Decreasing Sedentary Behaviors in Youth to Prevent and Manage Childhood Obesity: Is It Realistic?

PURPOSE OF REVIEW: Decreasing sedentary behaviors has been proposed as one approach to reduce the rate of obesity in youth. This review summarizes the contemporary literature examining the efficacy of these interventions in the school and community along with an additional focus on the role of socioeconomic status in these interventions. RECENT FINDINGS: Studies that focus on decreasing sedentary behavior have utilized a wide variety of strategies in a number of settings. The effects of these interventions are often hindered by non-standard outcome measures, study infidelity, and subjective measures of sedentary time. However, interventions that incorporate engaged stakeholders and include younger subjects appear to be the most likely to succeed. Promising interventions to decrease sedentary behaviors have been shown in recent clinical trials; however, replicating and sustaining these results is challenging. From the available literature, school-based interventions have the potential of reaching the largest group of children. In contrast, interventions in younger children, particularly those with invested parents, seem to be the most effective.

The Healthy Eating Assessment Tool (HEAT): A Simplified 10-Point Assessment of CHILD-2 Dietary Compliance for Children and Adolescents with Dyslipidemia.

Traditional dietary assessment tools used to determine achievement of cholesterol-lowering dietary targets, defined in the Cardiovascular Health Integrated Lifestyle Diet (CHILD-2), are time intensive. We sought to determine the utility of the Healthy Eating Assessment Tool (HEAT), a simplified 10-point dietary assessment tool, in relation to meeting dietary cut points of the CHILD-2, as well as its association with markers of adiposity and lipid variables. We performed a 2-year single-center, prospective cross-sectional study of pediatric patients with dyslipidemia. HEAT score associations with meeting CHILD-2 fat targets were modest. Only patients with the highest HEAT scores (good 43%, excellent 64%) met the CHILD-2 cut point of <25% total fat calories (p = 0.03), with a non-significant trend for limiting the percentage of daily saturated fat to <8% (excellent 64%), and no association with cholesterol intake. There were more consistent associations with markers of adiposity (body mass index z-score r = -0.31, p = <0.01 and waist-to-height ratio r = -0.31, p = <0.01), and there was no independent association with lipid levels. While fat-restricted diets are safe, they are not particularly effective for treatment of dyslipidemia or for weight management alone. The HEAT may be a more useful and simplified way of assessing and tracking broader dietary goals in clinical practice.

Quantitative Assessment and Spatial Analysis of Metals and Metalloids in Soil Using the Geo-Accumulation Index in the Capital Town of Romblon Province, Philippines.

The municipality of Romblon in the Philippines is an island known for its marble industry. The subsurface of the Philippines is known for its limestone. The production of marble into slab, tiles, and novelty items requires heavy equipment to cut rocks and boulders. The finishing of marble requires polishing to smoothen the surface. During the manufacturing process, massive amounts of particulates and slurry are produced, and with a lack of technology and human expertise, the environment can be adversely affected. Hence, this study assessed and monitored the environmental conditions in the municipality of Romblon, particularly the soils and sediments, which were affected due to uncontrolled discharges and particulates deposition. A total of fifty-six soil and twenty-three sediment samples were collected and used to estimate the metal and metalloid (MM) concentrations in the whole area using a neural network-particle swarm optimization inverse distance weighting model (NN-PSO). There were nine MMs; e.g., As, Cr, Ni, Pb, Cu, Ba, Mn, Zn and Fe, with significant concentrations detected in the area in both soils and sediments. The geo-accumulation index was computed to assess the level of contamination in the area, and only the soil exhibited contamination with zinc, while others were still on a safe level. Nemerow's pollution index (NPI) was calculated for the samples collected, and soil was evaluated and seen to have a light pollution level, while sediment was considered as "clean". Furthermore, the single ecological risk (Er) index for both soil and sediment samples was considered to be a low pollution risk because all values of Er were less than 40.

Socioeconomic Status and Kawasaki Disease Outcomes in a Single-Payer Health Care System.

