National policies to limit food marketing and competitive food sales in schools: a global scoping review.

School food environments contribute to children's nutritional intake and overall health. As such, the World Health Organization and other public health organizations encourage policies that restrict children's access and exposure to foods and beverages that do not build health in and around schools. This global scoping review explores the presence and characteristics of policies that restrict competitive food sales and marketing for unhealthy foods across 193 countries using evidence from policy databases, grey literature, peer-reviewed literature, and primary policy documents. Policies were included if they were nationally mandated and regulated marketing and/or competitive foods in the school environments. Worldwide, only 28% of countries were found to have any national-level policy restricting food marketing or competitive food sales in schools: 16% of countries restrict marketing, 25% restrict competitive foods, and 12% restrict both. Over half of policies were found in high-income countries. No low-income countries had either policy type. Eight marketing policies (27%) and 14 competitive foods policies (29%) lacked explicit guidelines for either policy monitoring or enforcement. Future research is needed to assess the prevalence of policies aimed at improving other key aspects of the school food environment, such as dietary quality of school meals or food procurement, as well as assess implementation and efficacy of existing policies.

Knowledge and perceptions of nutrition assistance programmes among young adult students.

The purpose of this qualitative study was to investigate the perceptions of nutrition assistance programmes among young adult students in the United States, and to identify how the current social and political climate, including the COVID-19 pandemic, has impacted these perceptions and the overall willingness of young adult students to participate in these programmes. Participants were recruited via email and social media to participate in 20-min virtual, semi-structured interviews. Twenty-three participants, between the ages of 18 and 25 years from three states in the United States were interviewed. Ten participants reported having experienced food insecurity (FI) in their lifetime, with 21 participants currently having enough food to eat, while two sometimes did not currently have enough to eat. Seven participants had utilised nutrition programmes in their lifetime. Interviews were video and audio recorded, transcribed, and coded using a six-step thematic analysis. Young adult students were largely unaware of nutrition assistance programmes and eligibility requirements but still perceived these programmes to be successful, with a higher proportion of the participants who had utilised a nutrition assistance programme in their lifetime expressing the view that they were generally successful compared to those who had never utilised one. Most were cognizant of the social stigma surrounding these programmes yet expressed a willingness to utilise them and reported an increased willingness to utilise nutrition assistance programmes as a result of the COVID-19 pandemic. COVID-19 made young adult students aware of FI and the important role nutrition assistance programmes play in our society. Young adult students expressed the belief that the Biden administration will have a positive impact on nutrition assistance programmes but had a general hesitation to discuss politics. The COVID-19 pandemic has increased young adult students' willingness to utilise nutrition assistance programmes, although, access to these programmes remains low due to a lack of knowledge and general unawareness of programme availability and accessibility. Education is needed to improve overall knowledge of, and facilitate access to, nutrition assistance programmes while combating perceptions around stigma.

Continuous Glucose Monitoring for Patients with COVID-19 Pneumonia: Initial Experience at a Tertiary Care Center.

OBJECTIVE: Patients hospitalized with COVID-19 and hyperglycemia require frequent glucose monitoring, usually performed with glucometers. Continuous glucose monitors (CGMs) are common in the outpatient setting but not yet approved for hospital use. We evaluated CGM accuracy, safety for insulin dosing, and CGM clinical reliability in 20 adult patients hospitalized with COVID-19 and hyperglycemia. METHODS: Study patients were fitted with a remotely monitored CGM. CGM values were evaluated against glucometer readings. The CGM sensor calibration was performed if necessary. CGM values were used to dose insulin, without glucometer confirmation. RESULTS: CGM accuracy against glucometer, expressed as mean absolute relative difference (MARD), was calculated using 812 paired glucometer-CGM values. The aggregate MARD was 10.4%. For time in range and grades 1 and 2 hyperglycemia, MARD was 11.4%, 9.4%, and 9.1%, respectively, with a small variation between medical floors and intensive care units. There was no MARD correlation with mean arterial blood pressure levels, oxygen saturation, daily hemoglobin levels, and glomerular filtration rates. CGM clinical reliability was high, with 99.7% of the CGM values falling within the "safe" zones of Clarke error grid. After CGM placement, the frequency of glucometer measurements decreased from 5 to 3 and then 2 per day, reducing nurse presence in patient rooms and limiting viral exposure. CONCLUSION: With twice daily, on-demand calibration, the inpatient CGM use was safe for insulin dosing, decreasing the frequency of glucometer fingersticks. For glucose levels >70 mg/dL, CGMs showed adequate accuracy, without interference from vital and laboratory values.

