Energy intake and energy expenditure among overweight children at the ages of 7-17 years : with focus on lipid intake

Övervikt och fetma är idag ett stort problem i världen hos både barn och vuxna och trots att andelen barn med fetma har minskat kvarstår problemen. Övervikt och fetma i barndomen ökar risken för en rad olika sjukdomar och för att nå en optimal hälsa är fysisk aktivitet samt rätt kost avgörande faktorer. Det här kandidatarbetet har genomförts vid pediatriska forskningslaboratoriet på Akademiska barnsjukhuset. Syftet med arbetet är att undersöka energiintaget med fokus på fettintag och energiförbrukningen hos överviktiga pojkar och flickor i åldrarna 7-17 år utifrån skattad aktivitets- och matdagbok. Syftet är även att jämföra dessa data med NNRs rekommendationer och mellan könen. I studien deltog 46 stycken överviktiga barn, 20 pojkar och 26 flickor. Befintlig data från barnens fysiska aktivitet och energiintag från registrerade aktivitets- och matdagböcker samlades in och sammanställdes. Energiintag, energiförbrukning och fettintag jämfördes med Nordens Näringsrekommendationer (NNR) samt mellan könen. Studien visade på att inga av barnen med övervikt uppnådde den fysiska aktiviteten som rekommenderas av NNR. Den självrapporterade fysiska aktiviteten för pojkarna varierade mellan 125-216 kJ/kg-kroppsvikt/dygn och för flickorna mellan 104-228 kJ/kg-kroppsvikt/dygn. En signifikant skillnad uppvisades mellan könen. Energiintaget varierade mellan 1158-3382 kcal/dygn för pojkarna och 463-7875 kcal/dygn för flickorna. 9 stycken barn hamnade över rekommenderat dagligt energiintag (NNR) medan 37 barn hamnade under. Fettintaget hos barnen låg generellt på en högre nivå än vad som rekommenderas (NNR), men detta är inte statistiskt fastställt. Denna studie tyder på att pojkar med övervikt har en högre fysisk aktivitetsnivå än flickor med övervikt. Gruppen som undersöktes nådde inte upp till vad som rekommenderas av NNR gällande fysisk aktivitet och en stor del av gruppen rapporterade ett högre fettintag samt ett lägre energiintag än vad som rekommenderas. Det behövs större studier med fler deltagare för att kunna dra mer pålitliga resultat och slutsatser gällande dessa frågor.Overweight and obesity are a big problem around the world among both children and adolescents. Even though the number of children having obesity has decreased the problem still remains. Overweight and obesity during childhood increase the risk for certain diseases and to be able to receive an optimal health both physical activity and a good diet are required. This thesis has been carried out in pediatric research laboratory at the University Children's Hospital. The aim of the report is to study energy intake with focus on fat intake and energy expenditure among overweighed boys and girls at the ages of 7-17 years based on estimated physical activity and food diary. The aim was also to compare these data with Nordic Nutrition Recommendations (NNR) and between the sexes. The study involved 46 overweighed children, 20 of them were boys and 26 of them were girls. Existing data on children's physical activity and energy intake from registered physical activity and food diaries were collected and compiled. Energy intake, energy expenditure and fat intake were compared with NNR and between the sexes. The result of the study is that none of the children with obesity achieved the physical activity that was recommended by the NNR. The self-reported physical activity for the boys ranged from 125 to 216 kJ / kg-body weight / day and for the girls between 104 to 228 kJ / kg-body weight / day. A significant difference was shown between the sexes. The energy intake ranged between 1158-3382 kcal / day for the boys and 463-7875 kcal / day for the girls. 9 children had a higher daily energy intake then recommended by NNR, while 37 children were under. Among the children the fat intake was generally higher then recommended (NNR). This was not statistically confirmed. The conclusion of the study is that overweighed boys have a higher level of physical activity than overweighed girls. The participants in this study did not achieve the level of physical activity recommended by NNR and a large part of the group reported a higher fat intake and a lower energy intake than recommended. More detailed researches are needed with more participants to draw more reliable results and conclusions regarding these issues

Vilka ingredienser har ersatt sockret i produkter märkta med ”utan tillsatt socker” och hur har det påverkat produktens innehåll av energi, fett, kolhydrater, sockerarter och protein?

