Comparison of actigraphy-measured and parent-reported sleep in association with weight status among preschool children.

This study compared weekday and weekend actigraphy-measured and parent-reported sleep in relation to weight status among preschool-aged children. Participants were 3-6 years old preschoolers from the cross-sectional DAGIS-study with sleep data for ≥2 weekday and ≥2 weekend nights. Parents-reported sleep onset and wake-up times were gathered alongside 24 h hip-worn actigraphy. An unsupervised Hidden-Markov Model algorithm provided actigraphy-measured night time sleep without the guidance of reported sleep times. Waist-to-height ratio and age-and-sex-specific body mass index characterised weight status. Comparison of methods were assessed with consistency in quintile divisions and Spearman correlations. Associations between sleep and weight status were assessed with adjusted regression models. Participants included 638 children (49% girls) with a mean ± SD age of 4.76 ± 0.89. On weekdays, 98%-99% of actigraphy-measured and parent-reported sleep estimates were classified in the same or adjacent quintile and were strongly correlated (rs = 0.79-0.85, p < 0.001). On weekends, 84%-98% of actigraphy-measured and parent-reported sleep estimates were respectively classified and correlations were moderate to strong (rs = 0.62-0.86, p < 0.001). Compared with actigraphy-measured sleep, parent-reported sleep had consistently earlier onset, later wake-up, and greater duration. Earlier actigraphy-measured weekday sleep onset and midpoint were associated with a higher body mass index (respective ß-estimates: -0.63, p < 0.01 and -0.75, p < 0.01) and waist-to-height ratio (-0.004, p = 0.03 and -0.01, p = 0.02). Though the sleep estimation methods were consistent and correlated, actigraphy measures should be favoured as they are more objective and sensitive to identifying associations between sleep timing and weight status compared with parent reports.

Food consumption and nutrient intake of Finnish preschool children according to parental educational level.

We examined the association between parental educational level (PEL) and children's food consumption and nutrient intake in a sample of Finnish 3- to 6-year-old preschoolers (n 811). The data were obtained from the cross-sectional DAGIS project, conducted in eight municipalities in Finland during 2015-2016. The food consumption and nutrient intake were assessed using food records. The highest educational level of the family was used as the indicator of socio-economic status. Differences in diet by PEL were analysed using a hierarchical linear model adjusted for energy intake. Compared with high PEL, low PEL was associated with a child's lower consumption of fresh vegetables and salads, vegetarian dishes, berries, white bread, blended spread, skimmed milk and ice cream but higher consumption of milk with 1-1·5 % fat content, dairy-based desserts and sugar-sweetened soft drinks. Food consumption was also examined after disaggregating dishes into their ingredients. Low PEL was associated with lower consumption of vegetables, nuts and seeds, berries and fish but higher consumption of red meat. Children in the low PEL, compared with the high PEL group, had a lower intake of protein, fibre, EPA, DHA, vitamin D, riboflavin, vitamin B6, folate, vitamin B12, vitamin C, potassium, phosphorous, Ca, Mg, Zn and iodine but a higher intake of fat and saturated, trans and MUFA. The observed diet-related disparities highlight the need for policy actions and interventions supporting healthy eating patterns such as high consumption of vegetables, nuts and berries in childhood, paying special attention to those with low PEL.

Association of the timing of evening eating with BMI Z-score and waist-to-height ratio among preschool-aged children in Finland.

Later timing of eating has been associated with higher adiposity among adults and children in several studies, but not all. Moreover, studies in younger children are scarce. Hence, this study investigated the associations of the timing of evening eating with BMI Z-score and waist-to-height ratio (WHtR), and whether these associations were moderated by chronotype among 627 preschoolers (3-6-year-olds) from the cross-sectional DAGIS survey in Finland. Food intake was measured with 3-d food records, and sleep was measured with hip-worn actigraphy. Three variables were formed to describe the timing of evening eating: (1) clock time of the last eating occasion (EO); (2) time between the last EO and sleep onset; and (3) percentage of total daily energy intake (%TDEI) consumed 2 h before sleep onset or later. Chronotype was assessed as a sleep debt-corrected midpoint of sleep on the weekend (actigraphy data). The data were analysed with adjusted linear mixed effects models. After adjusting for several confounders, the last EO occurring closer to sleep onset (estimate = -0·006, 95 % CI (-0·010, -0·001)) and higher %TDEI consumed before sleep onset (estimate = 0·0004, 95 % CI (0·00003, 0·0007)) were associated with higher WHtR. No associations with BMI Z-score were found after adjustments. Clock time of the last EO was not significantly associated with the outcomes, and no interactions with chronotype emerged. The results highlight the importance of studying the timing of eating relative to sleep timing instead of only as clock time.