Background: For patients with Kawasaki disease (KD), lower socioeconomic status (SES) may adversely affect the timeliness of presentation and initiation of intravenous immune globulin, and coronary artery outcomes. Multipayer systems have been shown to affect health care equity and access to health care negatively. We sought to determine the association of SES with KD outcomes in a single-payer health care system. Methods: Patients with KD presenting from 2007 to 2017 at a single institution were included. SES data were obtained by matching patient postal code district with data from the 2016 Census Canada. Results: SES data were linked for 1018 patients. The proportion of households living below the after-tax low-income cutoff in the patient's postal code district was 13% for not treated, 13% for delayed intravenous immune globulin treatment, and 12% for prompt treatment (P = 0.58). Likewise, the average median annual household income was unrelated to delayed or no treatment. The percentage >15 years of age with advanced education differed between groups at 33%, 29%, and 31% for delayed treatment, prompt treatment, and missed groups, respectively (P = 0.004). SES variables were not significantly different for those with vs without coronary artery aneurysms (max Z-score: >2.5), including the proportion of households living below low-income cutoff (12% vs 13%; P = 0.37), average median annual household income (CAD$81,220 vs $82,055; P = 0.78), and proportion with a university degree (33% vs 31%; P = 0.49), even after adjusting for sex, age, year, and KD type. Conclusions: Timeliness of treatment for KD and coronary artery outcomes were not associated with SES variables within a single-payer health care system.

Contexte: Chez les patients atteints de la maladie de Kawasaki (MK), un statut socioéconomique (SSE) plus difficile pourrait retarder le moment de la première consultation et le début du traitement par immunoglobuline intraveineuse (IgIV) ainsi que peser sur les résultats associés aux artères coronaires. Il a été démontré que les systèmes à payeurs multiples compromettent l'équité en matière de soins de santé et l'accès à ces derniers. Nous avons cherché à déterminer s'il existait un rapport entre le SSE et les résultats associés à la MK au sein d'un système de soins de santé à payeur unique. Méthodologie: L'étude comprenait des patients atteints de la MK qui se sont présentés à un même établissement entre 2007 et 2017. Les données sur le SSE ont été obtenues en associant le code postal des patients aux données du recensement canadien de 2016. Résultats: Les données sur le SSE de 1 018 patients ont été répertoriées. La proportion des foyers qui étaient sous le seuil de faible revenu (SFR) après impôt dans la circonscription correspondant à leur code postal était la suivante : 13 % pour les patients non traités, 13 % pour les patients chez qui le traitement par IgIV a été tardif et 12 % pour les patients qui ont rapidement reçu un traitement (p = 0,58). De même, aucune relation n'a été établie entre le revenu annuel médian des ménages et un traitement tardif ou une absence de traitement. Le pourcentage de personnes âgées de plus de 15 ans ayant un niveau de scolarité élevé différait d'un groupe à l'autre, soit respectivement 33 %, 29 % et 31 % pour les groupes à traitement tardif, à traitement rapide et sans traitement (p = 0,004). Les variables en matière de SSE n'étaient pas significativement différentes chez les patients présentant des anévrismes coronariens et chez ceux n'en présentant pas (score z maximal > 2,5), peu importe la proportion des foyers qui étaient sous le SFR après impôt (12 % contre 13 %; p = 0,37), le revenu annuel médian des ménages (81 220 $ CA contre 82 055 $; p = 0,78) ou le taux de diplomation universitaire (33 % contre 31 %; p = 0,49), et ce, même après ajustement en fonction du sexe, de l'âge et du type de MK. Conclusions: Aucune corrélation n'a été établie entre le SSE et le délai avant l'instauration d'un traitement contre la MK ou les résultats liés aux artères coronaires dans le contexte d'un système de soins de santé à payeur unique.

Late Complication of Congenital Diaphragmatic Hernia Repair: Recurrent Small Bowel Obstruction.

ABSTRACT: Congenital diaphragmatic hernia (CDH) is associated with high early mortality. However, advances in newborn care have led to improved survival into adolescence and early adulthood. We report a 17-year-old adolescent boy with recurrent small bowel obstruction after CDH repair at 2 days of age. Emergency physicians should be aware of late complications after neonatal CDH repair.

Career decision making in undergraduate medical education.

