Cardiorespiratory Fitness and Physical Activity in Pediatric Diabetes: A Systemic Review and Meta-Analysis.

Importance: It is unclear whether cardiorespiratory fitness (CRF) and physical activity are lower among youths with type 1 diabetes (T1D) and type 2 diabetes (T2D) compared with youths without diabetes. Objective: To describe the magnitude, precision, and constancy of the differences in CRF and physical activity among youths with and without diabetes. Data Sources: MEDLINE, Embase, CINAHL, and SPORTDiscus were searched from January 1, 2000, to May 1, 2022, for eligible studies. Study Selection: Observational studies with measures of CRF and physical activity in children and adolescents aged 18 years or younger with T1D or T2D and a control group were included. Data Extraction and Synthesis: Data extraction was completed by 2 independent reviewers. A random-effects meta-analysis model was used to estimate differences in main outcomes. The pooled effect estimate was measured as standardized mean differences (SMDs) with 95% CIs. The Preferred Reporting Items for Systematic Review and Meta-Analyses guideline was followed. Main Outcomes and Measures: The main outcomes were objectively measured CRF obtained from a graded maximal exercise test and subjective or objective measures of physical activity. Subgroup analyses were performed for weight status and measurement type for outcome measures. Results: Of 7857 unique citations retrieved, 9 studies (755 participants) with measures of CRF and 9 studies (1233 participants) with measures of physical activity for youths with T2D were included; for youths with T1D, 23 studies with measures of CRF (2082 participants) and 36 studies with measures of PA (12 196 participants) were included. Random-effects models revealed that directly measured CRF was lower in youths with T2D (SMD, -1.06; 95% CI, -1.57 to -0.56; I2 = 84%; 9 studies; 755 participants) and in youths with T1D (SMD, -0.39; 95% CI, -0.70 to -0.09; I2 = 89%; 22 studies; 2082 participants) compared with controls. Random-effects models revealed that daily physical activity was marginally lower in youths with T1D (SMD, -0.29; 95% CI, -0.46 to -0.11; I2 = 89%; 31 studies; 12 196 participants) but not different among youths with T2D (SMD, -0.56; 95% CI, -1.28 to 0.16; I2 = 91%; 9 studies; 1233 participants) compared with controls. When analyses were restricted to studies with objective measures, physical activity was significantly lower in youths with T2D (SMD, -0.71; 95% CI, -1.36 to -0.05; I2 = 23%; 3 studies; 332 participants) and T1D (SMD, -0.67; 95% CI, -1.17 to -0.17; I2 = 93%; 12 studies; 1357 participants) compared with controls. Conclusions and Relevance: These findings suggest that deficits in CRF may be larger and more consistent in youths with T2D compared with youths with T1D, suggesting an increased risk for cardiovascular disease-related morbidity in adolescents with diabetes, particularly among those with T2D. The findings reinforce calls for novel interventions to empower youths living with diabetes to engage in regular physical activity and increase their CRF.

Early life adversity and obesity risk in adolescence: a 9-year population-based prospective cohort study.

BACKGROUND: There are few prospective studies of factors that mediate the association between exposure to adverse childhood experiences (ACEs) and obesity in adolescence. Our aim was to address this limitation. METHODS: We used prospective data from the Growing up in Ireland cohort study, with measurements at 9, 13, and 18 years old. The exposures were 14 adverse experiences before age 9. The main outcome was body mass index (BMI) at 18 years. Mediators were daily activity, diet quality, self-image and behavioural difficulties at 13 years. RESULTS: Among the 4561 adolescents in the final cohort, 77.2% experienced any adversity, 50.5% were female and 26.7% were overweight/obese at 18 years. BMI Z was higher at ages 9 (0.54 vs 0.43, p < 0.05, 95% CI of difference: -0.22, -0.01) and 13 years (0.50 vs 0.35, p < 0.05, 95% CI of difference: -0.25, -0.06), in those exposed to an ACE, compared to those unexposed. Structural equation models revealed that behavioural difficulties (ß = 0.01; 95% CI: 0.007-0.018, p < 0.001) and self-concept (ß = 0.0027; 95% CI: 0.0004-0.0050, p = 0.026) indirectly mediate the association between exposure to ACEs and BMI at 18 years. CONCLUSIONS: The association between ACEs and BMI in adolescence is mediated by behavioural difficulties and self-concept. IMPACT: In a previous study, we found modest associations between exposure to a range of adverse childhood experiences and weight gain at 13 years of age. The strength of the association between adverse childhood experiences and weight gain was lower at 18 years of age compared to the association observed at 13 years and was no longer significant after controlling for confounding and including possible mediators. The association between adverse childhood experiences and BMI in adolescence is indirectly mediated by behavioural difficulties and self-concept.