How energy balance-related behaviours, temperament, stress and overweight associate: a cross-sectional study of Finnish preschoolers.

OBJECTIVE: This study aimed to (1) examine the clustering of energy balance-related behaviours (EBRB) and (2) investigate whether EBRB clusters, temperament and hair cortisol concentration (HCC) associate with overweight. DESIGN: We assessed food consumption using food records, screen time (ST) using sedentary behaviour diaries, sleep consistency and temperament (negative affectivity, surgency, effortful control) using questionnaires and HCC using hair samples. Accelerometers were used to assess physical activity (PA) intensities, sleep duration and sleep efficiency. Researchers measured each child's weight and height. We used finite mixture models to identify EBRB clusters and multilevel logistic regression models to examine the associations between EBRB clusters, temperament, HCC and overweight. SETTING: The cross-sectional DAGIS survey, data collected in 2015-2016. PARTICIPANTS: Finnish 3-6-year-olds (n 864) recruited through preschools. RESULTS: One-third of the participants were categorised into the cluster labelled 'Unhealthy diet, excessive screen time', characterised by unhealthy dietary choices (e.g. greater consumption of high-fat, high-sugar dairy products) and longer ST. Two-thirds were categorised into the second cluster, labelled 'Healthy diet, moderate screen time'. PA and sleep were irrelevant for clustering. Higher negative affectivity and lower effortful control associated with the 'Unhealthy diet, excessive screen time' cluster. EBRB clusters and HCC did not associate with overweight, but surgency was positively associated with overweight (OR = 1·63, 95 % CI 1·17, 2·25). CONCLUSIONS: Of the EBRB, food consumption and ST seem to associate. As temperament associates with EBRB clusters and overweight, tailored support acknowledging the child's temperament could be profitable in maintaining a healthy weight.

Indoleamine 2,3-dioxygenase (IDO)-1 and IDO-2 activity and severe course of COVID-19.

COVID-19 is a pandemic with high morbidity and mortality. In an autopsy cohort of COVID-19 patients, we found extensive accumulation of the tryptophan degradation products 3-hydroxy-anthranilic acid and quinolinic acid in the lungs, heart, and brain. This was not related to the expression of the tryptophan-catabolizing indoleamine 2,3-dioxygenase (IDO)-1, but rather to that of its isoform IDO-2, which otherwise is expressed rarely. Bioavailability of tryptophan is an absolute requirement for proper cell functioning and synthesis of hormones, whereas its degradation products can cause cell death. Markers of apoptosis and severe cellular stress were associated with IDO-2 expression in large areas of lung and heart tissue, whereas affected areas in brain were more restricted. Analyses of tissue, cerebrospinal fluid, and sequential plasma samples indicate early initiation of the kynurenine/aryl-hydrocarbon receptor/IDO-2 axis as a positive feedback loop, potentially leading to severe COVID-19 pathology. © 2021 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Associations between socioeconomic status, home food availability, parental role-modeling, and children's fruit and vegetable consumption: a mediation analysis.