BACKGROUND: It is unclear how medical students prioritize different factors when selecting a specialty. With rising under and unemployment rates a novel approach to career counselling is becoming increasingly important. A better understanding of specialty selection could lead to improved career satisfaction amongst graduates while also meeting the health care needs of Canadians. METHODS: Medical students from the University of Toronto participated in a two-phase study looking at factors impacting specialty selection. Phase I consisted of focus groups, conducted independently for each year, and Phase II was a 21-question electronic survey sent to all students. RESULTS: Twenty-one students participated in the focus group phase and 95 in the survey phase. Primary themes related to career selection identified in Phase I in order of frequency included personal life factors (36), professional life factors (36), passion/interest (20), changing interests (19) and hidden curriculum (15). The survey phase had similar results with passion (83), lifestyle (79), flexibility (75), employment opportunities (60) and family (50) being ranked as the factors most important in specialty selection. CONCLUSION: Personal factors, professional factors and passion/interest may be key themes for medical students when deciding which specialty to pursue. Targeting career counselling around these areas may be important.

CONTEXTE: On ne comprend pas bien comment les étudiants en médecine priorisent différents facteurs au moment de choisir une spécialité. Étant donné la hausse des taux de sous-emploi et de chômage, il devient de plus en plus important d'adopter une nouvelle approche d'orientation professionnelle. Une meilleure compréhension choix d'une spécialité pourrait accroître le niveau de satisfaction des diplômés en ce qui a trait à leur choix de carrière tout en satisfaisant aussi les besoins en soins de santé des Canadiens et Canadiennes. MÉTHODES: Les étudiants en médecine de l'Université de Toronto ont participé à une recherche comportant deux phases examinant les facteurs influençant le choix d'une spécialité. La Phase I comportait des groupes de discussion dirigés indépendamment pour chaque cohorte tandis que la Phase II consistait en un sondage électronique de 21 questions transmis à tous les étudiants. RÉSULTATS: Vingt et un étudiants ont participé à la phase des groupes de discussion et 95 à la phase du sondage. Les principaux thèmes liés au choix de carrière qui ont été identifiés durant la Phase I sont les suivants (en ordre de fréquence) : les facteurs de vie personnelle (36), les facteurs de vie professionnelle (36), la passion/l'intérêt (20), les champs d'intérêt changeants (19) et le curriculum caché (15). La phase de sondage a donné des résultats semblables. La passion (83), le style de vie (79), la souplesse (75), les possibilités d'emploi (60) et la famille (50) se sont révélés comme étant les facteurs les plus importants dans le choix d'une spécialité.Conclusion :Les facteurs personnels, les facteurs professionnels et la passion/l'intérêt pourraient être les principaux thèmes que partagent les étudiants en médecine au moment de décider à quelle spécialité ils aspirent. Il semble important de cibler les démarches d'orientation professionnelle sur ces thèmes.

Keeping caries at bay in breastfeeding babies.

As an infant grows, human milk may become the substrate for cariogenic bacteria. Here's what to watch for and how to counsel parents.

Current and future developments in the treatment of virus-induced hypercytokinemia.

Emerging pathogenic viruses such as Ebola and Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) can cause acute infections through the evasion of the host's antiviral immune responses and by inducing the upregulation of inflammatory cytokines. This immune dysregulation, termed a cytokine storm or hypercytokinemia, is potentially fatal and is a significant underlying factor in increased mortality of infected patients. The prevalence of global outbreaks in recent years has offered opportunities to study the progression of various viral infections and have provided an improved understanding of hypercytokinemia associated with these diseases. However, despite this increased knowledge and the study of the infections caused by a range of emerging viruses, the therapeutic options still remain limited. This review aims to explore alternative experimental strategies for treating hypercytokinemia induced by the Ebola, avian influenza and Dengue viruses; outlining their modes of action, summarizing their preclinical assessments and potential clinical applications.

The breastfeeding paradox: Relevance for household food insecurity.

