Recipient obesity does not affect survival after deceased donor liver transplantation for hepatocellular carcinoma. A national retrospective cohort study in the United States.

BACKGROUND: The oncological effects of obesity on liver transplant (LT) patients with hepatocellular carcinoma (HCC) remains unclear. We investigated patient overall survival and tested two-way interactions between donor and recipient obesity status. METHODS: Using the UNOS database, a total of 8352 LT recipients with HCC were included. Donors and recipients were stratified in normal weight (NW), overweight (OW) and obese (OB). Hazard ratios (HR) for any cause of death and interactions between recipient and donor BMI were estimated by multivariate flexible parametric models. RESULTS: Five-year overall survival was 66% for NW, 67% for OW and 68% for OB recipients. The HRs of death from all causes were 0.96 (95% CI: 0.86-1.08) for OW and 0.93 (95% CI: 0.82-1.05) for OB recipients when compared to NW patients. At multivariate analysis, predictors of inferior survival were recipient age (≥65 years), donor age (≥45 years), need for pre-operative dialysis, HCV infection, transplants performed before 2007, and UNOS regions 2,3,9,10, and 11. The lowest adjusted HR was measured for recipients with BMI between 25 and 35 and there were no interactions between recipient and donor BMI. CONCLUSIONS: the overall survival of LT recipients with HCC was not affected by donor or recipient obesity.

Describing Food Availability in Schools Using Different Healthy Eating Guidelines: Moving Forward with Simpler Nutrition Recommendations.

PURPOSE: Internationally, there is debate on whether a nutrient or a food-based approach to policy is more effective. This study describes the food/beverage availability in schools in Nova Scotia through a comparison of a traditional nutrient classification ("Maximum/Moderate/Minimum"), currently used in the provincial school policy and a simplified food-based system ("Core/Extra"). METHODS: School food environment audits were conducted in schools (n = 25) to record the food and beverages available. Registered dietitians categorized information using both the nutrient-based and simplified food-based classification systems. Number and percent in each category were described for items. RESULTS: Food and beverage items consisted of breakfast, lunch, snacks, beverages, and vending of which 81% were permissible by the policy, whereas only 54% were categorized as Core. Many snacks and vending items classified as Extra fell within either Moderate (45% and 35%, respectively) or Minimum (29% and 33%, respectively) categories. CONCLUSIONS: Dietitians have a role to support interpretation of classification systems for school nutrition policies. The nutrient-based classification used in the policy permitted some items not essential to a healthy diet as defined by the Extra food-based classification. However, the food-based Core/Extra categorization had less detail to classify nutrients.

Percentile curves for cardiometabolic disease markers in Canadian children and youth: a cross-sectional study.

BACKGROUND: The objective of this study to develop percentile curves for cardiometabolic disease markers in a population-based sample of Canadian children and youth. METHODS: The analysis used data from 6116 children and adolescents between 6 and 19 years of age who participated in the Canadian Health Measures Survey cycles 1 (2007/2009), 2 (2009/2011), and 3 (2012/2013). Total cholesterol, HDL cholesterol, and hemoglobin A1c levels as well as fasting levels of triglycerides, insulin, and homeostasis model assessment insulin resistance were measured using standardized procedures. Age- and sex-specific centiles for all markers were calculated using Cole and Green's LMS method. RESULTS: With the exception of hemoglobin A1c, all markers showed age- and sex-related differences during childhood and adolescence. CONCLUSIONS: We have developed centile curves for cardiometabolic disease markers in Canadian children and adolescents and demonstrated age and sex differences that should be considered when evaluating these markers in this age group.

A translational approach to characterization and measurement of health-promoting school ethos.

A health promoting schools (HPS) approach is hypothesized to influence student health and wellbeing by promoting a 'school ethos' that reflects the physical environment, social relations, organisational structure, policies and practices within schools. This complex set of factors makes health promoting school ethos (HPSE) challenging to define and measure. This work sought to theorise, develop and pilot a measure of HPSE as the context for implementation of HPS initiatives. We used a multi-method, iterative process to identify relevant HPSE concepts through triangulation of conceptual literature, existing tools and the tacit knowledge of school stakeholders. The HPSE measurement tool was administered to 18 elementary schools through a principal and teacher survey and an environmental assessment, followed by the development of HPSE scores for each school. Testing for internal consistency of items was used to examine theorized concepts, and scores for each school are summarised. HPSE included eight conceptual dimensions with internal consistency ranging from α = 0.60 to α = 0.87. Total HPSE scores across schools (N = 18) ranged from 1 to 8 (mean = 3.94, SD = 2.1), with 28-65% of schools reporting 'high' on respective HPSE dimensions. Schools included a heterogeneous mixture of HPSE scores, particularly across different dimensions. Our novel approach to tool development allowed us to conceptualize HPSE using a flexible process comprising different types and sources of evidence. The HPSE tool holds potential for identification and measurement of critical components of different school context as it relates to HPS.