BACKGROUND: Recent literature has suggested that associations and interactions between family socioeconomic status (SES) and home food environment influence children's diet, but little is known about the mediation roles of parental role-modeling and food availability in the socioeconomic inequalities of children's diet. This study aimed to determine the associations between family SES and children's fruit and vegetable (FV) consumption and to assess the mediation roles of parental role-modeling and food availability in the above associations. METHODS: Cross-sectional data of 574 Finnish children (aged 3 to 6) were analyzed. Parents completed an FFQ assessing their children's FV consumption frequency and a questionnaire assessing SES and home food environment. Two exposure variables: parental educational level ("low", "middle", and "high") and the relative family income tertiles of the family were used. The frequencies of parental role-modeling of FV and sugary food and drink (SFD) consumption, and the availability of FV and SFD at home were calculated. Single- and multiple-mediator models were created using IBM SPSS 27.0. RESULTS: The positive association between high parental educational level and children's FV consumption (direct effect coefficient: 2.76, 95% CI: 0.51-4.86) was partially mediated by more frequent parental role-modeling of FV consumption (indirect effect coefficient: 0.89, 95% CI: 0.10-1.76), higher availability of FV (indirect effect coefficient: 1.00, 95% CI: 0.35-1.77), and lower availability of SFD (indirect effect coefficient: -0.30, 95% CI: -0.72 - -0.01). The relative family income was not directly associated with the outcome. However, the higher relative family income level indirectly predicted the Children's FV consumption (full mediation) through more frequent parental role-modeling of FV consumption (indirect effect coefficient: 0.91, 95% CI: 0.06-1.83) and higher availability of FV (indirect effect coefficient: 0.98, 95% CI: 0.40-1.67). Parental role-modeling on SFD consumption did not mediate any of the above associations. CONCLUSIONS: Parental educational level showed more associations with children's FV consumption than relative family income. Our findings suggest that reducing the availability of SFD is as important as increasing the availability of FV to enhance children's FV consumption. Future interventions to improve children's dietary behaviors should pay greater attention to the lower SES segments of society. Longitudinal studies and intervention studies supporting these findings are needed for making meaningful recommendations for health promotion.

The role of parental congruence in pre-school children's screen time, moderated by parental education.

AIM: This study investigated whether parental congruency regarding screen time (ST) is associated with ST in pre-school children. In addition, we investigated whether parental education levels moderated this relationship. METHODS: A cross-sectional study was conducted in 2015-2016 in Finland (N = 688). Parents completed a questionnaire reporting their children's sedentary behaviour, their parental congruency regarding ST rules, and their educational level. Associations were examined using linear regression. RESULTS: Children of parents with higher congruence regarding ST rules engaged in less ST, this was moderated by parental education levels. Children whose parents had a high level of education and parents' who strongly agree or somewhat agree on ST rules was negatively associated with ST. Furthermore, children whose parents had a medium level of education and parents' who strongly agree on ST rules was negatively associated with ST. CONCLUSION: Children of parents who agree on ST rules engaged in less ST compared with children of parents who do not agree on ST rules. Providing advice to parents regarding parental congruency could be the focus of future interventions.

Spatiotemporal analysis of tumour-infiltrating immune cells in biliary carcinogenesis.

BACKGROUND: Intraductal papillary neoplasms (IPN) and biliary epithelial neoplasia (BilIN) are well-defined precursor lesions of biliary tract carcinoma (BTC). The aim of this study was to provide a comprehensive characterisation of the inflammatory microenvironment in BTC precursor lesions. METHODS: Immunohistochemistry was employed to assess tumour-infiltrating immune cells in tissue samples from patients, for whom precursor lesions were identified alongside invasive BTC. The spatiotemporal evolution of the immune microenvironment during IPN-associated carcinogenesis was comprehensively analysed using triplet sample sets of non-neoplastic epithelium, precursor lesion and invasive BTC. Immune-cell dynamics during IPN- and BilIN-associated carcinogenesis were subsequently compared. RESULTS: Stromal CD3+ (P = 0.002), CD4+ (P = 0.007) and CD8+ (P < 0.001) T cells, CD20+ B cells (P = 0.008), MUM1+ plasma cells (P = 0.012) and CD163+ M2-like macrophages (P = 0.008) significantly decreased in IPN compared to non-tumorous biliary epithelium. Upon transition from IPN to invasive BTC, stromal CD68+ (P = 0.001) and CD163+ (P < 0.001) macrophages significantly increased. In contrast, BilIN-driven carcinogenesis was characterised by significant reduction of intraepithelial CD8+ T-lymphocytic infiltration from non-tumorous epithelium via BilIN (P = 0.008) to BTC (P = 0.004). CONCLUSION: IPN and BilIN are immunologically distinct entities that undergo different immune-cell variations during biliary carcinogenesis. Intraepithelial CD8+ T-lymphocytic infiltration of biliary tissue decreased already at the IPN-precursor stage, whereas BilIN-associated carcinogenesis showed a slowly progressing reduction towards invasive carcinoma.

Outcomes of Irreversible Electroporation for Perihilar Cholangiocarcinoma: A Prospective Pilot Study.