Labels such as “no added sugar” is commonly used by food manufacturers and consumers may think that these products are healthier than similar products that contain “added sugar”. To recreate the sweet taste, the mouthfeel and texture in products with “no added sugar”, some other kind of ingredients need to be added. This can contribute to changes in the nutritional composition in the product. The aim of this study was to determine whether a replacement of sugar by other ingredients in the products; quark, muesli and protein bars change the energy, fat, carbohydrate, sugar and protein content. The aim was also to identify the used sweeteners in the selected products labelled with “no added sugars” and investigate the definition of the term “added sugar”. The study showed that the most commonly used sweeteners in products on the market labelled with “no added sugar” were; asesulfame k, aspartame, barley malt syrup, maltodextrin, oligofructose, fruits (dried, juice, concentrate and puree) and maltitol. Quark with “added sugar” contained more energy, fat, carbohydrates and sugars compared to quark with “no added sugar”. Protein bars with “added sugar” contained more energy, carbohydrates and sugars compared to protein bars with “no added sugar”. Protein bars with “no added sugar” contained more protein. Muesli with “added sugar” contained more sugars compared to muesli with “no added sugar”. Muesli with “no added sugar” contained more energy, fat and protein. The study also shows that the definition of “added sugar” differs between agencies and it can be hard for consumers to understand which kind of sweeteners that can replace sugar in products labelled with “no added sugar”.Livsmedelsprodukter märkta med bland annat ”utan tillsatt socker” syns ofta i mataffärerna. Konsumenter kan tro att dessa produkter är ett hälsosammare alternativ jämfört med liknande produkter som innehåller socker. För att bevara sötman, munkänslan och texturen i produkter märkta med ”utan tillsatt socker” behövs någon annan ingrediens tillsättas, vilket kan leda till att näringsinnehållet i produkten ändras. Syftet med studien var att undersöka hur innehållet av energi, fett, kolhydrater, sockerarter och protein påverkas av ingredienser som ersätter sockret i produkterna; kvarg, müsli och proteinbars märkta med ”utan tillsatt socker”. Syftet var också att undersöka vad produkten har sötats med istället för socker i de utvalda produkterna märkta med ”utan tillsatt socker” samt att undersöka definitionen av ”tillsatt socker”. Studien visade på att de vanligaste ingredienserna istället för socker i produkterna på marknaden märkta med ”utan tillsatt socker” var; asesulfam k, aspartam, maltsirap, oligofruktos, frukt (torkad, juice, koncentrat och puré) och maltitol. Kvarg med ”tillsatt socker” innehöll mer energi, fett, kolhydrater och sockerarter jämfört med kvarg märkt med ”utan tillsatt socker”. Protein bars med ”tillsatt socker” innehöll mer energi, kolhydrater och sockerarter jämfört med protein bars märkt med ”utan tillsatt socker”. Protein bars märkt med ”utan tillsatt socker” innehöll mer protein. Müsli med ”tillsatt socker” innehöll mer sockerarter jämfört med müsli märkt med ”utan tillsatt socker”. Müsli märkt med ”utan tillsatt socker” innehöll mer energi, fett och protein. Studien visade också på att ”tillsatt socker” varierar i definition mellan olika myndigheter. Komplexiteten gör det svårt för konsumenter att veta vilka ingredienser som kan ersätta sockret i produkter märkta med ”utan tillsatt socker”

Changes in acute hospital costs after employing clinical facilitators to improve stroke care in Victoria, Australia

BackgroundHospital costs for stroke are increasing and variability in care quality creates inefficiencies. In 2007, the Victorian Government (Australia) employed clinical facilitators for three years in eight public hospitals to improve stroke care. Literature on the cost implications of such roles is rare. We report changes in the costs of acute stroke care following implementation of this program.MethodsObservational controlled before-and-after cohort design. Standardised hospital costing data were compared pre-program (financial year 2006-07) and post-program (2010-11) for all admitted episodes of stroke or transient ischaemic attack (TIA) using ICD-10 discharge codes. Costs in Australian dollars (AUD) were adjusted to a common year 2010. Generalised linear regression models were used for adjusted comparisons.ResultsA 20% increase in stroke and TIA episodes was observed: 2624 pre-program (age>75years: 53%) and 3142 post-program (age>75years: 51%); largely explained by more TIA admissions (up from 785 to 1072). Average length of stay reduced by 22% (pre-program 7.3days to post-program 5.7days, pPeer reviewe

Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom

Stroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations. Specialist participants were identified using purposive sampling from two new services: Australia's Victorian Stroke Telemedicine Program (n = 6; 2010-13) and the United Kingdom's Cumbria and Lancashire telestroke network (n = 5; 2010-2012). Semi-structured interviews were conducted pre- and post-implementation, recorded and transcribed verbatim. Deductive thematic and content analysis (NVivo) was undertaken by two independent coders using Normalisation Process Theory to explore integration of telemedicine into practice. Agreement between coders was M = 91%, SD = 9 and weighted average κ = 0.70. Cross-cultural similarities and differences were found. In both countries, specialists described old and new consulting practices, the purpose and value of telemedicine systems, and concerns regarding confidence in the assessment and diagnostic skills of unknown colleagues requesting telemedicine support. Australian specialists discussed how remote consultations impacted on usual roles and suggested future improvements, while United Kingdom specialists discussed system governance, policy and procedures. Australian and United Kingdom specialists reported telemedicine required changes in work practice and development of new skills. Both groups described potential for improvements in stroke telemedicine systems with Australian specialists more focused on role change and the United Kingdom on system governance issues. Future research should examine if cross-cultural variation reflects different models of care and extends to other networks