Annotated expression and activity data for murine recombinase alleles and transgenes: the CrePortal resource.

Recombinase alleles and transgenes can be used to facilitate spatio-temporal specificity of gene disruption or transgene expression. However, the versatility of this in vivo recombination system relies on having detailed and accurate characterization of recombinase expression and activity to enable selection of the appropriate allele or transgene. The CrePortal ( http://www.informatics.jax.org/home/recombinase ) leverages the informatics infrastructure of Mouse Genome Informatics to integrate data from the scientific literature, direct data submissions from the scientific community at-large, and from major projects developing new recombinase lines and characterizing recombinase expression and specificity patterns. Searching the CrePortal by recombinase activity or specific recombinase gene driver provides users with a recombinase alleles and transgenes activity tissue summary and matrix comparison of gene expression and recombinase activity with links to generation details, a recombinase activity grid, and associated phenotype annotations. Future improvements will add cell type-based activity annotations. The CrePortal provides a comprehensive presentation of recombinase allele and transgene data to assist researchers in selection of the recombinase allele or transgene based on where and when recombination is desired.

Pornography Use and Intimate Partner Violence Among a Sample of U.S. Army Soldiers in 2018: A Cross-Sectional Study.

The objective of the present study was to determine whether there is an association between pornography use and reported intimate partner violence (IPV) perpetration among a sample of soldiers in the US Army. The study was a secondary analysis of cross-sectional data collected from soldiers at a military installation in 2018 (n = 9,052). IPV was defined as any self-reported perpetration of physical, sexual, or psychological abuse of an intimate partner. Multivariable negative binomial regressions were used to assess the association between pornography use and any lifetime perpetration of IPV, controlling for gender, age group, race/ethnicity, relationship status, educational status, military rank, hazardous drinking, depression, stimulant use, depressant use, and post-traumatic stress disorder. Of the population analyzed, 41% of soldiers reported any pornography use per week, and 9.6% reported perpetrating any form of IPV. Soldiers who reported pornography use had between a 1.72- and 3.56-fold greater likelihood of reporting any lifetime perpetration of IPV, controlling for covariates. Given the prevalence and detrimental effects of IPV, longitudinal studies should be designed to further understand predictors of IPV in military populations.

Hypothermia in Young Infants: Frequency and Yield of Sepsis Workup.

OBJECTIVES: Serious bacterial infections (SBIs) in young infants can present with fever or hypothermia. There are substantial data on fever as a presentation for SBI that help to inform the clinical approach. In contrast, data on hypothermia are lacking, thus leaving clinicians without guidance. We aimed to describe the workup and findings, specifically the occurrence, of SBIs in infants younger than 60 days of life with hypothermia. METHODS: We reviewed the medical records of infants younger than 60 days of life with rectal temperature of less than 36.5°C upon arrival to a children's hospital emergency department between January 2013 and December 2014. Comparisons were made between those who were found to have an SBI and those without. Serious bacterial infection was defined as bacteremia, bacterial meningitis, pneumonia, or urinary tract infection (UTI). RESULTS: From the 414 patients identified, 104 (25%) underwent a sepsis evaluation of blood, urine, and/or cerebrospinal fluid culture. Serious bacterial infections were identified in 9 patients: 4 with UTI, 1 with pneumonia, 2 with bacteremia, 1 with pneumonia and UTI, and 1 with meningitis and bacteremia. Compared with patients with negative cultures, patients with SBI were older and had elevated absolute band counts and elevated immature-to-total neutrophil ratio. CONCLUSIONS: Approximately a quarter of infants younger than 60 days with hypothermia were evaluated for SBI. Serious bacterial infection was identified in 9% of evaluated infants (2% of all hypothermic infants). Hypothermia can be a presenting sign of SBI.

Comparing measures of free-living sleep in school-aged children.

OBJECTIVE/BACKGROUND: Recent technological advances and emerging commercially-available consumer-friendly sleep assessment products affords researchers with a host of tools to consider for capturing free-living sleep in children. The purpose of this study was to compare free-living sleep characteristics (duration and bed/wake times) across different measures in children. METHODS: Elementary school-aged children (N = 30, mean age 7.2 years, 63% boys, 87% non-Hispanic white) wore an ActiGraph GT9X Link© and Fitbit Charge HR© on the non-dominant wrist, with a Beddit 3 Sleep Monitor© affixed to their mattress for two consecutive weekend nights of free-living sleep. Parents completed a sleep log of bed and wake times. Absolute differences in bed and wake times were examined and Bland Altman plots assessed the level of agreement across sleep measures. RESULTS: Across the four sleep measures, total sleep time (TST) ranged from 458 min/night (ActiGraph GT9X Link©) to 613 min/night (Parent report). Mean bed and wake times ranged from 8:46PM to 9:03PM, and 6:52AM to 7:16AM, respectively. Pearson correlation coefficients were moderate between all four sleep measures (range r = 0.30-0.71). Bland-Altman plots indicated the highest level of agreement for TST was between Beddit 3 Sleep Monitor© and Fitbit Charge HR© (mean difference -11.7, limits of agreement: 119.0, -142.4 min). CONCLUSIONS: The findings from this study show a high level of agreement of when a child goes to sleep and wakes up across a variety of sleep measures; however, more work is needed to classify TST once the sleep period has commenced.