PURPOSE: To investigate the safety and efficacy of percutaneous or open irreversible electroporation (IRE) in a prospective cohort of patients with locally advanced, unresectable perihilar cholangiocarcinoma (PHC). MATERIALS AND METHODS: In a multicenter Phase I/II study, patients with unresectable PHC due to extensive vascular involvement or N2 lymph node metastases or local recurrence after resection for PHC were included and treated by open or percutaneous IRE combined with palliative chemotherapy (current standard of care). The primary outcome was the number of major adverse events occurring within 90 d after IRE (grade ≥3), and the upper limit was predefined at 60%. Secondary outcomes included technical success rate, hospital stay, and overall survival (OS). RESULTS: Twelve patients (mean age, 63 y ± 12) were treated with IRE. The major adverse event rate was 50% (6 of 12 patients), and no 90-d mortality was observed. All procedures were technically successful, with no intraprocedural adverse events requiring additional interventions. The median OS from diagnosis was 21 mos (95% confidence interval, 15-27 mos), with a 1-y survival rate of 75% after IRE. CONCLUSIONS: Percutaneous IRE in selected patients with locally advanced PHC seems feasible, with a major adverse event rate of 50%, which was below the predefined upper safety limit in this prospective study. Future comparative research exploring the efficacy of IRE is warranted.

Sustainability analysis of Finnish pre-schoolers' diet based on targets of the EAT-Lancet reference diet.

PURPOSE: The EAT-Lancet reference diet is a healthy plant-based diet produced within planetary boundaries. To inform the food system transformation, we compared Finnish pre-schoolers' food consumption with the reference diet's food group targets. METHODS: Food record data for 3- to 6-year-old pre-schoolers were collected in the cross-sectional DAGIS survey. Ingredients of composite dishes were available in the data. In addition, we manually decomposed industrial products such as sausages and biscuits by estimating the shares of ingredients. We also estimated the consumption of added sugars and converted the consumption of dairy products into milk equivalents. We used usual intake modelling to estimate the mean consumption and the proportion of children who met the reference diet's targets. We set the target amounts separately for 3- to 4-year-olds and 5- to 6-year-olds in grams by proportioning the published target amounts (assuming a 2500 kcal diet) to the children's mean reported energy intake. RESULTS: For both age groups (3- to 4-year-olds, n = 460; 5- to 6-year-olds, n = 402), the daily mean consumption of whole grains, vegetables, legumes, nuts, and unsaturated oils was below targets, whereas the consumption of red meat, dairy foods, tubers, and added sugars was above targets. The consumption of fruit and fish was in line with targets. CONCLUSION: To comply with the reference diet's targets, major changes in the diets of Finnish children are needed. The key food groups targeted for higher consumption are whole grains and legumes and targeted for lower consumption red meat and dairy products.

ACE2 Protein Expression During Childhood, Adolescence, and Early Adulthood.

Purpose and context. Angiotensin-converting enzyme 2 is the entry receptor for SARS-CoV and SARS-CoV-2. Variations in ACE2 expression might explain age-related symptomatology of COVID-19, that is, more gastro-intestinal symptoms and less pulmonary complaints. This study qualitatively investigated ACE2 protein expression in various organs from the fetal to the young adolescent stage. Method. Autopsy samples from lung, heart, liver, stomach, small intestine, pancreas, kidney, adrenals, and brain (when available) were obtained from twenty subjects aged 24 weeks gestational age through 28 years. Formalin-fixed paraffin-embedded 4-um-thick tissue sections were stained against ACE2. Key results. We showed that the extent of ACE2 expression is age-related. With age, expression increases in lungs and decreases in intestines. In the other examined organs, ACE2 protein expression did not change with age. In brain tissue, ACE2 was expressed in astrocytes and endothelial cells. Conclusions. Age-related ACE2 expression differences could be one substrate of the selective clinical vulnerability of the respiratory and gastro-intestinal system to SARS-CoV-2 infection during infancy.

Comparing estimates of physical activity in children across different cut-points and the associations with weight status.

