Exposome changes in primary school children following the wide population non-pharmacological interventions implemented due to COVID-19 in Cyprus: A national survey.

BACKGROUND: Non-pharmacological interventions (NPI), including lockdowns, have been used to address the COVID-19 pandemic. We describe changes in the environment and lifestyle of school children in Cyprus before the lockdown and during school re-opening, and assess compliance to NPI, using the exposome concept. METHODS: During June 2020, parents completed an online questionnaire about their children's lifestyle/behaviours for two periods; school re-opening (May 21-June 26) following the population-wide lockdown, and the school period before lockdown (before March). FINDINGS: Responses were received for 1509 children from over 180 primary schools. More than 72% of children complied with most NPI measures; however, only 48% decreased the number of vulnerable contacts at home. Sugary food consumption was higher in the post-lockdown period with 37% and 26% of the children eating sugary items daily and 4-6 times/week, compared to 33% and 19%, respectively, for the pre-lockdown period (p<0.001). Children's physical activity decreased compared to pre-lockdown (p<0.001), while screen time increased in the post-lockdown period, with 25% of children spending 4-7 hours/day in front of screens vs. 10% in the pre-lockdown period (p<0.001). About half of the children washed their hands with soap 4-7 times/day post-lockdown vs. 30% in the pre-lockdown period (p<0.001). INTERPRETATION: This national survey showed a high degree of compliance to NPI measures among school children. Furthermore, the exposome profile of children may be affected in the months following NPI measures due to alterations in diet, physical activity, sedentary behaviour, and hand hygiene habits. FUNDING: Partial funding by the EXPOSOGAS project, H2020 Research and Innovation Programme (grant #810995).

Contrasting short-term temperature effects on the profiling of metabolic and stress hormones in non-obese healthy adults: A randomized cross-over trial.

The manifestation of elevated and sustained air temperature gradient profiles in urban dwellings represents an emerging planetary health phenomenon. There is currently limited evidence about the effect of elevated air temperatures on metabolic health. The aim of this work was to assess changes in metabolic and stress hormonal profiles during a short-term stay in a mountainous, climate-cooler setting against those observed in the urban setting. A prospective, randomized, 2 x 2 cross-over trial of non-obese healthy adults in urban and mountainous areas of a Mediterranean country (Cyprus) was set up during summer, under real-life conditions. The intervention was a short-term stay (mean ± SD: 7 ± 3 days) in a mountainous, climate-cooler setting (altitude range: 650-1200 m), being ~1-h drive away from the main urban centres of Cyprus. The primary endpoint was the change in metabolic hormones levels (leptin and adiponectin) and stress hormone levels (cortisol) between the two settings. Personal air and skin temperature sensors were deployed while biospecimen were collected in each setting. A total of 41 participants between 20 and 60 years old were enrolled and randomized during July 2018, of whom 39 received the allocated intervention, 8 were lost to follow up or excluded from analysis and a total of 31 participants were analysed. A significant leptin reduction (ß = -0.255; 95% CI: -0.472, -0.038; p = 0.024) was observed for non-obese healthy adults during their short-term stay in the mountainous environment. The intervention effect on adiponectin or cortisol levels was not statistically significant (ß = 0.058; 95% CI: -0.237, 0.353; p = 0.702), and (ß = -0.026; 95% CI: -0.530, 0.478; p = 0.920), respectively. In additional analyses, daily max skin temperature surrogate measures were significantly associated with leptin levels (ß = 0.34; 95% CI: 0.051, 0.633; p = 0.024). During summer season, a short-term stay in climatologically cooler areas improved the leptin levels of non-obese healthy adults who permanently reside in urban areas of a Mediterranean country. A larger sample is needed to confirm the trial findings that could provide the rationale for such public health interventions in climate-impacted urban areas of our planet.

A novel approach for increasing fruit consumption in children.

Despite the well-documented health benefits of fruits and vegetables and the public health campaigns promoting their consumption, children's intake is below the recommended levels. A randomized controlled trial for evaluating the effectiveness of a school-based intervention for increasing children's fruit intake, with the teacher being the exposure model, was designed. Two hundred eighteen elementary school students (aged 9 years) in Cyprus were randomly assigned into two 1-year intervention groups, the Educational Material group (EDUC) (n=59) and the Exposure group (EXPO) (n=67), or a control group (n=58). Children's dietary intake was assessed through 2-day dietary records before the intervention began (October 2008), at the end of the intervention (June 2009), and at 1-year follow-up (June 2010). Students in the EDUC group received a weekly educational program for increasing awareness and improving skills regarding fruit preparation/consumption and students in the EXPO group were exposed to the consumption of a fruit on a daily basis by their teacher. The control group members received no intervention. Repeated measures analysis of variance was used to evaluate the group effect and the time×group interaction. Higher fruit intake was reported by the children in the EXPO and the EDUC groups compared with the control group at the end of the intervention: a statistically significant group effect was found (P<0.001). At 1-year follow-up, results remained significant only for the children in the EXPO group (P<0.001). Exposure to fruit consumption by schoolteachers may be a more effective way for improving fruit intake of children compared with traditional educational approaches.