting of children, distance and time to school for researchers and practitioners

Novel intravesical bacterial immunotherapy induces rejection of BCG-unresponsive established bladder tumors

Background Intravesical BCG is the gold-standard therapy for non-muscle invasive bladder cancer (NMIBC); however, it still fails in a significant proportion of patients, so improved treatment options are urgently needed. Methods Here, we compared BCG antitumoral efficacy with another live attenuated mycobacteria, MTBVAC, in an orthotopic mouse model of bladder cancer (BC). We aimed to identify both bacterial and host immunological factors to understand the antitumoral mechanisms behind effective bacterial immunotherapy for BC. Results We found that the expression of the BCG-absent proteins ESAT6/CFP10 by MTBVAC was determinant in mediating bladder colonization by the bacteria, which correlated with augmented antitumoral efficacy. We further analyzed the mechanism of action of bacterial immunotherapy and found that it critically relied on the adaptive cytotoxic response. MTBVAC enhanced both tumor antigen-specific CD4 + and CD8 + T-cell responses, in a process dependent on stimulation of type 1 conventional dendritic cells. Importantly, improved intravesical bacterial immunotherapy using MBTVAC induced eradication of fully established bladder tumors, both as a monotherapy and specially in combination with the immune checkpoint inhibitor antiprogrammed cell death ligand 1 (anti PD-L1). Conclusion These results contribute to the understanding of the mechanisms behind successful bacterial immunotherapy against BC and characterize a novel therapeutic approach for BCG-unresponsive NMIBC cases. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ

Vulnerabilidad y adaptación de la zona costera colombiana al ascenso acelerado del nivel del mar

El país posee una variada y dinámica zona costera, que alcanza 3340 Km de extensión y que comprende dos litorales, el Caribe y el pacífico, y un territorio insular en el que se incluye el Archipiélago de San Andrés y Providencia. En su zona de costa y plataforma continental se encuentran importantes ecosistemas como manglares, praderas de fanerógamas y arrecifes coralinos, distribuidas por sus costas bajas y estuarinas, bahías, ensenadas y las costas arenosas y acantiladas. Tanto su línea de costa alta, como las planicies litorales bajas y ecosistemas costeros serán afectados por el actual cambio climático, y en especial, por el ascenso acelerado del nivel del mar. Los efectos del potencial ascenso del nivel marino fueron evaluados mediante indicadores geomorfológicos y morfo- dinámicos, con base en la caracterización física del litoral, la evaluación de su susceptibilidad y la proyección de los posibles cambios biofísicos que causará el incremento en un metro del nivel del mar en los próximos 100 años. De acuerdo con esta evaluación, en las costas colombianas es posible la inundación permanente de 4900 Km2 de costas bajas, el encharcamiento fuerte a total anegamiento de 5100 Km2 de áreas costeras moderadamente susceptibles, así como el encharcamiento de zonas aledañas y la profundización de los cuerpos de agua localizados en la zona litoral y la plataforma. Igualmente causará el incremento de la erosión en zonas especialmente sensibles, donde la actividad antrópica a reducido la capacidad de amortiguación de los sistemas litorales. Sistemas naturales como las playas y marismas serán los mas afectados por la erosión y la inundación litoral de acuerdo con esta evaluación. Se pudo establecer que los potenciales cambios biofísicos que afectarán el litoral colombiano por el cambio del nivel del mar harán que parte importante de la población, las actividades económicas y la infraestructura vital del país sean amenazadas por la inundación marina. La población que se encuentra en áreas bajo amenaza por inundación alcanza aproximadamente 1.4 millones de habitantes del litoral, población que esta dominantemente asentada en el sector urbano (85%). Para el litoral Caribe, sólo el 9% de las viviendas urbanas presentan alta vulnerabilidad a la inundación, porcentaje que llega al 46% en el sector rural. En el litoral Pacífico, el 48% de las viviendas del sector urbano y 87% del sector rural son altamente vulnerables, sin embargo, debido a las tradiciones culturales gran porcentaje de ellas están construidas sobre palafitos, costumbre que facilitará la adaptación. En cuanto a la vulnerabilidad social de los hogares en el litoral Caribe el 74% son moderadamente vulnerables, el 17% altamente vulnerables y el 9% son poco vulnerables. En el litoral Pacífico los hogares con alta vulnerabilidad social alcanzan el 13%, son moderadamente vulnerables el 62% y el restante 25% tiene baja vulnerabilidad. Respecto a las actividades económicas, se analizaron los principales sectores económicos asentados en el litoral Caribe, donde se concentra preferencialmente la infraestructura industrial y portuaria. El análisis de los elementos socioeconómicos permitió concluir que en el sector agropecuario, de las 1.533.290 Has de cultivos y pastos reportadas el 21% están expuestas a los diferentes grados de amenaza por inundación, de las cuales el 49% presentan alta vulnerabilidad y que está representada en cultivos de banano y palma africana principalmente. En el sector industrial, se encontró que el 75.3% (475 Has) del área ocupada por los establecimientos manufactureros en Barranquilla y el 99.7% (877 Has) en Cartagena son de alta vulnerabilidad. Para la infraestructura vial se considera que el 44.8% de la infraestructura vial terrestre tiene alta vulnerabilidad, el 5.2% vulnerabilidad moderada y el 22.7% es poco vulnerable. En las zonas insulares se analizó la vulnerabilidad de la isla de San Andrés, ubicada en el mar Caribe y que hace parte de un extenso archipiélago coralino de 52.2. km2. La isla de San Andrés cubre un área de 27 Km2, de los cuales el 17% sería inundado por un ascenso proyectado de 1 metro del nivel del mar, espacio que se localiza en las zonas norte y este de la isla. Las zonas mas afectadas por la inundación representan la mayor parte de la riqueza natural de la isla, y es también el sector donde se asienta la infraestructura turística y comercial. La alta vulnerabilidad de estas zonas es debida a la presencia de rellenos habilitados en la década de los años 50. Igualmente, la infraestructura de servicios públicos será afectada, en especial el alcantarillado, el abastecimiento de agua potable y la infraestructura vial, además del incremento de los actuales procesos de erosión. Se considera la implementación de medidas de adaptación tendientes a recuperar y fortalecer los mecanismos de resiliencia del litoral que faciliten la adaptación natural de las zonas costeras al ascenso del nivel del mar. Opciones adicionales como la preservación de humedales costeros, regulación de los usos y actividades en las zonas amenazadas por la inundación y la protección de zonas de interés socioeconómico vital complementan la estrategia de adaptación, consolidada en el marco del manejo integrado de zonas costeras que ha establecido el país para sus litorales

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030