This study aimed to compare sedentary time (SED) and intensity-specific physical activity (PA) estimates and the associations of SED and PA with body mass index (BMI) and waist circumference (WC) using three different sets of cut-points in preschool-aged children. A total of 751 children (4.7 ± 0.9 years, boys 52.7%) wore an ActiGraph GT3X+BT accelerometer on their hip for 7 days (24 h). Euclidean norm -1 G with negative values rounded to zero (ENMO) and activity counts from vertical axis (VACounts) and vector magnitude (VMCounts) were derived. Estimates of SED and light, moderate, vigorous, and moderate-to-vigorous PA (MVPA) were calculated for commonly used cut-points by Hildebrand et al., Butte et al., and Evenson et al. Furthermore, the prevalence of meeting the PA recommendation, 180 min/day of which at least 60 min/day being MVPA, were assessed for the cut-points. Multilevel mixed analysis was used to examine associations of SED and PA with BMI and WC. In accordance with the results, SED and PA intensity estimates differed largely across cut-points (i.e., SED = 22-341 min/day; light PA = 52-257 min/day; moderate PA = 5-18 min/day; vigorous PA = 7-17 min/day; MVPA = 13-35 min/day), and the prevalence of children meeting the PA recommendation varied from 4% to 70%. Associations of SED and PA with BMI or WC varied between the cut-points. Our results indicate that SED and PA estimates in preschool-aged children between studies using these cut-points are poorly comparable. Methods facilitating accelerometer-derived PA estimate comparison between studies are highly warranted.

Effects of the DAGIS randomized controlled trial on home environment and children's food consumption according to the degree of implementation.

BACKGROUND: Combining process evaluation data with effectiveness data and examining the possible mediators of intervention effects elicits valuable knowledge about how and for whom these interventions are effective. The aim of this study was to examine whether the parental degree of implementation (DOI) of a home-involving preschool intervention affected children's food consumption via home mediators. METHODS: The five-month Increased Health and Wellbeing in Preschools (DAGIS) intervention involved 476 participating children aged 3-6 years and was conducted in 2017-2018. Parents reported children's food consumption (g/day) outside childcare hours, the availability of foods at home, role modelling of food consumption, and the norms related to food consumption. In addition, parents reported the extent to which they had implemented the intervention program at home. Mediation analyses were conducted to examine the effect of low and high DOI compared to control group on the change in children's consumption of fruit and vegetables (FV), sugary everyday foods, sugary treats, and sugar-sweetened beverages (SSB) via food availability in the home, parental role modelling and parental norms. RESULTS: Compared to the control group, there was a direct effect of a high DOI on diminishing consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No indirect effects were detected. In the high DOI group, a change in parental norm was associated with increased FV consumption showing an indirect effect (B 4.31, 95% CI 0.23, 10.59). In the low DOI group, there was an indirect effect via decreased food availability leading to decreased sugary everyday food consumption (B -2.17, 95% CI -5.09,  -0.09). CONCLUSIONS: Combining process evaluation and effectiveness data revealed a decrease in children's SSB consumption only in the high DOI group, as well as indirect effects on children's consumption of FV and sugary everyday foods. In order to gain more intervention effects, further studies are required in order to examine parental facilitators and barriers to the implementation of interventions and how to impact effectively the determinants of the targeted behavior. TRIAL REGISTRATION: ISRCTN57165350 (8 January, 2015).

Eligibility for Liver Transplantation in Patients with Perihilar Cholangiocarcinoma.

BACKGROUND: Liver transplantation (LT) has been performed in a select group of patients presenting with unresectable or primary sclerosing cholangitis (PSC)-associated perihilar cholangiocarcinoma (pCCA) in the Mayo Clinic with a reported 5-year overall survival (OS) of 53% on intention-to-treat analysis. The objective of this study was to estimate eligibility for LT in a cohort of pCCA patients in two tertiary referral centers. METHODS: Patients diagnosed with pCCA between 2002 and 2014 were included from two tertiary referral centers in the Netherlands. The selection criteria used by the Mayo Clinic were retrospectively applied to determine the proportion of patients that would have been eligible for LT. RESULTS: A total of 732 consecutive patients with pCCA were identified, of whom 24 (4%) had PSC-associated pCCA. Overall, 154 patients had resectable disease on imaging and 335 patients were ineligible for LT because of lymph node or distant metastases. An age limit of 70 years led to the exclusion of 50 patients who would otherwise be eligible for LT. After applying the Mayo Clinic criteria, only 34 patients (5%) were potentially eligible for LT. Median survival from diagnosis for these 34 patients was 13 months (95% CI 3-23). CONCLUSION: Only 5% of all patients presenting with pCCA were potentially eligible for LT under the Mayo criteria. Without transplantation, a median OS of about 1 year was observed.

