Impact on adolescent mental health of replacing screen-use with exercise: A prospective cohort study

BACKGROUND: Screen-based device use could increase the risk of adolescent depression. Distinct modalities of screen-use may have differential effects on mental health. We used compositional data analysis to examine how theoretically replacing different screen-uses with exercise might influence future adolescent emotional distress. METHODS: In 4,599 adolescents (55% female) from a nationally-representative, prospective cohort, we used time-use diary data at age 14 to estimate daily screen use (television, social media, video game, general computer use) and exercise (team sport and individual exercise). The outcome was emotional distress at age 17, assessed using the emotional symptoms subscale of the Strengths and Difficulties Questionnaire. RESULTS: Theoretically replacing 60 minutes of total screen time with exercise at age 14 was associated with a 0.05 (95%CI -0.08, -0.02) score reduction on the emotional symptoms' subscale at 17 in fully-adjusted models. Replacing 60 minutes of television or social media use with team sports was associated with a reduction of 0.17 (95%CI, -0.31, -0.04) and 0.15 (95%CI, -0.29, -0.01) in emotional symptom scores, respectively. We found no change in emotional symptom scores when replacing video game or general computer use with team sport, or when replacing any screen time with individual exercise. LIMITATIONS: No direct measure of depressive symptoms at follow-up. CONCLUSIONS: Replacing any screen time with exercise could reduce emotional distress, but the largest effect sizes were associated with replacing time in television watching and social media with team sports. Recommendations to limit screen-use in adolescents may require a nuanced approach for protecting mental health

Frailty is associated with objectively assessed sedentary behaviour patterns in older adults: Evidence from the Toledo Study for Healthy Aging (TSHA)

Objective: The aim of this study was to examine the association of sedentary behaviour patterns with frailty in older people. Setting: Clinical setting. Design: Cross-sectional, observational study. Participants and measurements: A triaxial accelerometer was used in a subsample from the Toledo Study for Healthy Aging (519 participants, 67–97 years) to assess several sedentary behaviour patterns including sedentary time per day, the number and duration (min) of breaks in sedentary time per day, and the proportion of the day spent in sedentary bouts of 10 minutes or more. Frailty was assessed using the Frailty Trait Scale (FTS). Regression analysis was used to ascertain the associations between sedentary behaviour patterns and frailty. Results: Sedentary time per day and the proportion of the day spent in sedentary bouts of 10 minutes or more, were positively associated with frailty in the study sample. Conversely, the time spent in breaks in sedentary time was negatively associated with frailty. Conclusion: In summary, breaking up sedentary time and time spent in sedentary behaviour are associated with frailty in older people

Comparative study on the clinical-nutritional status of obese postmenopausal women on a weight loss programme based on prepared dishes