Seroprevalence of SARS-CoV-2 antibodies among healthcare workers in Dutch hospitals after the 2020 first wave: a multicentre cross-sectional study with prospective follow-up.

BACKGROUND: We aimed to estimate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence and describe its determinants and associated symptoms among unvaccinated healthcare workers (HCWs) after the first wave of the pandemic. METHODS: HCWs from 13 Dutch hospitals were screened for antibodies against the spike protein of SARS-CoV-2 in June-July 2020 and after three months. Participants completed a retrospective questionnaire on determinants for occupational and community exposure to SARS-CoV-2 and symptoms suggestive of COVID-19 experienced since January 2020. The seroprevalence was calculated per baseline characteristic and symptom at baseline and after follow-up. Adjusted odds ratios (aOR) for seropositivity were determined using logistic regression. RESULTS: Among 2328 HCWs, 323 (13.9%) were seropositive at enrolment, 49 of whom (15%) reported no previous symptoms suggestive of COVID-19. During follow-up, only 1% of the tested participants seroconverted. Seroprevalence was higher in younger HCWs compared to the mid-age category (aOR 1.53, 95% CI 1.07-2.18). Nurses (aOR 2.21, 95% CI 1.34-3.64) and administrative staff (aOR 1.87, 95% CI 1.02-3.43) had a higher seroprevalence than physicians. The highest seroprevalence was observed in HCWs in the emergency department (ED) (aOR 1.79, 95% CI 1.10-2.91), the lowest in HCWs in the intensive, high, or medium care units (aOR 0.47, 95% CI 0.31-0.71). Chronic respiratory disease, smoking, and having a dog were independently associated with a lower seroprevalence, while HCWs with diabetes mellitus had a higher seroprevalence. In a multivariable model containing all self-reported symptoms since January 2020, altered smell and taste, fever, general malaise/fatigue, and muscle aches were positively associated with developing antibodies, while sore throat and chills were negatively associated. CONCLUSIONS: The SARS-CoV-2 seroprevalence in unvaccinated HCWs of 13 Dutch hospitals was 14% in June-July 2020 and remained stable after three months. A higher seroprevalence was observed in the ED and among nurses, administrative and young staff, and those with diabetes mellitus, while a lower seroprevalence was found in HCWs in intensive, high, or medium care, and those with self-reported lung disease, smokers, and dog owners. A history of altered smell or taste, fever, muscle aches and fatigue were independently associated with the presence of SARS-CoV-2 antibodies in unvaccinated HCWs.

Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children: protocol for a community-driven continuous quality improvement approach.

BACKGROUND: Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children works towards developing a spectrum of effective, community-based services and supports. These services and supports are organised into a coordinated network, build meaningful partnerships with families and address their cultural and linguistic needs, to help children to function better at home, in school, in the community, and throughout life. This study is conducted in partnership with primary healthcare (PHC) and other services in three diverse Indigenous Australian communities. It entails conceptualising, co-designing, implementing, and evaluating the effectiveness of systems integration to promote the mental health and wellbeing of Indigenous school-aged children (4-17 years). This paper outlines a protocol for implementing such complex community-driven research. METHODS/DESIGN: Using continuous quality improvement processes, community co-designed strategies for improved systems integration will be informed by narratives from yarning circles with Indigenous children and service providers, and quantitative data from surveys of service providers and audits of PHC client records and intersectoral systems. Agreed strategies to improve the integration of community-based services and supports will be modelled using microsimulation software, with a preferred model implemented in each community. The evaluation will investigate changes in the: 1) availability of services that are community-driven, youth-informed and culturally competent; 2) extent of collaborative service networks; 3) identification by PHC services of children's social and emotional wellbeing concerns; and 4) ratio of children receiving services to identified need. Costs and benefits of improvements to systems integration will also be calculated. DISCUSSION: The study will provide evidence-informed, community-driven, and tested models that can be used for implementing systems integration to promote the mental health and wellbeing of Indigenous children. It will identify the situational enablers and barriers that impact systems integration and determine the extent to which systems integration improves service availability, systems and child outcomes. Evidence for the cost effectiveness of systems-level integration will contribute to national mental health policy reform.