Associations between hair and salivary cortisol, salivary alpha-amylase, and temperament dimensions among 3-6-year-olds.

Associations between hair cortisol concentration (HCC), diurnal salivary cortisol (sCort) and alpha-amylase (sAA), and temperament dimensions were examined among 3-6-year-old Finnish children (n = 833). Children's hair samples were collected at preschool, while parents collected five saliva samples from children during one weekend day and completed a questionnaire assessing child's temperament dimensions i.e. surgency, negative affectivity, and effortful control (HCC, n = 677; AUCg of sAA, n = 380; AUCg of sCort, n = 302; temperament dimensions, n = 751). In linear regression analysis, diurnal sCort associated positively with HCC, the association persisting after adjustments (ß 0.31, 95% CI 0.20-0.42). In logistic regression analysis, increasing scores in effortful control associated with higher likelihood of having high HCC (OR 1.47, 95% CI 1.07-2.03), the association slightly attenuating to non-significant after adjustments. Otherwise, no clear indication for associations between temperament and stress-related biomarkers were found.

Are associations between home environment and preschool children's sedentary time influenced by parental educational level in a cross-sectional survey?

BACKGROUND: Childhood obesity is a major public health concern, especially in low socioeconomic groups. Sedentary time (SED) is an important predictor of obesity. To be able to diminish SED it is important to find modifiable predictors of sedentary behavior. The home environment associated with children's SED may vary by parental socioeconomic status. This study aims to clarify the association between parental educational level (PEL) and the home environment of 3-6-year-old children, and to examine how home environment associates with children's SED, and whether PEL modifies these associations. METHODS: A cross-sectional Increased health and wellbeing in preschools (DAGIS) study was conducted in 2015-2016 in Finland. The parents (n = 809) filled in questionnaires assessing PEL, and the home physical and social environment related to children's SED. Children's SED was measured with accelerometers, which the children (n = 745) wore for 1 week. RESULTS: High PEL was associated with a home environment restraining sedentary behaviour compared with low PEL. Stricter descriptive norms about screen time, considering it important to limit the child's screen time, and satisfaction about the child's screen time associated with children's lower SED. The association with parental psychological control and SED was influenced by PEL. In the PEL stratified analyses, however, the associations between psychological control and SED did not reach statistical significance. CONCLUSIONS: Future interventions aiming to decrease SED should pay attention to relevant factors in children's sedentary behaviour home environment. It is important to acknowledge the possible PEL differences in these factors.

COVID-19: Histopathological correlates of imaging patterns on chest computed tomography.

BACKGROUND AND OBJECTIVE: Patients with coronavirus disease 2019 (COVID-19) pneumonia present with typical findings on chest computed tomography (CT), but the underlying histopathological patterns are unknown. Through direct regional correlation of imaging findings to histopathological patterns, this study aimed to explain typical COVID-19 CT patterns at tissue level. METHODS: Eight autopsy cases were prospectively selected of patients with PCR-proven COVID-19 pneumonia with varying clinical manifestations and causes of death. All had been subjected to chest CT imaging 24-72 h prior to death. Twenty-seven lung areas with typical COVID-19 patterns and two radiologically unaffected pulmonary areas were correlated to histopathological findings in the same lung regions. RESULTS: Two dominant radiological patterns were observed: ground-glass opacity (GGO) (n = 11) and consolidation (n = 16). In seven of 11 sampled areas of GGO, diffuse alveolar damage (DAD) was observed. In four areas of GGO, the histological pattern was vascular damage and thrombosis, with (n = 2) or without DAD (n = 2). DAD was also observed in five of 16 samples derived from areas of radiological consolidation. Seven areas of consolidation were based on a combination of DAD, vascular damage and thrombosis. In four areas of consolidation, bronchopneumonia was found. Unexpectedly, in samples from radiologically unaffected lung parenchyma, evidence was found of vascular damage and thrombosis. CONCLUSION: In COVID-19, radiological findings of GGO and consolidation are mostly explained by DAD or a combination of DAD and vascular damage plus thrombosis. However, the different typical CT patterns in COVID-19 are not related to specific histopathological patterns. Microvascular damage and thrombosis are even encountered in the radiologically normal lung.

Temperament, physical activity and sedentary time in preschoolers - the DAGIS study.