Comparative Study; English Abstract; Journal Article;INTRODUCTION Few studies have evaluated the efficacy and reliability of weight loss-focussed prepared food dishes in obese post-menopausal women. OBJECTIVE To compare the efficacy of a weight loss programme based on a balanced hypocaloric diet using prepared dishes* with that of a similar programme based on standard commercially available foods and with a non-intervened control group. A further aim was to evaluate the subjectivity of participants in the preparation of the diet-adjusted dishes based on usually consumed products. SUBJECTS Obese post-menopausal women aged between 55 and 65 years. DESIGN Controlled longitudinal interventional study. METHOD The sample of 75 female volunteers were divided into three groups of 25 women: a control group, who continued to consume their usual non-dietary adjusted meals (CG), an intervened group, treated with a diet adjusted to their individual requirements and based on standard commercially available food (SG), and another intervened group, treated with a similarly adjusted diet but based on prepared dishes (PG). Data were gathered on anthropometric variables, consumption habits and physical activity levels, and clinical-nutritional controls were conducted at the start and every two weeks to the end of the 8-week study in order to evaluate biochemical changes. RESULTS The weight loss was slightly higher in the prepared-dishes group (PG) than in the standard food diet group (SG), but the difference was not statistically significant, whereas it was considerably higher in both groups than in the non-dietary adjusted control group (CG) and this difference was highly significant (losses of 7.60 kg in PG and 7.01 kg in SG versus 2.10 kg in CG (p < 0.01). However, the PG showed a significantly higher (p < 0.01) loss of fatty mass and abdominal circumference versus the SG women. CONCLUSION More weight was lost by the two groups treated with a diet based on prepared dishes or usual food items in comparison to untreated controls, but the diet based on prepared dishes obtained more reliable and higher quality outcomes, achieving a positive change at fatty compartment level and in the abdominal circumference.El presente proyecto ha sido financiado por la empresa Deliline® S. A.YesIntroducción: Son escasos los estudios que hayan evaluado la eficacia y la fiabilidad de los platos de comidas preparadas* enfocadas a la pérdida de peso en la mujer posmenopáusica obesa. Objetivo: Evaluar la eficiencia de un programa de pérdida de peso basado en una ingesta hipocalórica equilibrada, a partir de platos preparados* comparando con otra basada en alimentos de consumo habitual en el mercado y con un grupo control no intervenido. En el presente estudio se pretende, además, valorar la subjetividad de la participante a la hora de preparar los platos ajustados a la dieta de restricción basada en productos de consumo habitual. Sujetos de estudio: mujeres posmenopáusicas obesas, con edad comprendida entre 55-65 años. Diseño del estudio: Estudio longitudinal de intervención y controlado. Metodología: La muestra de 75 mujeres voluntarias se divide en tres grupos de 25 mujeres; uno con alimentación habitual, sin dieta ajustada (GC), otro intervenido mediante tratamiento con una dieta ajustada a los requerimientos individuales, pero con productos de consumo habitual en mercado (GE) y un tercero intervenido con dieta ajustada del mismo modo al anterior, pero con platos preparados (GD). Se registraron datos antropométricos, hábitos de consumo y nivel de actividad física. También se realizaron controles clínico-nutricionales para evaluar cambios bioquímicos al inicio del estudio, cada 2 semanas y al final del estudio, durante 8 semanas. Resultados: El grupo basado en platos preparados GD muestra resultados de pérdida de peso ligeramente mayores, aunque no estadísticamente significativos, al grupo de dieta estándar GE, mostrando, sin embargo, ambos, descensos muy significativos respecto al grupo no ajustado GC (con una pérdida de 7,60 kg en GD, 7,01 kg en el grupo GE y 2,10 kg en GC). Sin embargo, éste grupo de mujeres alimentadas con dieta hipocalórica basada en platos preparados GD, presenta (p < 0,01) una mayor pérdida significativa, tanto de masa grasa como de perímetro abdominal. Conclusión: Las mujeres tratadas con dieta basada en platos preparados GD y las tratadas con dieta ajustada habitual GE presentan una mayor pérdida de peso, pero el grupo GD mostró unos resultados más fiables y de calidad, dado el cambio positivo encontrado a nivel de compartimento graso y en el perímetro abdominal de las participantes del grupo objeto del estudio

Practical steps needed to achieve impact of the WHO 2019 movement behaviour guidelines for children under the age of 5 : the SUNRISE Study Europe Group evaluation

The World Health Organisation (WHO) guidelines for the ‘24-h movement behaviours’1 (physical activity (PA), sedentary behaviour (SB) including screen time, and sleep) in the under-5s were published in April 2019 (Supplementary Figure S1).2 The guidelines were developed as a response to the childhood obesity pandemic,2 to help ensure that under-5s have healthy levels of PA, screen time, and sleep. Evidence review and synthesis showed that these behaviours influenced a wide range of other outcomes, with substantial short-term and long-term consequences (e.g., cognitive, social and emotional development; language development; cardiometabolic health; bone and skeletal health; motor development; physical fitness; growth; and wellbeing).2 Five years later, it is now appropriate to test whether key actions in response to these guidelines were taken across Europe, and to consider ways of increasing the impact of the WHO Guidelines across Europe in the next 5 years. Therefore, the SUNRISE Study Europe Group considered three tests to examine if European public health policy and clinical practice were sufficiently responsive to the WHO Guidelines: (1) Do European nations have national guidelines for the movement behaviours in the under-5s or have they adopted/adapted the WHO Guidelines? (2) Do they have adequate surveillance of the movement behaviours in these age groups? (3) Do they have specific movement behaviour policies for children under-5

Reference values for wrist-worn accelerometer physical activity metrics in England children and adolescents.