Mitigating the harmful effects of adverse social conditions is critical to promoting optimal health and development throughout the life course. Many Canadians worry over food access or struggle with household food insecurity. Public policy positions breastfeeding as a step toward eradicating poverty. Breastfeeding fulfills food security criteria by providing the infant access to sufficient, safe and nutritious food that meets dietary needs and food preferences. Unfortunately, a breastfeeding paradox exists where infants of low-income families who would most gain from the health benefits, are least likely to breastfeed. Solving household food insecurity and breastfeeding rates may be best realized at the public policy level. Notably, the health care provider's competencies as medical expert, professional, communicator and advocate are paramount. Our commentary aims to highlight the critical link between breastfeeding and household food insecurity that may provide opportunities to affect clinical practice, public policy and child health outcomes.

The paediatrician and middle childhood parenting.

The 'forgotten years' of middle childhood, from age 6 to 12, represent a critical period in child development. Emotional, social and physical development during this time have a lifelong impact on health and adult contributions to society. Mental health conditions have displaced physical illness as the leading childhood disability. Positive parenting can improve child behaviour, prevent early-onset conduct problems and provide a buffer from adverse childhood events resulting in decreased toxic stress and improved health. Medical homes can play a key role in supporting parents with positive parenting skills that are practical, evidence-based and useful in everyday life. Paediatricians need to explore the domains that promote healthy development, including caring environments, fundamental needs and nurturing relationships. Our objective is to promote high-quality positive parenting through middle childhood by identifying opportunities for paediatricians to frame parenting discussions in the context of development, behaviour and safety and to provide access to valuable parenting resources.

Les « années oubliées ¼ de la phase intermédiaire de l'enfance, entre l'âge de six et 12 ans, sont une période critique du développement de l'enfant. Pendant cette période, le développement émotionnel, social et physique a des conséquences permanentes sur la santé et l'apport de l'adulte à la société. Les troubles de santé mentale ont remplacé les maladies physiques comme principale affection de l'enfance. Des pratiques parentales positives peuvent améliorer le comportement de l'enfant, prévenir les troubles des conduites d'apparition précoce et limiter les événements indésirables de l'enfance, réduisant ainsi le stress toxique et améliorant la santé. Les milieux médicaux peuvent beaucoup contribuer à soutenir les parents afin qu'ils acquièrent des compétences parentales positives pratiques, fondées sur des données probantes et utiles dans la vie quoti- dienne. Les pédiatres doivent explorer les sphères qui favorisent un développement sain, y compris les environnements attentionnés, les besoins fondamentaux et les relations aimantes. Afin de promouvoir des pratiques parentales positives de qualité tout au long de la phase intermédiaire de l'enfance, les auteurs visent à cerner les occasions que peuvent saisir les pédiatres pour structurer les discussions avec les parents sur le développement, le comportement et la sécurité et les orienter vers des ressources intéressantes sur ce type de pratiques.

Bisphosphocins: novel antimicrobials for enhanced killing of drug-resistant and biofilm-forming bacteria.

The global prevalence of antibiotic resistance and the threat posed by drug-resistant superbugs are a leading challenge confronting modern medicine in the 21st century. However, the progress on the development of novel antibiotics to combat this problem is severely lagging. A more concerted effort to develop novel therapeutic agents with robust activity and unique mechanisms of action will be needed to overcome the problem of drug resistance. Furthermore, biofilm forming bacteria are known to be increasingly resistant to the actions of antibiotics and are a leading cause of mortality or morbidity in nosocomial infections. Bisphosphocins (also scientifically known as nubiotics) are novel small protonated deoxynucleotide molecules, and exert their antibacterial activity by depolarization of the bacterial cell membrane, causing bacterial cell death. Bisphosphocins may represent an effective weapon against antibiotic-resistant and biofilm-forming pathogenic bacteria. Preclinical efficacy studies in animals have shown that the compounds are safe and, efficacious against various bacterial infections, including drug-resistant pathogens. In vitro biochemical analysis confirmed that the bactericidal activity of bisphosphocins is mediated by depolarization of the bacterial cell membrane, and these compounds are better able to penetrate through bacterial biofilm and kill the biofilm encased bacteria. This article will cover the structure, mode of action, safety, efficacy and the current state of development of bisphosphocins. Together, the information presented here will present a strong case for bisphosphocins to be considered for use as new weapons to complement the existing arsenal of antimicrobial drugs and as a first line defence against drug-resistant and biofilm-forming bacteria.