Evaluation of a health promoting schools program in a school board in Nova Scotia, Canada.

A Health promoting schools (HPS) approach aims to make schools a healthy place through a holistic approach that promotes a supportive 'school ethos' and emphasizes improvements in physical, social, and emotional well-being and educational outcomes. A HPS initiative in rural Nova Scotia (Canada) provided an opportunity for a population-level natural experiment. This study investigated student well-being and health behaviours between schools with and without HPS implementation and schools with high and low school ethos scores. Student well-being, nutrition, and physical activity were examined in a cross-sectional survey of elementary students in Nova Scotia, Canada in 2014. Multiple regression was used to assess the relationship with student well-being using the Quality of Life in School (QoLS) instrument and health behaviours. The main exposure was attending one of the 10 HPS schools; secondary exposure was the school ethos score. The overall QoLS score and its subdomain scores in the adjusted models were higher in students attending HPS schools compared to those in non-HPS schools, but the differences were not statistically significant and the effect sizes were small. Students in schools that scored high on school ethos score had higher scores for the QoLS and its subdomains, but the difference was only significant for the teacher-student relationship domain. Although this study did not find significant differences between HPS and non-HPS schools, our results highlight the complexity of evaluating HPS effects in the real world. The findings suggest a potential role of a supportive school ethos for student well-being in school.

Birth Weight for Gestational Age, Anthropometric Measures, and Cardiovascular Disease Markers in Children.

OBJECTIVE: To examine the association of birth weight for gestational age with anthropometric measures and cardiometabolic markers in a population-based sample of Canadian children. STUDY DESIGN: The study used data from 2016 children aged 6-12 years from the first 2 cycles of the Canadian Health Measures Survey, a population-based survey of Canadian residents. The main exposure was birth weight for gestational age (small [SGA], large [LGA], and appropriate for gestational age [AGA]). The outcomes were anthropometric measures, blood pressure, and laboratory cardiovascular disease markers. The association between the exposure and the outcomes was examined using multiple regression. Analyses were weighted to account for the complex sampling design and for nonresponse. RESULTS: SGA infants had lower and LGA infants had higher z scores for anthropometric measures compared with the AGA group but most differences were not statistically significant. There were no differences between the SGA or LGA infants and the AGA group in blood pressure or individual cardiometabolic markers but SGA infants were significantly less likely to have elevated levels of 3 or more components of the metabolic syndrome compared with their AGA peers. CONCLUSIONS: Former SGA and LGA infants have lower (SGA) and higher (LGA) body mass index and waist circumference, respectively, than their AGA peers. The known long-term increased cardiovascular disease risk among SGA or LGA infants was not reflected in the blood pressure and laboratory measurements at age 6-12 years.

Percentile Curves for Anthropometric Measures for Canadian Children and Youth.

Body mass index (BMI) is commonly used to assess a child's weight status but it does not provide information about the distribution of body fat. Since the disease risks associated with obesity are related to the amount and distribution of body fat, measures that assess visceral or subcutaneous fat, such as waist circumference (WC), waist-to-height ratio (WHtR), or skinfolds thickness may be more suitable. The objective of this study was to develop percentile curves for BMI, WC, WHtR, and sum of 5 skinfolds (SF5) in a representative sample of Canadian children and youth. The analysis used data from 4115 children and adolescents between 6 and 19 years of age that participated in the Canadian Health Measures Survey Cycles 1 (2007/2009) and 2 (2009/2011). BMI, WC, WHtR, and SF5 were measured using standardized procedures. Age- and sex-specific centiles were calculated using the LMS method and the percentiles that intersect the adult cutpoints for BMI, WC, and WHtR at age 18 years were determined. Percentile curves for all measures showed an upward shift compared to curves from the pre-obesity epidemic era. The adult cutoffs for overweight and obesity corresponded to the 72nd and 91st percentile, respectively, for both sexes. The current study has presented for the first time percentile curves for BMI, WC, WHtR, and SF5 in a representative sample of Canadian children and youth. The percentile curves presented are meant to be descriptive rather than prescriptive as associations with cardiovascular disease markers or outcomes were not assessed.

Brief emergency department interventions for youth who use alcohol and other drugs: a systematic review.