Validity and Wearability of Consumer-based Fitness Trackers in Free-living Children.

Over the past decade wearable fitness trackers (WFTs) have grown in popularity with more recent versions able to capture the pulse rate noninvasively on the wrist of the wearer. Most of evidence on the validity of WFTs have explored adults in clinical settings. Thus, the purpose of this study is to 1) evaluate the validity of a wrist-placed WFT in determining heart rate, and 2) examine the wear compliance of a wrist-placed WFT, in children in free-living settings. In study 1, 19 children (5-12 yrs) wore a Fitbit Charge HR© and a Polar chest strap heart rate (HR) monitor for 2 hours while performing sedentary-to-vigorous activities at a holiday camp in December 2016. In study 2, 20 children with mild developmental disabilities (8-13 yrs) were asked to wear a Fitbit Alta HR© during summer 2017. In study 1, mean absolute percent difference between the WFT HR and criterion was 6.9%. Overall, >75% of WFT HRs were within 5-10% of the criterion. Bland Altman plots indicated a moderate-to-high level of agreement between the WFT and criterion (mean difference 4.1%; Limits of Agreement 26.8, -18.5%). In study 2, participants had the device in their possession for 43 days (SD±14, range 14 - 56 days) and wore it on 67% of those days (range: 20 - 96%) for at least 10 hours/day. Preliminary evidence suggests that WFTs can provide comparable HR estimates to a criterion field-based measure and children can wear WFTs for extended monitoring periods in free-living settings.

Changes in children's sleep and physical activity during a 1-week versus a 3-week break from school: a natural experiment.

Study Objectives: To examine changes in elementary aged children's sleep and physical activity during a 1-week and a 3-week school break. Methods: Sleep and physical activity of elementary children (n = 154, age = 5-9 years, 44.8% female, 65.5% African American) were collected over 7 weeks that included a 1-week break in two schools and a 3-week break in a single school. Mixed regression models estimated sleep and physical activity changes within and between groups (i.e. 1-week vs. 3-weeks) during school and school break weeks. Results: Compared to school weeks, bed times shifted 72.7 (95% CI = 57.5, 87.9) and 75.4 (95% CI = 58.1, 92.7) minutes later on weekdays during the 1-week and 3-week break, respectively. Wake times shifted 111.6 (95% CI = 94.3, 128.9) and 99.8 (95% CI = 80.5, 119.1) minutes later on weekdays during 1-week and 3-week breaks. On weekdays during the 3-week break, children engaged in 33.1 (95% CI = 14.1, 52.2) more sedentary minutes and -12.2 (-20.2, -4.2) fewer moderate-to-vigorous physical activity minutes/day. No statistically significant changes in children's sedentary, light, or moderate-to-vigorous physical activity (MVPA) minutes were observed on weekdays during the 1-week break. Between-group differences in the change in time sedentary (32.1-95% CI = 5.8, 58.4), and moderate-to-vigorous (-13.0-95% CI = -23.9, -2.0) physical activity were observed. Conclusions: Children's sleep shifted later on both 1-week and 3-week breaks. Children's activity changed minimally on weekdays during a 1-week school break and more during a 3-week school break. Displaced sleep and reductions in activity are intervention targets for mitigating unhealthy weight gain during extended breaks from school.

PROACTIVE PROTOCOL-BASED MANAGEMENT OF HYPERGLYCEMIA AND DIABETES IN COLORECTAL SURGERY PATIENTS.