BACKGROUND: Identifying individual characteristics linked with physical activity (PA) and sedentary time (SED) can assist in designing health-enhancing interventions for children. We examined cross-sectional associations of temperament characteristics with 1) PA and SED and 2) meeting the PA recommendation in Finnish children. METHODS: Altogether, 697 children (age: 4.7 ± 0.9 years, 51.6% boys) within the Increased Health and Wellbeing in Preschools (DAGIS) study were included. Parents responded to the Very Short Form of the Children's Behavior Questionnaire consisting of three temperament dimensions: surgency, negative affectivity, and effortful control. PA and SED were assessed for 7 days (24 h per day) using a hip-worn ActiGraph accelerometer, and the daily minutes spent in light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and SED were calculated. The PA recommendation was defined as having PA at least 180 min/day, of which at least 60 min/day was in moderate-to-vigorous PA. Adjusted linear and logistic regression analyses were applied. RESULTS: Surgency was associated with LPA (B = 3.80, p = 0.004), MPA (B = 4.87, p < 0.001), VPA (B = 2.91, p < 0.001), SED (B = - 11.45, p < 0.001), and higher odds of meeting the PA recommendation (OR = 1.56, p < 0.001). Effortful control was associated with MPA (B = - 3.63, p < 0.001), VPA (B = - 2.50, p < 0.001), SED (B = 8.66, p < 0.001), and lower odds of meeting the PA recommendation (OR = 0.61, p = 0.004). Negative affectivity was not associated with PA, SED, or meeting the PA recommendation. CONCLUSION: Children's temperament should be considered when promoting PA in preschoolers. Special attention should be paid to children scoring high in the temperament dimension effortful control.

Does temperament make children differently susceptible to their home physical food environment? A cross-sectional DAGIS study on 3-6 year old Finnish children's food consumption.

Consistently linked with children's food consumption are food availability and accessibility. However, less is known about potential individual differences among young children in their susceptibility to home food environments. The purpose of the study was to examine whether the association between home food availability and accessibility of sugar-rich foods and drinks (SFD) or fruits and vegetables (FV) and children's consumption of these foods differ according to their temperament. The study used two cross-sectional datasets collected as part of the Increased Health and Wellbeing in Preschools (DAGIS) study: 1) a cross-sectional data of 864 children aged 3-6 years old collected between fall 2015 and spring 2016, and 2) an intervention baseline data of 802 children aged 3-6 collected in fall 2017. Parents reported their children's temperament, consumption of FV and SFD, and home availability and accessibility of SFD and FV. Examination of whether associations between home availability and accessibility of FV and their consumption differ according to children's temperament involved using linear regression models. Similar models were used to examine association between home availability and accessibility of SFD and their consumption, and the moderating role of temperament. The association between home accessibility of SFD and their consumption frequency was dependent on the level of children's negative affectivity. More frequent consumption of SFD was observed with higher home accessibility of SFD. The association was stronger in children with higher scores in negative affectivity. No other interactions were found. Children with higher negative affectivity are possibly more vulnerable to food cues in the home environment than children with lower negative affectivity. Consideration of children's individual characteristics is necessary in supporting their healthy eating.

Does health literacy explain regional health disparities among adolescents in Finland?

Health literacy (HL)-as a broad range of health-related competencies-has been proposed to be a promising construct in understanding health disparities better, also among adolescents. Several factors have been found to explain differences in adolescents' HL levels; however, not much is known about how different regions of a country or majority/minority status is associated with HL, or whether HL is associated with regional health disparities. The aim of this study was to examine and compare HL and health levels among majority- and minority-language-speaking adolescents living in different regions of Finland, and to explore if HL explains regional health disparities, taking into account other important structural stratifying factors. The study uses Health Behaviour in School-aged Children survey data, collected among 13- and 15-year-old pupils in Finnish- and Swedish-speaking schools in Finland in 2014 (N = 3853/1123; 85/83%). Findings suggest that regional differences in HL levels and regional health disparities exist in both language groups. Health disparities were present in the Finnish-speaking sample among boys, the proportion rating their health as excellent ranging from 23 to 31% across regions, and in the Swedish-speaking sample among girls, the corresponding numbers ranging from 13 to 20%. In addition to other important structural stratifying factors, comprehensive HL explains these regional health disparities. This study adds to prior studies on the role of HL as a modifiable health resource by showing that regional health disparities among adolescents can partially be attributed to corresponding HL differences.