OBJECTIVE: Brief intervention (BI) is recommended for use with youth who use alcohol and other drugs. Emergency departments (EDs) can provide BIs at a time directly linked to harmful and hazardous use. The objective of this systematic review was to determine the effectiveness of ED-based BIs. METHODS: We searched 14 electronic databases, a clinical trial registry, conference proceedings, and study references. We included randomized controlled trials with youth 21 years or younger. Two reviewers independently selected studies and assessed methodological quality. One reviewer extracted and a second verified data. We summarized findings qualitatively. RESULTS: Two trials with low risk of bias, 2 trials with unclear risk of bias, and 5 trials with high risk of bias were included. Trials evaluated targeted BIs for alcohol-positive (n = 3) and alcohol/other drug-positive youth (n = 1) and universal BIs for youth reporting recent alcohol (n = 4) or cannabis use (n = 1). Few differences were found in favor of ED-based BIs, and variation in outcome measurement and poor study quality precluded firm conclusions for many comparisons. Universal and targeted BIs did not significantly reduce alcohol use more than other care. In one targeted BI trial with high risk of bias, motivational interviewing (MI) that involved parents reduced drinking quantity per occasion and high-volume alcohol use compared with MI that was delivered to youth only. Another trial with high risk of bias reported an increase in abstinence and reduction in physical altercations when youth received peer-delivered universal MI for cannabis use. In 2 trials with unclear risk of bias, MI reduced drinking and driving and alcohol-related injuries after the ED visit. Computer-based MI delivered universally in 1 trial with low risk of bias reduced alcohol-related consequences 6 months after the ED visit. CONCLUSIONS: Clear benefits of using ED-based BI to reduce alcohol and other drug use and associated injuries or high-risk behaviours remain inconclusive because of variation in assessing outcomes and poor study quality.

Instruments to detect alcohol and other drug misuse in the emergency department: a systematic review.

CONTEXT: Alcohol and other drug (AOD) misuse by youth is a significant public health concern. Unanticipated treatment for AOD-related morbidities is often sought in hospital emergency departments (EDs). Screening instruments that rapidly identify patients who require further diagnostic evaluation and/or brief intervention are critically important. OBJECTIVE: To summarize evidence on screening instruments that can assist emergency care clinicians in identifying AOD misuse in pediatric patients. METHODS: Fourteen electronic databases (including Medline, Embase, and PsycINFO) and reference screening were used. Psychometric and prospective diagnostic studies were selected if the instrument focused on detecting AOD misuse in patients aged 21 years or younger in the ED. Two reviewers independently assessed quality and extracted data. Validity and reliability data were collected for psychometric studies. Instrument performance was assessed by using sensitivity, specificity, and positive (LR(+)) and negative (LR(-)) likelihood ratios. Meta-analysis was not possible because of clinical and measurement heterogeneity. RESULTS: Of the 1545 references initially identified, 6 studies met inclusion criteria; these studies evaluated 11 instruments for universal or targeted screening of alcohol misuse. Instruments based on diagnostic criteria for AOD disorders were effective in detecting alcohol abuse and dependence (sensitivity: 0.88; specificity: 0.90; LR(+): 8.80) and cannabis use disorder (sensitivity: 0.96; specificity: 0.86; LR(+): 6.83). CONCLUSIONS: On the basis of the current evidence, we recommend that emergency care clinicians use a 2-question instrument for detecting youth alcohol misuse and a 1-question instrument for detecting cannabis misuse. Additional research is required to definitively answer whether these tools should be used as targeted or universal screening approaches in the ED.

A Description of Emergency Care Received by Children and Youth with Mental Health Presentations for Alcohol and Other Drug use in two Alberta Emergency Departments.

OBJECTIVE: This paper describes patient and treatment characteristics of pediatric mental health Emergency Department (ED) visits associated with alcohol and other drug (AOD) use. METHOD: A medical record and administrative database review was conducted. Proportional allocation random stratified sampling identified a representative sample of pediatric (≤18 years) mental health presentations to two tertiary care EDs between April 2004 and March 2006. Descriptive statistics were used to summarize data from 161 patients with associated AOD use. RESULTS: More females (56.5%) and youth aged 15 to 18 years (70.8%) attended the ED for mental health complaints associated with AOD use. Alcohol (48.4%) and over-the-counter or prescription medications (25.5%) were the most commonly used substances. Twenty-four percent of patients had a documented psychiatric history. The most common psychiatric assessments provided were for suicidality (31.1%) and mood (18.0%). Brief counselling was provided in 31.7% of visits. Consultation with psychiatry occurred less than 20% of the time. Most patients were discharged from the ED (65.2%). Sixty-eight percent of patient records did not have documented discharge planning. CONCLUSIONS: When youth present to the ED for mental health concerns related to AOD use, mental health assessments and follow-up care are not occurring in all cases and reasons for this oversight need to be explored.