OBJECTIVE: The management of diabetic patients undergoing elective abdominal surgery continues to be unsystematic, despite evidence that standardized perioperative glycemic control is associated with fewer postoperative surgical complications. We examined the efficacy of a pre-operative diabetes optimization protocol implemented at a single institution in improving perioperative glycemic control with a target blood glucose of 80 to 180 mg/dL. METHODS: Patients with established and newly diagnosed diabetes who underwent elective colorectal surgery were included. The control group comprised 103 patients from January 1, 2011, through December 31, 2013, before protocol implementation. The glycemic-optimized group included 96 patients following protocol implementation from January 1, 2014, through July 31, 2016. Data included demographic information, blood glucose levels, insulin doses, hypoglycemic events, and clinical outcomes (length of stay, re-admissions, complications, and mortality). RESULTS: Patients enrolled in the glycemic optimization protocol had significantly lower glucose levels intra-operatively (145.0 mg/dL vs. 158.1 mg/dL; P = .03) and postoperatively (135.6 mg/dL vs. 145.2 mg/dL; P = .005). A higher proportion of patients enrolled in the protocol received insulin than patients in the control group (0.63 vs. 0.48; P = .01), but the insulin was administered less frequently (median [interquartile range] number of times, 6.0 [2.0 to 11.0] vs. 7.0 [5.0 to 11.0]; P = .04). Two episodes of symptomatic hypoglycemia occurred in the control group. There was no difference in clinical outcomes. CONCLUSION: Improved peri-operative glycemic control was observed following implementation of a standardized institutional protocol for managing diabetic patients undergoing elective colorectal surgery. ABBREVIATIONS: HbA1c = glycated hemoglobin A1c; IQR = interquartile range.

A Modern Epidemic: Increasing Pediatric Emergency Department Visits and Admissions for Headache.

OBJECTIVE: Headaches represent 0.9% to 2.6% of visits to a pediatric emergency department (PED). We noted a trend of increasing visits for headache in our tertiary care PED and sought to further characterize this trend. METHODS: We identified PED visits with International Classification of Disease, Ninth Revision, Clinical Modification diagnoses for headache at 25 hospitals in Pediatric Health Information System between 2003 and 2013. To further characterize demographics and treatment trends over time we used the electronic health record in our emergency department to identify children ages four to 18 between January 2007 and December 2014 with International Classification of Disease, Ninth Revision codes for headache: a random sample of 50 visits per year were chosen for chart review. RESULTS: Pediatric Health Information System visits for headache increased by 166% (18,041 in 2003 and 48,020 in 2013); by comparison, total PED visits increased by 57.6%. The percent admission increased by 300% (2020 admissions in 2003 and 8087 admissions in 2013). At our hospital, headache visits increased 111% from 896 visits in 2007 to 1887 visits in 2014; total PED visits increased 30.2%. The admission percentage for headache increased 187% with 156 admissions in 2007 and 448 in 2014. Management over time differed in the frequency of head computed tomography which decreased 3.7% per year (r = -0.93, 95% CI -0.99, -0.64) from 34% in 2007 to 18% in 2014. CONCLUSION: Pediatric emergency department visits for headache are increasing and a growing proportion of these patients are admitted. This finding identifies a potential patient population to target for interventions to improve outpatient management and reduce pediatric emergency department utilization.

Ropivacaine Intramuscular Paracervical Injections for Pediatric Headache: A Randomized Placebo-Controlled Trial.

STUDY OBJECTIVE: We seek to determine whether ropivacaine cervical paraspinal injections compared with normal saline solution injections provide headache relief to pediatric patients that is sufficient for emergency department (ED) discharge. METHODS: We enrolled children aged 7 to 17 years in a double-blinded, randomized, controlled trial of patients presenting to a pediatric ED with headache. Subjects were randomized into 1 of 3 groups: bilateral cervical paraspinal injections of either (1) 0.5% ropivacaine or (2) normal saline solution, or (3) a natural history group (not blinded) receiving no headache therapy for the first 30 minutes. Pain scores were assessed at enrollment and at 10-, 20-, and 30-minute intervals after the administration of the injections. After the intervention period of 30 minutes, additional therapy was provided as needed. Primary outcome was the proportion of children discharged with adequate pain relief at 30 minutes without additional therapy. Secondary outcomes included reduction in pain scores, reoccurrence of headache, and re-presentation to health care with headache. RESULTS: One hundred fifty-three children were enrolled. The proportion discharged with adequate pain relief 30 minutes after the injections did not differ between the 2 intervention groups (32% in the ropivacaine group versus 28% in the saline solution group; effect difference 4%; 95% confidence interval -14% to 21%). In contrast, only 4% percent of patients in the natural history group were discharged without additional therapy after the 30-minute assessment. Reduction of pain scores (2.0 and 2.2 in ropivacaine versus saline solution), headache reoccurrence, and return to care was similar between the 2 treatment groups. CONCLUSION: Cervical paraspinal injections of either ropivacaine or saline solution were effective for approximately one third of patients.