Background: Over the last decade use of raw acceleration metrics to assess physical activity has increased. Metrics such as Euclidean Norm Minus One (ENMO), and Mean Amplitude Deviation (MAD) can be used to generate metrics which describe physical activity volume (average acceleration), intensity distribution (intensity gradient), and intensity of the most active periods (MX metrics) of the day. Presently, relatively little comparative data for these metrics exists in youth. To address this need, this study presents age- and sex-specific reference percentile values in England youth and compares physical activity volume and intensity profiles by age and sex. Methods: Wrist-worn accelerometer data from 10 studies involving youth aged 5 to 15 y were pooled. Weekday and weekend waking hours were first calculated for youth in school Years (Y) 1&2, Y4&5, Y6&7, and Y8&9 to determine waking hours durations by age-groups and day types. A valid waking hours day was defined as accelerometer wear for ≥ 600 min·d-1 and participants with ≥ 3 valid weekdays and ≥ 1 valid weekend day were included. Mean ENMO- and MAD-generated average acceleration, intensity gradient, and MX metrics were calculated and summarised as weighted week averages. Sex-specific smoothed percentile curves were generated for each metric using Generalized Additive Models for Location Scale and Shape. Linear mixed models examined age and sex differences. Results: The analytical sample included 1250 participants. Physical activity peaked between ages 6.5-10.5 y, depending on metric. For all metrics the highest activity levels occurred in less active participants (3rd-50th percentile) and girls, 0.5 to 1.5 y earlier than more active peers, and boys, respectively. Irrespective of metric, boys were more active than girls (p < .001) and physical activity was lowest in the Y8&9 group, particularly when compared to the Y1&2 group (p < .001). Conclusions: Percentile reference values for average acceleration, intensity gradient, and MX metrics have utility in describing age- and sex-specific values for physical activity volume and intensity in youth. There is a need to generate nationally-representative wrist-acceleration population-referenced norms for these metrics to further facilitate health-related physical activity research and promotion

Factors influencing sedentary behaviours after stroke:Findings from qualitative observations and interviews with stroke survivors and their caregivers

Background Stroke survivors are more sedentary than healthy, age-matched controls, independent of functional capacity. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour. Methods Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 h) were analysed thematically and interview data (n = 31 stroke survivors, n = 12 caregivers) were analysed using the Framework approach. Results Observation participants differed in functional ability whereas stroke survivor interviewees were all ambulant. Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers’ influence on, and role in influencing stroke survivors’ sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers’ inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement. Conclusions Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach to develop strategies to reduce sedentary behaviour after stroke

What to consider when pseudohypoparathyroidism is ruled out: IPPSD and differential diagnosis

Background: Pseudohypoparathyroidism (PHP) is a rare disease whose phenotypic features are rather difficult to identify in some cases. Thus, although these patients may present with the Albright''s hereditary osteodystrophy (AHO) phenotype, which is characterized by small stature, obesity with a rounded face, subcutaneous ossifications, mental retardation and brachydactyly, its manifestations are somewhat variable. Indeed, some of them present with a complete phenotype, whereas others show only subtle manifestations. In addition, the features of the AHO phenotype are not specific to it and a similar phenotype is also commonly observed in other syndromes. Brachydactyly type E (BDE) is the most specific and objective feature of the AHO phenotype, and several genes have been associated with syndromic BDE in the past few years. Moreover, these syndromes have a skeletal and endocrinological phenotype that overlaps with AHO/PHP. In light of the above, we have developed an algorithm to aid in genetic testing of patients with clinical features of AHO but with no causative molecular defect at the GNAS locus. Starting with the feature of brachydactyly, this algorithm allows the differential diagnosis to be broadened and, with the addition of other clinical features, can guide genetic testing. Methods: We reviewed our series of patients (n = 23) with a clinical diagnosis of AHO and with brachydactyly type E or similar pattern, who were negative for GNAS anomalies, and classify them according to the diagnosis algorithm to finally propose and analyse the most probable gene(s) in each case. Results: A review of the clinical data for our series of patients, and subsequent analysis of the candidate gene(s), allowed detection of the underlying molecular defect in 12 out of 23 patients: five patients harboured a mutation in PRKAR1A, one in PDE4D, four in TRPS1 and two in PTHLH. Conclusions: This study confirmed that the screening of other genes implicated in syndromes with BDE and AHO or a similar phenotype is very helpful for establishing a correct genetic diagnosis for those patients who have been misdiagnosed with "AHO-like phenotype" with an unknown genetic cause, and also for better describing the characteristic and differential features of these less common syndromes

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection