The Effects of the Jump-In Whole-School Intervention on the Weight Development of Children in Amsterdam, the Netherlands

BACKGROUNDThis study assessed the effects of the “Jump-in” whole-school intervention in Amsterdam, the Netherlands, on children's weight development by comparing children exposed to the intervention and controls from 3 other large Dutch cities. Jump-in is a comprehensive intervention that aims to stimulate healthy nutrition and physical activity in children at primary schools in Amsterdam. In addition, the relationship between the intervention's implementation degree and its effectiveness was studied.METHODSDemographic and anthropometric data, collected by youth health care professionals via routine health checks at T0 (2014) and T1 (2019), were used to analyze possible intervention effects by comparing the weight development of children exposed to the Jump-in intervention versus unexposed controls. Implementation logs from health promotion professionals were used to determine intervention effects per implementation degree. Multilevel regression analyses were used for all analyses.RESULTSIn total, 4299 children were included mean age ± 5.5 years (T0), 10.6 years (T1), and ≈50% boys/girls at both times. Receiving the fully implemented intervention resulted in a decline in standardized body-mass index (zBMI) compared to the controls (−0.23, confidence interval [CI] −0.33, −0.13). It also led to higher odds to move into a healthier weight category over time (odds ratio [OR] 1.36, CI 1.06, 1.74), yet no statistically significant shift towards a healthy weight was found.CONCLUSIONSRelative to the controls, children exposed to the intervention showed positive zBMI developments, with stronger effects when the implementation degree was higher. Despite positive results, creating more impact might require the further integration of school-based programs into whole-systems approaches that include other energy-balance behaviors

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

Teachers' causal attributions in problematic situations.

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