Nucleic acid-based drugs against emerging zoonotic viruses.

Global outbreaks of diseases caused by zoonotic viruses have steadily increased in recent years. Emerging zoonotic viruses are generally phylogenetically diverse, are unpredictable and are known to cause diseases with high case fatality rates in humans and are hard to protect against due to lack of approved antiviral drugs. The aim of this review is to discuss how advances in genomics, rational drug design and innate immune signaling can contribute to the design of nucleic acid-based drugs to combat these emerging threats. Specifically, the antiviral activity of siRNAs, antisense oligonucleotides is mediated by sequence-specific gene silencing, and broad-spectrum innate and antiviral immune responses can be elicited by toll-like receptor agonists. This review will summarize their current state of development, safety and efficacy, and provide perspectives on future development.

The potential of liposome-encapsulated ciprofloxacin as a tularemia therapy.

Liposome-encapsulation has been suggested as method to improve the efficacy of ciprofloxacin against the intracellular pathogen, Francisella tularensis. Early work with a prototype formulation, evaluated for use against the F. tularensis live vaccine strain, showed that a single dose of liposomal ciprofloxacin given by the intranasal or inhalational route could provide protection in a mouse model of pneumonic tularemia. Liposomal ciprofloxacin offered better protection than ciprofloxacin given by the same routes. Liposomal ciprofloxacin has been further developed by Aradigm Corporation for Pseudomonas aeruginosa infections in patients with cystic fibrosis and non-cystic fibrosis bronchiectasis. This advanced development formulation is safe, effective and well tolerated in human clinical trials. Further evaluation of the advanced liposomal ciprofloxacin formulation against the highly virulent F. tularensis Schu S4 strain has shown that aerosolized CFI (Ciprofloxacin encapsulated in liposomes for inhalation) provides significantly better protection than oral ciprofloxacin. Thus, liposomal ciprofloxacin is a promising treatment for tularemia and further research with the aim of enabling licensure under the animal rule is warranted.

Liposome encapsulation of ciprofloxacin improves protection against highly virulent Francisella tularensis strain Schu S4.

Liposome-encapsulated ciprofloxacin for inhalation (CFI) was investigated as a putative postexposure therapeutic for two strains of Francisella tularensis. The efficacies of oral ciprofloxacin and intranasally instilled CFI could not be distinguished in a mouse model of infection with the F. tularensis live vaccine strain (LVS), where a single dose of either formulation offered full protection against a lethal challenge. However, mouse studies with the more virulent Schu S4 strain of F. tularensis demonstrated that a higher level of protection against a lethal aerosol infection is provided by CFI than by oral ciprofloxacin. In addition, using this infection model, it was possible to discriminate the efficacy of intranasally instilled CFI from that of aerosolized CFI, with aerosolized CFI providing full protection after just a single dose. The improved efficacy of CFI compared to oral ciprofloxacin is likely due to the high sustained concentrations of ciprofloxacin in the lung. In summary, CFI may be a promising therapy, perhaps enabling the prophylactic regimen to be shortened, for use in the event of a deliberate release of F. tularensis. The prophylactic efficacy of CFI against other biological warfare (BW) threat agents also warrants investigation.

Aerosol and nasal delivery of vaccines and antiviral drugs against seasonal and pandemic influenza.

Influenza is primarily a respiratory tract infection involving the exacerbation and inflammation of the respiratory tract, which can progress to life-threatening pneumonia, hypercytokinemia, edema, acute lung injury, respiratory failure and death. Viral mutations and drug resistance are the leading challenges in influenza prevention and treatment. Aerosol inhalation provides rapid availability and sustained therapeutic levels of antiviral drugs in the respiratory tract, without causing a systemic burden to unaffected tissues and organs. Furthermore, aerosol delivery enhances the bioavailability of antiviral drugs with poor oral adsorption. Nasal spray delivery of vaccines provides a safe and needle-free means of vaccination, and contains live-attenuated virus that induces mucosal immunity and provides long-lasting immunity relative to injectable inactivated vaccines. Since influenza is a disease with respiratory clinical manifestations, specific delivery of antiviral drugs or vaccines to the respiratory tract may represent a safe and effective approach to combat influenza.