Thrombolysis ImPlementation in Stroke (TIPS): evaluating the effectiveness of a strategy to increase the adoption of best evidence practice – protocol for a cluster randomised controlled trial in acute stroke care

BACKGROUND Stroke is a leading cause of death and disability internationally. One of the three effective interventions in the acute phase of stroke care is thrombolytic therapy with tissue plasminogen activator (tPA), if given within 4.5 hours of onset to appropriate cases of ischaemic stroke. OBJECTIVES To test the effectiveness of a multi-component multidisciplinary collaborative approach compared to usual care as a strategy for increasing thrombolysis rates for all stroke patients at intervention hospitals, while maintaining accepted benchmarks for low rates of intracranial haemorrhage and high rates of functional outcomes for both groups at three months. METHODS AND DESIGN A cluster randomised controlled trial of 20 hospitals across 3 Australian states with 2 groups: multi- component multidisciplinary collaborative intervention as the experimental group and usual care as the control group. The intervention is based on behavioural theory and analysis of the steps, roles and barriers relating to rapid assessment for thrombolysis eligibility; it involves a comprehensive range of strategies addressing individual-level and system-level change at each site. The primary outcome is the difference in tPA rates between the two groups post-intervention. The secondary outcome is the proportion of tPA treated patients in both groups with good functional outcomes (modified Rankin Score (mRS <2) and the proportion with intracranial haemorrhage (mRS ≥2), compared to international benchmarks. DISCUSSION TIPS will trial a comprehensive, multi-component and multidisciplinary collaborative approach to improving thrombolysis rates at multiple sites. The trial has the potential to identify methods for optimal care which can be implemented for stroke patients during the acute phase. Study findings will include barriers and solutions to effective thrombolysis implementation and trial outcomes will be published whether significant or not. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12613000939796

Impact of computed tomography perfusion imaging on the response to tenecteplase in ischemic stroke: analysis of two randomized controlled trials

Background: We pooled 2 clinical trials of tenecteplase compared with alteplase for the treatment of acute ischemic stroke, 1 that demonstrated superiority of tenecteplase and the other that showed no difference between the treatments in patient clinical outcomes. We tested the hypotheses that reperfusion therapy with tenecteplase would be superior to alteplase in improving functional outcomes in the group of patients with target mismatch as identified with advanced imaging. Methods: We investigated whether tenecteplase-treated patients had a different 24-hour reduction in the National Institutes of Health Stroke Scale and a favorable odds ratio of a modified Rankin scale score of 0 to 1 versus 2 to 6 compared with alteplase-treated patients using linear regression to generate odds ratios. Imaging outcomes included rates of vessel recanalization and infarct growth at 24 hours and occurrence of large parenchymal hematoma. Baseline computed tomography perfusion was analyzed to assess whether patients met the target mismatch criteria (absolute mismatch volume &gt;15 mL, mismatch ratio &gt;1.8, baseline ischemic core &lt;70 mL, and volume of severely hypoperfused tissue &lt;100 mL). Patients meeting target mismatch criteria were analyzed as a subgroup to identify whether they had different treatment responses from the pooled group. Results: Of 146 pooled patients, 71 received alteplase and 75 received tenecteplase. Tenecteplase-treated patients had greater early clinical improvement (median National Institutes of Health Stroke Scale score change: tenecteplase, 7; alteplase, 2; P=0.018) and less parenchymal hematoma (2 of 75 versus 10 of 71; P=0.02). The pooled group did not show improved patient outcomes when treated with tenecteplase (modified Rankin scale score 0–1: odds ratio, 1.77; 95% confidence interval, 0.89–3.51; P=0.102) compared with alteplase therapy. However, in patients with target mismatch (33 tenecteplase, 35 alteplase), treatment with tenecteplase was associated with greater early clinical improvement (median National Institutes of Health Stroke Scale score change: tenecteplase, 6; alteplase, 1; P&lt;0.001) and better late independent recovery (modified Rankin scale score 0–1: odds ratio, 2.33; 95% confidence interval, 1.13–5.94; P=0.032) than those treated with alteplase. Conclusions: Tenecteplase may offer an improved efficacy and safety profile compared with alteplase, benefits possibly exaggerated in patients with baseline computed tomography perfusion–defined target mismatch. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01472926. URL: https://www.anzctr.org.au. Unique identifier: ACTRN12608000466347