Effect of orally administered melatonin on intraocular pressure of ophthalmologically normal dogs.

OBJECTIVE: To determine the effect of orally administered melatonin on the intraocular pressure (IOP) of ophthalmologically normal dogs. ANIMALS: 20 ophthalmologically normal dogs (40 eyes). PROCEDURES: In a randomized crossover study, each dog received a 7-day regimen of melatonin (0.1 to 0.2 mg/kg, PO, q 12 h) and a placebo (150 mg of lactose powder in a capsule, PO, q 12 h), with a 7-day washout period between treatment regimens. Rebound tonometry was used to measure the IOP in both eyes of each dog 5 times at 2-hour intervals on days 0 (before administration of the first dose), 2, 4, and 7 (after administration of the last dose) of each treatment period. Repeated-measures ANOVA was used to evaluate the effects of treatment, day, and IOP measurement time within day on IOP. RESULTS: Intraocular pressure was not significantly associated with treatment but was associated with day and the interaction between day and IOP measurement time within day. The mean ± SD IOP was 14.26 ± 2.95 and 14.34 ± 2.69 mm Hg for the melatonin and placebo regimens, respectively. Within each treatment period, the mean IOP tended to decrease from day 0 to 7 as well as within each day, which was attributed to the dogs becoming acclimated to the study protocol and natural diurnal variations in IOP. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that oral administration of melatonin (0.1 to 0.2 mg/kg, q 12 h for 7 d) did not significantly affect the IOP of ophthalmologically normal dogs.

Screening for latent tuberculosis infection by an Aboriginal Community Controlled Health Service, New South Wales, Australia, 2015.

OBJECTIVE: Ongoing transmission of tuberculosis (TB) continues in Indigenous communities in New South Wales (NSW), Australia. In a pilot project, a Public Health Unit TB team partnered with an Aboriginal Community Controlled Health Service (ACCHS) in a community with a cluster of TB to augment screening for latent TB infection (LTBI) using interferon-gamma release assay (IGRA). This study examined screening data and programme outcomes at 12 months post hoc to advise practice and policy formulation. METHODS: We conducted a retrospective, cross-sectional analysis of demographic and clinical data of ACCHS patients, stratified by IGRA testing status. Differences in sex and age distribution between the groups and cases of a genetically and epidemiologically linked TB cluster in Aboriginal people in NSW were assessed using non-parametric tests. RESULTS: Of 2019 Aboriginal and Torres Strait Islander people seen by general practitioners during the study period, 135 (6.7%) participated in the screening. Twenty-four (17.8%) participants were IGRA positive. One person was diagnosed with active TB. Twelve participants received a chest X-ray at the time of the positive test, and six participants had an additional chest X-ray within 12 months. None commenced preventive treatment for LTBI. DISCUSSION: ACCHS screening for LTBI reached individuals in the age group most commonly affected by TB in these Aboriginal communities. No conclusions can be made regarding the population prevalence due to the low screening rate. Further strategies need to be developed to increase appropriate follow-up and preventive treatment.

Addison's Disease Caused by Tuberculosis: Diagnostic and Therapeutic Difficulties.

OBJECTIVES: To demonstrate difficulties in diagnosing and treating Addison's disease caused by tuberculosis. MATERIALS AND METHODS: We present a clinical case and review of the literature. RESULTS: A 62-year-old man presented with gastrointestinal symptoms, weight loss and enlarged adrenal glands. After 2 months of diagnostic tests, a working diagnosis of Addison's disease due to extrapulmonary tuberculosis was made. Treatment was challenging due to interaction between rifampicin and steroids. CONCLUSION: Our case illustrates that in non-endemic countries, extrapulmonary tuberculosis still needs to be considered as a possible cause of Addison's disease. LEARNING POINTS: In non-endemic countries, extrapulmonary tuberculosis still needs to be considered as a possible cause of Addison's disease.Treating tuberculosis and adrenal cortex insufficiency can be challenging because of the interaction between rifampicin and adrenocorticoid drugs.Adrenal function does not recover in most cases of Addison's disease caused by tuberculosis.

Schirmer tear test I in dogs: results comparing placement in the ventral vs. dorsal conjunctival fornix.

OBJECTIVE: To compare Schirmer tear test I (STT I) values obtained from placement of tear strips in the ventral and dorsal conjunctival fornices in dogs. PROCEDURE: Schirmer tear test I was performed on each eye of 16 clinically normal dogs (32 eyes) in a crossover study. Initial tear strip placement site was randomized for each eye. Alternative placement site measurements were obtained after 1 week. RESULTS: The mean (± standard deviation, SD) STT I for dorsal and ventral conjunctival fornices was 20.44 (±4.46) mm/min and 23.56 (±3.98) mm/min, respectively. STT I values obtained from the ventral conjunctival fornix were significantly greater than those obtained from the dorsal conjunctival fornix (P = 0.004). CONCLUSIONS: Schirmer tear test I values were significantly greater with tear strips placed in the ventral conjunctival fornix.

Effect of auriculopalpebral nerve block on Schirmer tear test I values in normal horses.

OBJECTIVE: To compare Schirmer tear test I (STTI) values collected in normal horses with and without an auriculopalpebral nerve block. PROCEDURE: Schirmer tear test I values were measured in 20 clinically normal horses (38 eyes) with a median age of 12 years. The order of eyes tested was randomized. Within 24-48 h, at the same time of day, tear measurements were collected again after administration of an auriculopalpebral nerve block. Each block was performed a minimum of 5 min prior to each STT I. A repeated-measures model was used to analyze differences between STT I values in eyes with and without nerve blocks incorporating within horse correlation between eyes. The mixed-model included fixed factors of treatment and eye and a random intercept for each horse. An unstructured covariance structure was used. RESULTS: On average, STT I values measured in eyes after auriculopalpebral nerve blocks were 0.55 mm/min greater than those without nerve blocks. This difference was not statistically significant (P = 0.5268). CONCLUSIONS: There was no effect of auriculopalpebral nerve block on STT I values in normal horses.

[Health risks and advice for Hajj pilgrims]. / Gezondheidsrisico's en adviezen voor hadjpelgrims.

The Hajj, the pilgrimage to Mecca, is the largest mass migration in the world. Each year, 2.5 million Muslims from over 160 countries travel to the same place, 5000-6000 of these being from the Netherlands. During the Hajj, the pilgrims undergo great physical and emotional strain. Good medical preparation including vaccinations is very important for pilgrims who undertake the Hajj, in particular for those who are older and have chronic disease. The chance of transmission of infective disease is also high and rapid contagion of Hajj pilgrims could cause a pandemic. It is therefore important that the responsible doctor is aware of the health risks to the Hajj pilgrim and his environment.

Is there a need for dietary measures to further reduce LDL cholesterol in patients with type II diabetes mellitus on statin therapy?

PURPOSE: To study the need for dietary measures to further reduce LDL cholesterol in patients with type 2 diabetes mellitus on statin therapy. METHODS: A Pubmed, Embase, CINAHL and Cochrane library search was performed to identify relevant articles. After critical appraisal six articles were ranked according to relevance, validation and level of evidence. RESULTS: There were no studies performed among type II diabetics. Among patients with hypercholesterolaemia, diet led to an additional LDL reduction from 0.20 to 0.88 mmol/l, translating into 23% reduction in vascular risk. CONCLUSION: We recommend a low-fat diet on top of statin therapy in patients with type 2 diabetes mellitus assuming that effects found in hypercholesterolaemic patients also apply to type 2 diabetics.